Out-of-area travel from rural and urban counties: A study of ambulatory care sensitive hospitalizations for New York State residents

Rural patients who are admitted to hospitals outside their residence county or who travel great distances for hospitalization deprive local rural hosp itals of revenue. To provide more information about such rural residents, w e studied their characteristics compared to those admitted in the same coun ty. Characteristics studied included illness severity, demographics and cou nty resources. To validate the findings and to provide a different analytic approach, characteristics of residents who travel long distances for admis sion were also studied. We studied admissions for ambulatory care sensitive conditions, as they might be most responsive to policy changes such as inc reasing recruitment of local primary-care physicians. Hospital discharges d uring 1994 for 248,656 New York State residents were studied. We constructe d multivariate models using logistic regression and ordinary least squares methods. The models were applied to residents in three types of geographic location along an urban-rural continuum. Outside admissions were associated with younger age, higher illness severity and fewer county hospital resour ces. Same county admissions were associated with nonwhite race, and lack of insurance. Surprisingly, in rural counties, outside admissions were direct ly associated with increased primary-care providers. Results from the dista nce model generally supported findings from the outside admission model.