Michele Burlew

Meaningful Use of Health Information Technology by Rural Hospitals

PURPOSE This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. METHODS Data from the American Hospital Association (AHA) Annual Survey IT Supplement were analyzed, using t tests and probit regressions to assess whether implementation rates in CAHs and other rural hospitals are significantly different from rates in urban hospitals. FINDINGS Of the many measures we examined, only 4 have been met by a majority of rural hospitals: electronic recording of patient demographics and electronic access to lab reports, radiology reports, and radiology images. Meaningful use is even less prevalent among CAHs. We also find that rural hospitals lag behind urban institutions in nearly every measure of meaningful use. These differences are particularly large and significant for CAHs. CONCLUSION The meaningful use incentive system creates many challenges for CAHs. First, investments are evaluated and subsidies determined after adoption. Thus, CAHs must accept financial risk when adopting health IT; this may be particularly important for large expenditures. Second, the subsidies may be low for relatively small expenditures. Third, since the subsidies are based on observable costs, CAHs will receive no support for their intangible costs (eg, workflow disruption). A variety of policies may be used to address these problems of financial risk, uncertain returns in a rural setting, and limited resources.

Disparities in pediatric asthma hospitalizations.

OBJECTIVE The purpose of this project was to determine to what extent rural children are hospitalized for asthma, an ambulatory care sensitive condition defined by the Agency for Healthcare Research and Quality pediatric quality indicators; to analyze differences in hospitalization rates for asthma by state and by rurality; and to examine the relationships between asthma hospitalization rates and poverty, health insurance, and physician supply. METHODS The project used 2001 through 2004 hospital inpatient discharge data for children aged 2 to 17 years from six geographically diverse states in the Healthcare Cost and Utilization Project. County-level poverty, uninsurance estimates, and physician data came from the 2004 Area Resource File. Pediatric Quality Indicator software was used to calculate county-level admission rates for asthma. Multivariate regression models were specified to assess how sensitive hospitalization rates were to characteristics of the childrens counties of residence. RESULTS Pediatric asthma hospitalization rates per 100,000 children aged 2 to 17 years varied by state ranging from 51.1 to 185.9. When comparing all six states, rural children were the most likely to be hospitalized for asthma. However, after controlling for rurality, poverty, uninsurance, and physician supply, uninsurance was the only variable to significantly impact hospitalization rates. CONCLUSIONS These findings indicate that there are significant differences in pediatric asthma hospitalizations rates by and within states, which may best be addressed by targeting public health and healthcare interventions. In addition, the findings support efforts to increase health insurance coverage for children, especially rural children who are less likely to be insured.