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Population Health Management More Complex for Rural Children

A recent report states that rural children are like to face complex chronic diseases and care access issues that pose challenges for population health management.

By Jacqueline LaPointe

- Healthcare organizations may need to reevaluate their population health management strategies when it comes to children who live in rural areas. A recent study in the May edition of Pediatrics found that rural children are more likely to develop a chronic condition, incur higher healthcare costs, and reside in a healthcare provider shortage area.

Population health management more difficult for rural children

Researchers reported that 71.4 percent of rural children had at least one chronic condition, which was significantly higher than non-rural children (66.6 percent). About 44 percent of rural children also developed a complex chronic condition compared to 36.7 percent of non-rural pediatric patients.

The study also found that the average inpatient cost for rural children was $8,507 while the average cost was only $7,814 for non-rural children.

In addition to the prevalence of chronic diseases and higher healthcare costs, rural children who visited a children’s hospital were five times more likely to live in a medically underserved community. These areas did not have the healthcare infrastructure to adequately develop discharge care plans, especially for pediatric patients with complex chronic conditions.

“When hospitalized, rural children cost more and are readmitted more often than are non-rural children, even after controlling for indicators of medical complexity,” explained the report. “Hospitalized children from a rural area have a higher prevalence of a chronic condition, a CCC [complex chronic condition], and need for technology assistance.”

While approximately one in five children live in a rural area, rural children are more likely to face worse health outcomes than non-rural pediatric patients. In rural areas, there are also higher rates of chronic diseases, obesity, and tobacco use compared to urban communities.

Even though there is a substantial need for better healthcare services in rural areas, there are fewer general practice and specialty pediatricians per capita as well as fewer home- and community-based services, such as home nurses and physical therapists. Children’s hospitals, which account for more pediatric and surgical specialty care than any other healthcare facility, are also primarily located in non-rural areas.

The study showed that rural children did not have as much access to medical homes compared to non-rural children.

Using claims data from 41 children’s hospitals in the Pediatric Health Information System database from 2012, the study showed that children residing in provincial areas had to travel an average of 68 miles to a children’s hospital. Non-rural patients only had to travel 12 miles.

The study revealed that more rural children needed to travel to receive medical services. Rural pediatric patients accounted for 41.2 percent of all patients living in a healthcare professional shortage area.

Patient outcomes also declined because rural children were slightly more likely to experience a readmission within 30 days and longer length of stay per admission, explained the report. About 13 percent of rural children were readmitted to the children’s hospital within 30 days, which was modestly higher than non-rural patients (11.5 percent). The study also stated that the length of stay was one day longer for every ten hospitalized rural pediatric patients.

Rural children were oftentimes discharged from children’s hospitals to underserved or low-income area, even though they more likely to experience a complex medical condition, chronic disease, and 30-day readmission, explained the authors of the study.

Nearly 53 percent of rural pediatric patients lived in a ZIP code where the average income was less than 150 percent of the federal poverty line, the study reported.

Researchers noted that rural children may have had worse patient outcomes because rural families in low-income communities experienced challenges with adhering to a discharge care plan due to high healthcare costs. Families may also have found it difficult to attend scheduled follow-up appointments since many of the patients lived in healthcare professional shortage areas.

Through the study, researchers intended for the results to help children’s hospitals and policymakers to improve population health management programs for rural children.

“Children’s hospitals, and the states and surrounding regions in which they reside, may find this information useful as programs and policies emerge to (1) better integrate tertiary and community care and (2) optimize quality of care for rural children,” explained the report.

Dig Deeper:

Six Foundational Steps for Better Population Health Management

How Accountable Care Impacts Population Health Management


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