Abstract
BackgroundThere is increasing demand for post-acute care services, which is amplified by the COVID-19 pandemic.AimsWe studied the pattern of spatial association between post-acute care services and acute care facilities and evaluated how geographic variability could influence their use.MethodsWe compiled data on CMS-certified acute care and critical access hospitals and post-acute health care services (nursing homes, home health care services, inpatient rehabilitation facilities, long-term care hospitals, and hospice facilities). We used the colocation quotient (CLQ) to measure the magnitude and direction of association (clustering or segregation) between post-acute care providers and hospitals. This metric allows pairwise comparison of categorical data; a value <1 indicates spatial segregation and a value >1 spatial clustering. Unity marks the lack of spatial dependence (random distribution).ResultsWith the exception of nursing homes (CLQ 1.26), all other types of post-acute care providers are spatially segregated from rural critical access hospitals. Long-term care facilities ranked first (had the lowest global CLQ, 0.06), hospice facilities ranked last (had the highest global CLQ estimate, 0.54). Instead, post-acute care services either clustered with (inpatient rehabilitation 2.76, long-term care 2.10, nursing homes 1.37) or were only weakly segregated (home health care 0.86) from acute care hospitals. Home health care (1.44), hospice services (1.46), and nursing homes (1.08) spatially clustered with the same category of services. Results were robust in the sensitivity analysis and we provided illustrative examples of local variation for the states of MA and IA.ConclusionPost-acute care services are isolated from critical access hospitals, and have a clustering pattern with the same category services and acute care hospitals. Such misdistribution of resources may result in both underuse and a substitution effect on the type of post-acute care between rural and urban areas and undermine public health during increasing demand, such as the COVID-19 pandemic.
Highlights
After hospital discharge, many patients require additional support to recover, rehabilitate or manage chronic diseases
We studied the pattern of spatial association between post-acute care services and acute care facilities and evaluated how geographic variability could influence their use
With the exception of nursing homes (CLQ 1.26), all other types of post-acute care providers are spatially segregated from rural critical access hospitals
Summary
Many patients require additional support to recover, rehabilitate or manage chronic diseases. Between 2000–2015, the use of post-acute services by Medicare beneficiaries has risen from 21% to 26%, while discharges home declined [2]. The health insurance community, through “America’s Health Insurance Plans,” has advocated in late March 2020 that patients negative for COVID-19 should be discharged to alternate post-acute care facilities, so vital nosocomial structures and resources are preserved to handle the crisis [5]. With the increasing demand for post-acute care, fueled in the COVID-19 era, we explored whether a pattern of association exists between different provider types and hospital facilities and how such pattern could affect their use. There is increasing demand for post-acute care services, which is amplified by the COVID19 pandemic.
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