Rural Patients' Transitional Care Experiences: A Qualitative Analysis of Provider Notes

Rural patients face an increased risk of 30-day mortality after hospitalization, compared to their urban counterparts. The Department of Veterans Affairs (VA) Geriatric Learning Health System's operational partners sought to identify care-related and contextual factors associated with mortality among rural patients being discharged from hospital to home.

We examined clinical notes from medical records of 200 (N = 100 rural; N = 100 urban) Veterans ≥65 years-old who were discharged alive to home after a medical or neurological index admission but who died within 30 days of discharge. Text related to the post-discharge course was abstracted verbatim for qualitative analysis. Inductive and deductive codes were used to generate themes describing features of patients' experiences from hospital discharge to death. Cases exemplifying qualitative themes were identified to represent findings.

Three themes described key elements of patients' journeys from discharge to end of life that distinguished rural patients' experiences from urban patients: geographic distance barriers to accessing care settings (i.e., lengthy drive times), declining the offer of home health services, and high caregiver burden. These experiences negatively impacted patients-contributing to moments of discordance and uncertainty among the patients, care team, and caregivers.

Rural patients faced unique challenges during their transitional journeys. These findings provide targets for future studies seeking to reduce rural-urban disparities mortality for community-dwelling older patients transitioning from hospital to home.