Study Suggests Using One Classification System for Estimates of Urban/Rural Impact on AMI Outcomes among Veterans May Not Be Adequate
Among VA hospitals, Veterans with acute myocardial infarction (AMI) represent roughly 15,000 admissions, including more than 3,000 Veterans residing in rural settings. VA is actively pursuing innovative ways to improve access and quality of care for rural-dwelling Veterans (e.g., telehealth, community-based outpatient clinics), but rural VA patients continue to use fewer health care services. This retrospective cohort study examined whether: 1) two different rural classification systems identify differential rates of Veterans admitted for AMI; 2) rural-urban disparities exist for risk-adjusted AMI outcomes (measured by mortality and receipt of coronary revascularization); and 3) whether hospital transfer rates differ for patients admitted with AMI. Investigators identified 15,870 Veterans admitted for AMI to all VA hospitals. Rural residence was identified by both Rural-Urban Commuting Area (RUCA) codes (e.g., isolated town, small or large town, urban) and VA’s Urban/Rural/Highly Rural (URH) system.
Findings showed no observed differences between rural-dwelling and urban-dwelling Veterans in risk-adjusted 30-day mortality, regardless of the urban-rural classification system used. However, rural-dwelling Veterans were less likely to receive revascularization compared to urban-dwelling Veterans, but risk estimations were dependent upon the urban-rural classification system used. Regardless of classification system, Veterans residing in rural settings were transferred more often and were more likely to be admitted to VA hospitals without revascularization facilities. This study demonstrates that using a single rural classification system for estimating the effects of living in a rural setting on AMI outcomes among Veterans may not be adequate.
Abrams T, Vaughan-Sarrazin M, and Kaboli P. Mortality and revascularization following admission for acute myocardial infarction: Implication for rural Veterans. Journal of Rural Health Fall 2010;26(4):301-309.
This study was funded by VA. All authors are part of HSR&D’s Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City, IA.
