Rural/Urban Disparities in PQIs Among Patients with ADRD – Evidence of Hospital‐based HIT and Enabling Services

Abstract

AbstractBackgroundTo examine urban and rural disparities in potentially preventable hospitalizations (PPH) among patients with Alzheimer’s Disease and Related Dementias (ADRD) and the use of health information technology (HIT) and enabling services as mediators.MethodWe merged 2017 100% Medicare Fee‐For‐Service (FFS) claims with the Medicare Beneficiary Summary File, American Community Survey, and American Hospital Association Annual Survey to construct a dataset containing patient, hospital, and community‐level data. Logistic regression was applied to examine differences in PPH by HIT and enabling services.ResultThe rates of PPHs related to acute and chronic conditions for rural and micropolitan patients with ADRD were significantly higher compared to the rates among urban patients with ADRD. Having both telehealth post‐discharge and enabling services significantly decreases the odds of PPH due to acute (OR: 0.93, 95% CI: 0.89‐0.98, p‐value <0.01) and chronic conditions (OR: 0.96, 95% CI: 0.92‐1.00, p‐value = 0.07) compared to not having these available. The presence of both telehealth post‐discharge and enabling services significantly decreased the odds of PPH in patients with ADRD in rural (acute PPH OR: 0.56, 95% CI: 0.41‐0.77, p‐value <0.01; chronic PPH OR: 0.73, 95% CI: 0.55‐0.97, p‐value = 0.03) and micropolitan (acute PPH OR: 0.65, 95% CI: 0.57‐0.73, p‐value <0.01; chronic PPH OR: 0.83, 95% CI: 0.74‐0.93, p‐value <0.01) areas compared to urban patients with ADRD.ConclusionResults suggest that the combination of HIT telehealth post‐discharge and enabling services are important interventions in helping to reduce preventable hospitalizations among patients with ADRD living in rural and micropolitan areas.