Systematic Review of Rural and Urban Differences in Care Provided by Home Health Agencies in the United States.
Denise D Quigley, Ashley M Chastain, Jung A Kang and 4 others
PMID 36108785WHAT IT FOUND
Rural Medicare home health patients received fewer skilled visits, including physical therapy, and had more emergency room visits.
Hospitalization differences were mixed, and some rural agencies performed better on infection prevention practices.
Key findings
01Four of five utilization studies found rural Medicare beneficiaries had significantly lower home health care and physical therapy utilization; examples included 6% fewer rehabilitation visits after ICU stays, 11% lower physical therapy utilization after total knee arthroplasty, and 5.7% fewer visits from rehabilitation specialists.
02Both studies examining emergency room visits found rural patients had more emergency room visits after controlling for confounding variables.
03Hospitalization findings were mixed: rural heart failure patients had lower 30-day preventable readmissions, while two broader studies found rural patients were more likely to be hospitalized after risk adjustment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
Only 12 studies were included, and the authors describe the evidence as emerging. All included studies were cross-sectional or cohort designs, so they show associations, not effects of home health care. The data spanned 2009 to 2018, and several utilization findings came from pre-2015 data. Urban and rural definitions varied widely, including binary categories and several multi-category systems, which likely contributed to mixed results. No studies reported null urban-rural findings, which may suggest publication bias. Agency coverage areas and patient residence could not be reliably matched in publicly available datasets.
Declared interests
All authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that rural home health care is uniformly worse or that these differences prove a specific service caused poor outcomes. The included studies were cross-sectional or cohort, used different urban and rural definitions, and hospitalization findings were mixed.