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RHRC Projects 2012-2013

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Quality Implications of Transferring Emergency Department Patients from Rural Hospitals
Rural hospitals provide first-line treatment for emergency patients and play a crucial role in stabilizing patients and coordinating transfers to tertiary care. However, little is known about patients who are transferred directly from rural Emergency Departments to other hospitals or their impact on hospital mortality rates. The purpose of this project is to analyze the quality implications of transferring emergency patients from smaller rural hospitals to larger rural and urban facilities.The project will use Medicare inpatient and Emergency Department claims data and descriptive and multivariate statistical methods to: 1) compare patients who are transferred directly from rural hospital Emergency Departments to larger hospitals with those who are admitted as inpatients to rural hospitals in terms of diagnoses, comorbidities, demographics, and the care received and 2) analyze how the inclusion or exclusion of transferred emergency patients affects risk-adjusted mortality rates for transferring and receiving hospitals.

Quality of Obstetric Care and Perinatal Safety in Rural Hospitals
This project will examine obstetric care quality and perinatal safety in rural U.S. hospitals nationally, with a focus on rural hospitals in a nationally representative group of eight states. We will improve upon prior research by distinguishing elective obstetric procedures (e.g., labor induction, cesarean section), paying explicit attention to rural relevance in a broader range of measures, and analyzing quality-related policy implications. Using hospital discharge data from Healthcare Cost and Utilization Project national and state databases, we will measure obstetric care quality related to delivery mode, elective procedures, and perinatal safety. We will examine longitudinal trends in these outcomes and characterize outcomes for types of rural hospitals (including CAHs) and for different levels of rurality. We will also identify patient and hospital-level predictors of high or low quality.

Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
This project will provide information about the provision of observation care services in rural hospitals and organizational, geographic, and patient characteristics associated with their utilization.  It will also identify key rural Medicare beneficiary and rural provider related issues and explore options for minimizing unintended negative consequences that could result from the implementation of future guidelines and policies concerning the provision of observation care services in rural communities. Descriptive statistics will be used to profile the nature and scope of observation care services by patient, hospital, and market characteristics, using secondary data from Medicare hospital outpatient claims, Provider of Service data and AHA Annual Survey data. Qualitative data analysis will be used to profile key issues for rural Medicare beneficiaries and rural providers concerning observation care services and to identify state efforts to address these concerns.

The Relationship between Service Utilization and Costs for High Cost Rural Medicare Patients
The purpose of this study is to: 1) assess the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum; 2) examine the relationships between rural beneficiaries’ service utilization and market structure; and 3) evaluate provider-focused and beneficiary-focused strategies and policies for addressing high costs in specific rural contexts. The Medicare Beneficiary Annual Summary File will be used to analyze service use and per capita expenditures for rural Medicare beneficiaries, to identify factors associated with high Medicare expenditures for rural beneficiaries, and to describe service use and costs throughout the rural continuum as reflected in Hospital Service Areas. Multivariate regression analysis will be used to examine the relationships between provider market structure, beneficiary demographics, beneficiary service use and expenditures.