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Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty.
- Source :
-
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Mar; Vol. 40 (2), pp. 326-337. Date of Electronic Publication: 2024 Feb 20. - Publication Year :
- 2024
-
Abstract
- Purpose: Children with medical complexity (CMC) may be at increased risk of rural-urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural-urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery.<br />Methods: This retrospective cohort study of 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC <18 years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification.<br />Findings: Of 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with >20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR] = 0.95, 95% confidence interval [CI]: 0.94-0.96), more emergency visits (RR = 1.12, 95% CI: 1.08-1.16), and fewer hospitalization days (RR = 0.90, 95% CI = 0.85-0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects.<br />Conclusions: Rural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural-urban disparities.<br /> (© 2024 National Rural Health Association.)
Details
- Language :
- English
- ISSN :
- 1748-0361
- Volume :
- 40
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
- Publication Type :
- Academic Journal
- Accession number :
- 38379187
- Full Text :
- https://doi.org/10.1111/jrh.12827