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UMRHRC Projects 2009-2010

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Assessing the Rural Relevance of Hospital Outpatient Quality Measures
The purpose of this project is to determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and  to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures. This project will have three parts:

  1. an analysis of outpatient Medicare data to identify the most common diagnoses and procedures in rural hospital outpatient settings;
  2. a review of the literature and specifications for outpatient quality measures proposed by CMS and other potential outpatient measures;
  3. an expert panel to evaluate the rural relevance of the measures.

Rural Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology, and Care Coordination
Rural areas present special challenges for health care reform. It is important to examine the rural implications of health care reform proposals. The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues. The UMRHRC has access to a variety of potential data sources that can be used to assess the rural implications of health care reform. The specific analytic approaches used to address rural health care reform issues will depend on the topics chosen and the available data.

The Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
Readmission within 30 days of hospital discharge is an increasingly utilized measure of hospital care quality. Current knowledge of rural patients care quality may be expanded by assessing how patients’ use of rural hospitals, urban hospitals, and rural and urban hospital combinations and the type and timing of health services received by patients during and after hospital stays influence the likelihood of readmissions.

The purpose of this project is to:

  1. determine how location of hospitals used for initial admissions by rural patients affects readmission rates;
  2. assess how the use of swing beds affects rural patients’ readmissions;
  3. examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.

Kaplan-Meier curves and Medicare inpatient data for 2007 will be used to compare the probability of readmission for rural beneficiaries based on hospital location. The inpatient data will be matched with 5% carrier (physician/Part B), skilled nursing facility, and home health care data from the Medicare Chronic Condition Data Warehouse for beneficiaries with congestive heart failure and chronic obstructive pulmonary disease. The effect of the use of various post-acute services on readmissions will be analyzed using Cox regression while controlling for time to receive services, demographics, and patient severity.