AMBULATORY CARE SENSITIVE HOSPITALIZATION RATES IN THE AGED MEDICARE POPULATION IN UTAH, 1990 TO 1994 - A RURAL-URBAN COMPARISON

The objective of this study is to compare the likelihood of hospitaliz ation for conditions that are related to the adequacy and use of ambul atory health care services for Medicare beneficiaries residing in rura l and urban regions in Utah. The Health Care Financing Administration' s (HCFA) hospital discharge database (Utah hospitals: 1990 to 1994) wa s used to estimate hospitalization rates (with adjustment for out-of-s tate admissions) for ambulatory care sensitive conditions. Population estimates were obtained from HCFA beneficiary files. Regional hospital ization rates were obtained through ZIP code matching of the hospital discharge and beneficiary files. Medicare beneficiaries aged 65 and ol der residing in Utah during 1990 to 1994 are the subjects for the stud y. The main outcome measures include age and sex-adjusted hospitalizat ion rates by region for the entire state and rate ratio estimates for nonurban regions. The results of the study show that Medicare benefici aries residing in two rural-frontier regions were more likely than urb an beneficiaries to be hospitalized for ambulatory care sensitive cond itions. Rate ratio estimates were greater for 1.4 for both regions dur ing the study period. These findings suggest a pattern of an increased burden of avoidable secondary complications and disease progression a mong Utah Medicare beneficiaries residing in some rural regions. This increased burden may be the result of limitations in the ambulatory ca re system, medical care provider supply, and/or beneficiary propensity to seek care. Variation in disease prevalence or hospital use pattern s for these conditions also may be responsible for all or part of the observed variation in ambulatory care sensitive admission rates.