Rural and Urban Hospitals Differ in Patient Care

Megan Brooks

April 22, 2014

To some extent, the patient population served and inpatient care provided differ in rural and urban hospitals in the United States, new data from the Centers for Disease Control and Prevention show.

In 2010, although 17% of the US population lived in rural areas, only 12% of 35 million US hospitalizations were in rural hospitals, according to a data brief released today by the National Center for Health Statistics (NCHS).

Rural hospitals provided 11% of all 168 million hospital days of care and just 6% of the 51 million nonsurgical and surgical inpatient procedures performed.

A higher percentage of inpatients in rural hospitals were aged 65 and older (51%) compared with inpatients in urban hospitals (37%). In addition, a larger percentage of rural hospital inpatients had Medicare as their principal expected source of payment than urban inpatients (52% vs 41%).

Diagnoses Differ

Some diagnoses were relatively more common in either rural or urban hospitals, whereas other diagnoses were equally common in both settings, report Margaret Jean Hall, PhD, and Maria Owings, PhD, from the Centers for Disease Control and Prevention/NCHS Division of Health Care Statistics.

For first-listed diagnoses, childbirth, cancer, and poisonings were relatively more common among urban hospital inpatients, whereas dehydration, bronchitis, and pneumonia were frequent among rural hospital inpatients. The frequency of septicemia, congestive heart failure, and heart attack did not differ by hospital type, they say.

There also were similarities between rural and urban hospital inpatients in the average number of diagnoses (7.9 and 7.4, respectively), average lengths of stay (about 4.5 and 4.8 days, respectively), proportions of inpatients on Medicaid (15% and 18%), and the percentage who died before discharge (2% for both hospital settings).

Number of Procedures

However, there were differences by hospital setting in receipt of procedures: 64% of rural hospital inpatients compared with 38% of urban hospital inpatients had no surgical or nonsurgical procedures performed during their hospital stay. Urban hospital inpatients were more than twice as likely to have 3 or more procedures performed than rural hospital inpatients, the researchers report.

"This could be due to the shortage of specialty physicians in rural areas, the lack of other staff skilled in surgery, or the absence of costly equipment needed for many surgical and nonsurgical procedures in rural hospitals," they note. "Because of economies of scale, rural hospitals may forego offering many procedures and instead choose to focus on patients needing basic inpatient surgical care and on patients needing medical, rather than surgical, treatment."

After their hospital stay, a higher percentage of rural inpatients (7%) than urban inpatients (3%) were transferred to another short-term or long-term care facility (14% vs 11%).

The data for the brief are derived from the National Hospital Discharge Survey for 2010.

"Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010." NCHS Data Brief No. 147. Published online April 22, 2014. Full text


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