People with Alzheimer’s disease living in rural areas are much more likely to go to the emergency department (ED) for a preventable visit than their urban counterparts, a new study from the University of Maryland School of Public Health found.
The research team, led by Health Policy and Management Professor Jie Chen, included PhD candidates Nianyang Wang, the leading author, and Aitalohi Amaize.
They explored the rural and urban differences for older patients with Alzheimer’s disease and related dementias (ADRD) and the frequency of their preventable ED visits.
Preventable emergency department visits raise health care costs and reflect that people are not receiving the care needed to make such visits avoidable.
“Rural areas are home to a greater number of adults age 65 and older and also have greater rates of chronic illnesses,” Wang said.
“In addition, rural areas have less access to health care, and in particular, specialists and mental health professionals.”
The researchers examined the relationship between hospital Accountable Care Organization (ACO) affiliation and preventable ED visits for urban and rural ADRD patients.
The ACO model was created to promote care coordination among doctors, hospitals and other health professionals with the goal of increasing quality of care while mitigating costs, Wang said.
However, the benefits of ACOs haven’t made their way to rural areas.
Hospitals using the ACO model tend to be “large, urban and have more funding and data for care coordination programs,” the study said. Additionally, there are fewer ACO-affiliated hospitals in rural areas.
Increasing ACO-affiliated hospitals in rural communities may not only decrease preventable ED rates but also reduce urban and rural disparities, the researchers hypothesized.
The team showed that these hospitals had notably lower chances of preventable ED visits compared to unaffiliated ACO hospitals.
“The ACO model has the potential to decrease rural preventable ED visits among ADRD patients,” Wang said.
Amid the coronavirus pandemic, older patients with dementia and their caregivers face challenges to meet health needs, especially those living in rural areas, Chen said.
“Health care integration and coordination among health and social sectors have shown success in building a cost-effective health care delivery system before the pandemic,” she said. “The integration will continue to be the key driver during and post the pandemic.”
“A well-designed policy initiative, such as the Accountable Care Organization, can unite the health care and community stakeholders and build a strong public health integrated health care system to promote population health and health equity.”
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