A study that set out to examine the difference in the rate of post-hospital discharge adverse events between rural and urban patients reported little difference between the two populations, but did find that the number of such incidents has greatly increased.
The study, "Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study," published in the August 2015 edition of the Journal of General Internal Medicine, is the largest to date to examine post-discharge adverse events in urban and rural patients, said principal investigator Dennis Tsilimingras, M.D., M.P.H., assistant professor and director of patient safety in the Wayne State University School of Medicine's Department of Family Medicine and Public Health Sciences.
More than 28 percent of the study participants experienced an adverse event after discharge from the hospital, more than two-thirds of which were preventable or ameliorable, the study found.
While the study found little difference between the number of post-discharge adverse events between the urban and rural patients, Dr. Tsilimingras found the rate of such events "alarmingly high." The first post-discharge adverse event study, published in 2003, reported a rate of 19 percent in urban patients. His study found that rate jumped to 28 percent in urban and rural populations.
"This may indicate that a decade later we have made little progress in preventing post-discharge adverse events and we must do more to identify effective interventions for patients who are adopted by hospitals around the country, during this critical post-hospital discharge period when patients transition from the hospital to home," he said.
The study followed 684 patients who were under the care of hospitalist physicians and who were being discharged home, spoke English and could be contacted after discharge. The patients were identified as urban or rural based on the ZIP code in which they lived. While there was no difference in the rate of incidents between the two groups, post-discharge adverse events associated with hypertension and diabetes were found only in urban patients.
While Dr. Tsilimingras had hypothesized that rural patients might be at higher risk for post-discharge adverse events than urban patients, the results indicated that was not the case. In fact, the study found nearly identical rates of adverse events between rural and urban patients. However, further research may be needed to change the overall perception of the risks between the groups, he said.
"It may be that the reasons for post-discharge adverse events are different in the two populations," Dr. Tsilimingras said. "For example, rural patients may be at higher risk because of lack of access to health care, but that may be counter-balanced by urban patients actually being sicker. The study raises a number of hypotheses that we can test. The goal is to identify the risks inherent in different populations so that we can better target effective interventions for each group."
The study indicated a trend toward more management and therapeutic errors among urban patients, a factor that suggests these patients may be more medically complex, he said. Several "non-significant findings" provide hints at access-to-care issues among rural patients who had a trend toward adverse events of a longer duration and more adverse drug events due to anticoagulation, which required regular monitoring to prevent.
The findings, Dr. Tsilimingras said, may suggest potential customization of interventions to improve transitions of care based on residential status. They also justify the need for the effective implementation of interventions to improve patient safety upon discharge from a hospital.