Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

Nuako, Akua; Liu, Jingxia; Pham, Giang; Smock, Nina; James, Aimee S.; Baker, Timothy B.; Bierut, Laura J.; Colditz, Graham A.; Chen, Li‐Shiun

doi:10.1371/journal.pone.0263718

Cited by 26 publications

(17 citation statements)

References 33 publications

(36 reference statements)

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“…Unfortunately, most available studies in either developed 1 - 6 , 11 , 12 , 15 or developing 7 - 10 , 13 , 14 countries have compared outcomes between rural and urban patients admitted to hospitals located at their own place of residence. Such investigations often compare the facilities, competencies, and accessibilities of hospitals rather than the risk factors between rural and urban individuals.…”

Section: Introductionmentioning

confidence: 99%

Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Abbasi¹,

Sundin²,

Jalali³

et al. 2022

JTHC

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Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.

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Section: Introductionmentioning

confidence: 99%

Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Abbasi¹,

Sundin²,

Jalali³

et al. 2022

JTHC

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“…Our study adds to the sparse literature on the challenges related to FCs’ preparedness to support physical activity in the post-discharge period and stakes out important new ground by charting this issue specifically in the rural context. Our findings are embedded in rural communities, which are typified by older age and higher levels of chronicity [ 10 ], but less access to the healthcare system that their urban counterparts [ 21 ]. Consequently, FCs play an outsized role in rural healthcare.…”

Section: Discussionmentioning

confidence: 99%

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Fox

Butler

Sidani

et al. 2022

BMC Health Serv Res

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Background Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients’ engagement in physical activity. Yet, there is very little research on family caregivers’ perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored the challenges related to family caregivers’ preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission. Methods In this interpretive descriptive study, semi-structured interviews were conducted by telephone with 16 family caregivers. Interview transcripts were analyzed using thematic analysis. Results Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26–67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 75%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers generally felt unprepared to support their relative’s physical activity, 2) some family caregivers believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient physical activity preparation led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity. Conclusions Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative’s physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

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“…In a systematic review and meta-analysis, post-discharge follow-up was also found to be effective in reducing hospital readmissions [ 35 ]. Follow-up for the FCs of patients at risk for hospital readmission in rural communities is particularly crucial because these communities have minimal formal supports in place and patients in these communities have worse health status and lower primary and specialty health care use than their urban counterparts [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

et al. 2022

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Background There is a critical need for hospital-to-home transitional care interventions to prepare family caregivers for patients’ post-discharge care in rural communities. Four evidence-based interventions (named discharge planning, treatments, warning signs, and physical activity) have the potential to meet this need but family caregivers’ perspectives on the acceptability of the interventions have not been examined. This gap is significant because unacceptable interventions are unlikely to be used or used as designed, thereby undermining outcome achievement. Accordingly, this study examined the perceived acceptability of the four interventions to rural family caregivers. Materials and methods A multi-method descriptive design was used. The quantitative method entailed the administration of an established scale to assess the interventions’ perceived acceptability to family caregivers. The qualitative method involved semi-structured interviews to explore family caregivers’ perceived acceptability of the interventions in greater depth, including acceptable and unacceptable aspects, in the context of their own transitional care experience. Participants were the family caregivers of a relative who had been discharged home in a rural community from an acute care hospital in Ontario, Canada. Results The purposive sample included 16 participants who were mostly middle-aged women (n = 14; 87.5%) caring for a parent (n = 9; 56.3%) at high risk for hospital readmission. The mean scores on the acceptability measure were 3 or higher for all interventions, indicating that, on average, the four interventions were perceived as acceptable. In terms of acceptable aspects, four themes were identified: the interventions: 1) involve family caregivers and proactively prepare them for discharge, 2) provide clear, written, and detailed guidance, 3) place the onus on healthcare providers to initiate communication, and 4) ensure post-discharge follow-up. In terms of unacceptable aspects, one theme was identified: the physical activity intervention would be challenging to implement. Discussion The findings support implementing the four interventions in practice throughout the hospital-to-home transition. Healthcare providers should assess family caregivers’ comfort in participating in the physical activity intervention and tailor their role accordingly.

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Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

Cited by 26 publications

References 33 publications

Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

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