Missing the handoff: post-hospitalization follow-up care among rural Medicare beneficiaries with diabetes.

INTRODUCTION Diabetes is a condition that requires adequate care to ensure ideal outcomes. One need is for proper post-discharge follow-up care to reduce unnecessary hospital re-admissions. This care is more difficult in US rural areas due to lower physician and resource availability. The purpose of this analysis was to examine US urban-rural differences in 30 day post-discharge physician follow-up care. METHODS This analysis utilized data from 2005 Medicare claims files, merged with county-level information from the area resource file. Beneficiaries with diabetes and with a hospitalization served as the study population. Differences in hospitalization rates and 30 day physician follow-up care were estimated across levels of rurality. Multi-level multivariate models estimated the factors that significantly contributed to obtaining such care. RESULTS Approximately 90% of the study population had a follow-up physician visit within 30 days; this rate was lower among rural beneficiaries. Adjusted estimates indicated that beneficiaries in rural areas were not less likely to obtain a follow-up visit. Factors associated with obtaining a follow up included having addition comorbidities, being female or White, and living in the US Northeast. CONCLUSIONS This analysis found evidence that rural Medicare beneficiaries were less likely to obtain post-discharge physician follow-up visits within 30 days. The adjusted result indicate that other factors such as personal demographic and illness characteristics are more predictive of this behavior than the rural location itself. More research is needed to identify why these specific factors are associated with visit behavior, and how to design interventions to improve these rates.