Factors Affecting Hospitalizations of Long-Term Residents Differ in Urban, Rural Facilities

Being in a nursing home in a rural location did not influence hospitalization rates among long-stay residents, but staffing and other factors did appear to affect hospitalization rates differently in micropolitan and rural nursing homes compared with urban nursing homes, according to a study published online in the Journal of the American Medical Directors Association. 

Researchers looked at risk-adjusted hospitalization rates of long-stay residents over 10 quarters at 14,600 nursing homes in rural, micropolitan, and urban areas. Investigators analyzed relationships among rurality, nursing home and market factors, and quarterly, risk-adjusted rates of hospitalization.  

The study identified a risk-adjusted hospitalization rate of 9.8%, with no difference in rates at urban, micropolitan, and rural nursing homes.

When researchers considered various nursing home and market factors, they found urban nursing homes with higher percentages of Medicare and Medicaid residents and with any nurse practitioners or physician assistants on site had lower rehospitalization rates among long-stay residents. Such associations were insignificant, however, in rural nursing homes. Furthermore, a higher ratio of registered nurses to total nurses was associated with lower hospitalization rates—but only in urban nursing homes.

In micropolitan and rural nursing homes, meanwhile, higher median household income was linked with lower hospitalization rates among long-stay residents. 

“Future intervention on hospitalization should target factors unique to micropolitan/rural nursing homes,” researchers advised, “which adopt strategies appropriate to their setting.”

—Jolynn Tumolo 

Reference 

Xu H, Bowblis JR, Caprio TV, Li Y, Intrator O. Nursing Home and Market Factors and Risk-Adjusted Hospitalization Rates Among Urban, Micropolitan, and Rural Nursing Homes [published online ahead of print, 2020 Sep 29]. J Am Med Dir Assoc. 2020;S1525-8610(20)30735-0. doi:10.1016/j.jamda.2020.08.029