Defining Rurality in Hospice Research: Evaluation of Common Measures

Inconsistency in identifying rural hospices has biased research findings and policy analysis. The purpose of this study was to conduct a comprehensive evaluation of eight rural-urban classifications against the gold standard of the Office of Budget and Management (OMB) to determine the utility of alternative measures in hospice research. These classifications included: Urban-Rural Classification Scheme for Counties (URCSC), Urban Influence Codes (UIC), Rural-Urban Continuum Code (RUCC), Federal Office of Rural Health Policy (FORHP), Index of Relative Rurality (IRR), the U.S. Census Bureau, Rural-Urban Commuting Area codes (RUCA), and Frontier and Remote (FAR). The last and the U.S. Census Bureau classified the smallest number of hospices; URCSC, UIC, and RUCC were indistinguishable from the OMB; and RUCA, IRR, and FORHP classified as rural the largest number of hospices. The latter three classifications also had good agreement with the OMB and therefore can be recommended for use instead of the OMB.