An issue in Medicare redesign is whether beneficiaries have adequate access to health services. Barriers to care exist for many rural residents in the current system including hospital closures, fewer medical professionals, and a lack of specialty services. The purpose of this study: to determine if elderly rural patients, when controlling for patient-specific characteristics and the structure and availability of services, were more likely to experience different types of post-acute care and clinical and functional outcomes than a comparable nonrural population. The patient population (N=153)had undergone a primary hip arthroplasty. Using a retrospective convenience sample, organized by an adaptation of the Andersen model, patient characteristics were classified as environmental (market and patient location) and patient/family (predisposing, enabling, and need). The research questions proposed: 1. Is there a direct relationship between resource consumption (type of post-acute care received) and clinical/functional outcomes? 2. Is there a direct relationship between patient/family characteristics and clinical and functional outcomes? and 3. Do environmental factors moderate the relationship between patient/family characteristics and resource consumption? Research question 1, analyzed using analysis of covariance, found no significant relationship between the type of post acute care received and the patient outcome as measured by three dimensions of a standardized hip score. Research question 2 was tested using bivariate correlation and multiple regression: there was a negative correlation between the need (per-operative hip score) factors and hospital LOS, and a negative relationship between outcomes, as measured by the hip score, and need factors. Regression analysis revealed no significant predictive relationship except when examining the unadjusted hip score as the dependent variable. Logistic regression was used in question 3: there was no significant moderating effect. Variables influencing post-acute care utilization: female gender and functional deficits. Conclusion: Patients in rural locations were not significantly different than their non-rural counterparts.
Session #1181 - Health Systems
The 29th Annual MNRS Research Conference (April 1-4, 2005)