Reducing Rural and Urban Disparities in Potentially Preventable Hospitalizations: Evidence of Hospital-Based Health Information Technology and Enabling Services.

Abstract

Background: Telehealth and enabling services are promising approaches to address the intersecting challenges of chronic disease burden, a growing aging population, and poor access to care disproportionately affecting rural areas. Using potentially preventable hospitalizations (PPHs) as an indicator for health system efficiency and quality, this study examined the relationship between health information technology and hospital-provided enabling services on PPHs across rural, micropolitan, and metropolitan areas. Methods: We constructed a patient-, hospital-, community-, and state-level data set using the Medicare fee-for-service claims file and the Medicare Master Beneficiary Summary File, and the American Hospital Association Annual Survey. Logistic regressions were applied to examine associations between PPH and telehealth post-discharge, telehealth treatment, and telehealth post-discharge and enabling services. Results: Approximately 50% of rural and micropolitan residents (vs. 36% of urban residents) were treated in hospitals providing neither telehealth post-discharge services nor enabling services, and 7% (vs. 11% of urban residents) were treated in hospitals with both services. Telehealth post-discharge services were associated with significantly lower odds ratio (OR) of having any PPH due to acute (OR = 0.91, p < 0.001) and chronic conditions (OR = 0.94, p < 0.001). The ORs of having any PPH due to acute and chronic conditions were the least among beneficiaries who were treated in hospitals with both telehealth post-discharge and enabling services (OR = 0.56, p < 0.001, for acute conditions, and OR = 0.73, p < 0.001, for chronic conditions). Conclusions: Hospital use of post-discharge telehealth alongside enabling services may help provide timely access to care, improve care coordination, and reduce PPHs for older rural residents.