Skip to main content


Rural Children Face Steep Healthcare Challenges

By John Commins  
   April 20, 2016

Providers need to build better links between pediatric hospitals and rural providers, and risk adjustment is warranted for patients coming from a low-income, rural areas, researchers conclude.

One enduring trope of American culture is the healthy country life. Picture the oatmeal ads of gingham-and-overall-clad youngsters, straw hats atop towheads, laughing and skipping through fields of green clover, bathed in golden sunshine, breathing farm-fresh air, far from the toxins of urban life.

Of course, this is a myth for many people living in rural America, adults and children. Studies have shown that nearly one-in-five children in rural America live in poverty. Many of these children, particularly African-American children, are at greater risk of obesity, tobacco exposure, and chronic medical conditions.

Now, a new study in Pediatrics adds to that consensus and documents less-favorable outcomes for rural children at pediatric hospitals when compared with children from non-rural areas.  

The study, led by Alon Peltz, MD, MBA, a general pediatrician and Robert Wood Johnson Foundation Clinical Scholar at Yale University, examined more than 670,000 admissions at 41 pediatric hospitals (the majority of which are located in urban settings) in 24 states throughout 2012.

The researchers measured length of stay, hospital cost, and 30-day all-cause readmissions and tracked them against ZIP codes and U.S. Census data to classify children living in urban and rural areas, family income, and Health Profession Shortage Areas.

Here's what they found:  

  • Rural children accounted for more than 81,000 admissions, about 12% of the total admissions under these criteria, and the majority of these rural children lived in ZIP codes with high poverty levels.
  • On average they lived 68 miles from the pediatric hospital, compared with 12 miles for non-rural children, and in some instances it was not uncommon for children to travel from other states.
  • The rural children were more likely to live in a low-income ZIP code, (53% vs. 24%), and a HPSA (20% vs. 4%).
  • Rural children also had a higher prevalence of complex chronic conditions (44% vs 37%); experienced higher inpatient costs (mean: $8,507 vs $7,814); and were at slightly higher odds for a 30-day readmission.
  • And "despite a higher prevalence of these characteristics, rural children are more often discharged from children's hospitals to low-income and medically underserved areas."

Peltz says he and his colleagues were drawn to the study because of their own clinical experiences trying to coordinate post-discharge care for children from rural areas. "We wanted to assess who comes from rural communities and if they experience a hospitalization any differently than non-rural children," Peltz told me.

"What surprised us the most was even when we accounted for the differences in illness severity, and even when we went through and looked at who had which chronic condition, and could we standardize the level of severity between the kids from rural and non-rural communities, we were still seeing the difference in how long they stayed in the hospital and the readmissions rate."

Related: Population Health Poses Unique Challenges in Rural Areas

From a cold, hard, bottom line perspective, these findings are important for hospitals that face penalties for 30-day readmissions.


  • 1

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Get the latest on healthcare leadership in your inbox.