The Impact of Hospitalists on Inpatient and Primary Care in Rural Communities
The use of hospitalists has spread to smaller rural hospitals, but no studies in the peer-reviewed literature have examined their use in these settings. This project will begin to fill the gaps in existing knowledge by examining why and how hospitalists are being used in rural hospitals and the impact of their use on the provision of inpatient and primary care in rural communities.
This project has two purposes:
- to describe trends over time in the use of hospitalists by rural hospitals, characteristics of rural hospitals that use hospitalists, and the types of hospitalist models being used
- to assess the impact of hospitalist use on the provision of inpatient and primary care in rural areas, with a particular focus on physician supply, the quality of pneumonia care and patient satisfaction.
This project includes a descriptive analysis of hospitalist use using data from FY 2005-2009 AHA Annual Surveys and from a national survey of rural hospitals using hospitalists, and multivariate analyses of the relationships between hospitalist use and primary care physician supply, the quality of inpatient care and patient satisfaction in rural hospitals.
High Quality Rural Hospitals and Post-Acute Care Providers
Public reporting of quality measures has expanded to include process and outcome measures in a variety of health care settings, including hospitals, nursing homes and home health agencies. Many small rural hospitals participate in public reporting, and a number of measures address conditions commonly treated by rural hospitals, such as pneumonia and heart failure. However, low volume remains a problem, especially for calculating outcome measures such as mortality and readmission rates for rural providers. The purposes of this project are:
- to model alternative ways of identifying high quality rural hospitals and analyze factors related to quality in rural hospitals
- to examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.
This two-year project will use several large longitudinal national databases, including Hospital Compare inpatient measures (2004-2009), HCAHPS (2008-2009), Medicare inpatient claims (1998-2009), Nursing Home Compare (2003-2009), Home Health Compare (2004-2009), and AHA Annual Survey data (1998-2009). We will conduct descriptive and multivariate analyses.
Health Information Technology Implementation and Rural Hospital Outcomes
Current federal policies encourage the adoption and use of health information technology (IT). These policies entail subsidies for meaningful use, technical assistance for implementation, and eventually penalties for non-use. While health IT has the potential to improve quality, little is known about its value and consequences in rural settings.
The projects goals are:
- to measure the effect of health IT on quality outcomes in rural hospitals
- to identify the contextual determinants of health IT value.
We will use these results to understand the implications of current federal policies for rural hospitals. HIMSS and AHA data will be used to examine hospital IT diffusion trends. Medicare inpatient claims data will be used to measure patient-level severity and outcomes. We will employ multivariate methods and a difference-in-differences empirical strategy to measure the change in quality outcomes following IT adoption and how it relates to the rural context.