Rural Means Older and Sicker, Data Confirms

Federal data confirms what we know about rural hospitals and the care they deliver, and allows those of us who care about access to make a compelling case for providing good care to this population.

New data from the National Hospital Discharge Survey provides a predictable profile of rural hospitals and who they treat.

Many rural providers who look at this compilation from 2010, the latest available data, would likely nod their heads in recognition of the landscape. The data reviewed by the Centers for Disease Control and Prevention's National Center for Health Statistics found that:

• About 60% of the 6.1 million rural residents who were hospitalized in 2010 went to rural hospitals; the remaining 40% went to urban hospitals.
• About 51% of rural residents hospitalized in rural hospitals were aged 65 and over, compared with 37% of those hospitalized in urban hospitals. No significant difference was observed in the percentage of hospitalized rural residents under age 45 who were in rural hospitals compared with urban hospitals.
• Twenty-four percent of rural residents hospitalized in rural hospitals were aged 45–64 compared with 32% of those hospitalized in urban hospitals.
• Rural residents who remained in rural areas for their hospitalization were more likely to be older and on Medicare compared with those who went to urban areas.
• Almost 75% of rural residents who traveled to urban areas received surgical or nonsurgical procedures during their hospitalization, compared with only 38% of rural residents who were hospitalized in rural hospitals.
• More than 80% of rural residents who were discharged from urban hospitals had routine discharges, generally to their homes, compared with 63% of rural residents discharged from rural hospitals.
•  Seventy-four percent of hospitalized rural residents who were in urban hospitals received a surgical or nonsurgical procedure during their hospitalization, compared with only 38% of those hospitalized in rural hospitals.
• Rural residents hospitalized in urban hospitals were more than three times as likely to have three or more procedures as rural residents hospitalized in rural hospitals.

With this data, we can flesh out what's happening with rural care delivery.

About 17% of Americans live in rural areas, many of which are sparsely populated and medically underserved. The nearest provider could be 20 miles away, and the rural hospitals that provide the care are usually smaller, with low volumes, operating on a shoestring budget and with minimal staff and limited services.

The younger rural hospital patients, who are more likely to have greater mobility and access to commercial health insurance, likely seek care in urban settings because rural hospitals often don't have the funding or patient populations to support specialists or a particular area of specialty care, such as cardiac or oncology.

For the most part, these rural hospitals primarily serve an aging, poorer population admitted for low-acuity care of chronic diseases, and so they likely want to remain close to their homes and their personal physicians.

It would also be reasonable to conclude, however, that many elderly rural hospital patients get their care locally because of barriers to urban hospital access that younger rural residents can surmount. An elderly patient either may not have a car, or may not have a friend or family member who can drive them to the closest city for care.

Because more rural hospital patients are elderly and because specialty care options are limited, NCHS data also shows that rural hospital patients are more likely to be discharged into some sort of short-stay hospital or a long-term care facility.

Ultimately, this data confirms what we already know about rural hospitals and the care they deliver, which in many respects is significantly different that the care provided in urban settings. But telling us what we already know doesn't make the data any less valuable.

Rural providers may not be providing cutting-edge care for highly acute patients, but it's not realistic to expect that they would be, and it certainly doesn't negate the mission of rural providers.

This data allows those of us who care about access to healthcare in rural America to make a compelling case for the care provided and the people served.