Transitions in Care among Rural residents with Congestive Heart Failure

Critical Access Hospitals serve a substantial proportion of residents of small and remote rural counties

• Among persons with the three conditions studied, more than 40% of beneficiaries in living
in small and remote rural counties obtained initial care from a CAH. Nationally, 5.8% of all admissions were transferred to another facility
• The transfer rate was higher among rural (10.5%) and critical access (11.8%) hospital admissions than among urban hospital admissions (4.2%). The most common discharge destination after the transfer admission is home (42.5%)
• Within rural transfer patients, critical access hospital (CAH) patients were less likely to be discharged to home than patients from other rural hospitals (41.7% versus 44.3%).
• A discharge of death from the second hospital was more common for CAH transfer patients than for patients at other rural hospitals (11.0% versus 6.0%). Patients transferred from rural hospitals had a lower 30-day readmission rate than urban patients
• Patients transferred from a rural hospital or CAH had lower readmission rates (16.4%) than urban transfer patients (25.3%).
• Among those with a readmission, rural transfer patients were less likely to be readmitted to the original facility than urban transfer patients.

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