Geographic Disparities in Heart Failure Hospitalization Rates Among Medicare Beneficiaries

Casper, Michele; Nwaise, Isaac; Croft, Janet B.; Hong, Yuling; Fang, Jing; Greer, Sophia

doi:10.1016/j.jacc.2009.10.021

Cited by 35 publications

(29 citation statements)

References 11 publications

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“…24 The analysis was based on the claims data of Medicare beneficiaries and therefore included only individuals over the age of 65 years and did not include an analysis of rural and urban areas. However, it may be that the findings of higher re-hospitalization rates in these areas may reflect the rural nature of the communities.…”

Section: Discussionmentioning

confidence: 99%

Rural Patients’ Knowledge About Heart Failure

Dracup

Moser

Pelter

et al. 2014

Journal of Cardiovascular Nursing

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Background Heart failure (HF) is a potentially disabling condition requiring significant patient knowledge to manage the requirements of self-care. The need for self-care is important for all patients, but particularly for those living in rural areas that are geographically remote from health care services. Objective To identify the level of knowledge of rural patients with HF and the clinical and demographic characteristics associated with low levels of HF knowledge Methods Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed using the Heart Failure Knowledge Scale, the Short Test of Functional Health literacy in Adults, and the anxiety subscale of the Brief Symptom Inventory. Multiple linear regression was used to explore the contribution of sociodemographic and clinical variables to levels of HF knowledge. Results Mean age was 66±13 years; 59% were male, and 50.5% had an ejection fraction (EF) <40%. Mean percent correct on the HF Knowledge Scale was 69.5±13 (range 25 to 100) percent, with the most frequent incorrect items related to symptoms of HF and the need for daily weights. Males and older patients scored significantly lower in HF knowledge than females and younger patients (p = 0.002 and 0.011 respectively). Patients with preserved systolic function also scored significantly lower than those with systolic HF (p=0.030). Conclusion Patients can be identified who are at risk for poor self-care because of low levels of HF knowledge. Older patients, males and patients with HF with preserved systolic function may require special educational strategies to gain the knowledge required for effective self-care.

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Section: Discussionmentioning

confidence: 99%

Rural Patients’ Knowledge About Heart Failure

Dracup

Moser

Pelter

et al. 2014

Journal of Cardiovascular Nursing

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“…Although county-level HF hospitalization rates within the catchment area have not been assessed previously, our findings are consistent with those of prior studies of geographic variations in HF hospitalization and readmission rates among Medicare beneficiaries, that found higher hospitalization and readmission rates along the Mississippi River Valley and the Appalachian region. 2, 26 …”

Section: Discussionmentioning

confidence: 99%

“…2 Such strategies might include the formation of partnerships between relevant stakeholders, such as partnerships between health care organizations and hospitals to provide cardiac services to rural areas. A direct result of this study, for example, was the development of an HF outreach program in a region that we identified as having one of the highest rates of HF hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Geographic Variations in Heart Failure Hospitalizations Among Medicare Beneficiaries in the Tennessee Catchment Area

Ogunniyi

Holt

Croft

et al. 2012

The American Journal of the Medical Sciences

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Introduction Although differences in heart failure hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalization rates for heart failure among Medicare beneficiaries. Methods Using exploratory spatial data analysis techniques, we examined hospitalization rates for heart failure as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. Results The age-adjusted heart failure hospitalization rate (per 1,000) among Medicare beneficiaries was 23.3 (95% confidence interval [CI], 23.3–23.4) for the Tennessee catchment area, 21.4 (95% CI, 21.4 -21.5) for the non-catchment US area and 21.9 (95% CI, 21.9–22.0) for the overall US. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than the non catchment US area and the overall US, among men, women, and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6±7.6) and Kentucky (29.2±11.5), and the lowest were in North Carolina (21.7±5.7), closely and Virginia (21.8±6.6). Conclusions Knowledge of geographic differences in rates of hospitalization for heart failure can be useful in identifying needs of health care providers, allocating resources, developing comprehensive heart failure outreach programs, and formulating policies designed to reduce these differences.

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“…However, the use of readmissions as the sole measure of quality has been questioned by studies demonstrating that mortality for heart failure has decreased while readmissions rates have not (71,72) and an analysis showing an inverse relationship between mortality and heart failure readmission for hospitals with high readmission rates (73). Admission rates have also been shown to vary widely across U.S. regions for patients with heart failure (74). Preventable readmissions are thought to be due in part to poor transition from inpatient to outpatient care.…”

Section: Health Care Utilizationmentioning

confidence: 99%