Abstract
Post-acute care services (PACS) are one of the fastest growing programs funded by Centers for Medicare and Medicaid (CMS) with potential promise to rural communities. Emergency general surgery (EGS) is essential to many hospitals. Yet little is known about post-EGS PACS utilization, especially among rural communities with longstanding barriers to healthcare access and farther travel distances. This study seeks to uncover drivers of PACS utilization after EGS among rural patients.
Using the 2016-2022 National Inpatient Sample, we conducted a retrospective cohort study identifying hospitalizations of adult patients from rural areas, using NCHS urban-rural classification scheme, who underwent selected EGS procedures. Factors associated with PACS utilization defined as discharge to home healthcare (HHC) or other intermediate care facility (ICF, SNF) were evaluated. Adjusted multinomial logistic regression models were estimated controlling for demographic and clinical characteristics.
There were over 1,148,000 EGS hospitalizations in the United States for rural patients, of which 28.9% utilized PACS. CMS was the primary payer for 82% of the hospitalizations utilizing PACS. Factors significantly predictive of higher use of any type of PACS utilization included older age, greater comorbidities, increased LOS, Medicare/Medicaid payer, large bowel procedures, Northeast or South region, operative complications, and transferred-in status.
In one of the largest evaluations, nearly one-third of hospitalizations of rural patients received PACS after EGS. Surgeons, healthcare systems, and CMS can leverage these results to better predict which patients will require PACS and how to best improve its utilization for rural patients.
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