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Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment.
Carrie Henning-Smith1, Katy Kozhimannil, Michelle Casey
1Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
Medical Care
|August 12, 2017
Summary
Geographic location, especially rurality, impacts healthcare quality. Adjusting for sociodemographic factors revealed rurality differences in blood pressure and cholesterol checks, highlighting the need to include rurality in quality measure discussions.
Area of Science:
- Health Services Research
- Rural Health
- Healthcare Quality
Background:
- Sociodemographic factors are debated for risk-adjusting quality measures.
- Geographic location, particularly rurality, has been overlooked in these discussions.
Purpose of the Study:
- To investigate rurality-based differences in healthcare quality outcomes.
- To assess how individual and community sociodemographic adjustments affect these rurality-based quality differences.
Main Methods:
- Utilized 2012 Medicare Current Beneficiary Survey and 2012 County Health Rankings data.
- Compared six quality of care measures across rural noncore, micropolitan, and metropolitan areas.
- Employed multivariable logistic regression to analyze the impact of sociodemographic adjustments.
Main Results:
- Community-level factors mediated the rurality-quality relationship for change in health status.
- Adjusting for sociodemographic factors revealed rurality disparities in blood pressure and cholesterol checks.
- Inclusion of community and individual characteristics improved model fit for all quality scores.
Conclusions:
- Healthcare quality is influenced by individual, community, and geographic factors.
- Rurality is a significant consideration that should be incorporated into risk-adjustment debates for quality measures.
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