Abstract：
Urban-rural disparities in medical care, including in home healthcare, persist globally. With aging populations and medical advancements, demand for home health services rises, warranting investigation into home healthcare disparities. Our study aimed to (i) investigate the impact of rurality on home healthcare quality, and (ii) assess the temporal disparities and the changes in disparities in home healthcare quality between urban and rural home health agencies (HHAs), incorporating an analysis of geospatial distribution to visualize the underlying patterns. This study analyzed data from HHAs listed on the Centers for Medicare and Medicaid Services website, covering the period from 2010 to 2022. Data were classified into urban and rural categories for each HHA. We employed panel data analysis to examine the impact of rurality on home healthcare quality, specifically focusing on hospital admission and emergency room (ER) visit rates. Disparities between urban and rural HHAs were assessed using the Wilcoxon test, with results visualized through line and dot plots and heat maps to illustrate trends and differences comprehensively. Rurality is demonstrated as the most significant variable in hospital admission and ER visit rates in the panel data analysis. Urban HHAs consistently exhibit significantly lower hospital admission rates and ER visit rates compared to rural HHAs from 2010 to 2022. Longitudinally, the gap in hospital admission rates between urban and rural HHAs is shrinking, while there is an increasing gap in ER visit rates. In 2022, HHAs in Mountain areas, which are characterized by a higher proportion of rural regions, exhibited higher hospital admission and ER visit rates than other areas. This study underscores the persistent urban-rural disparities in home healthcare quality. The analysis emphasizes the ongoing need for targeted interventions to address disparities in home healthcare delivery and ensure equitable access to quality care across urban and rural regions. Our findings have the potential to inform policy and practice, promoting equity and efficiency in the long-term care system, for better health outcomes throughout the USA.
摘要：
背景：城乡医疗差距，包括家庭医疗保健，全球坚持。随着人口老龄化和医疗进步，对家庭保健服务的需求上升，保证对家庭保健差距进行调查。我们的研究旨在1)调查农村程度与家庭医疗质量之间的关系，和2)评估城乡家庭保健机构(HHA)之间家庭保健质量的时间差异和变化，结合地理空间分布的分析，以可视化潜在的模式。
方法：本研究分析了医疗保险和医疗补助服务中心（CMS）网站上列出的HHA数据，涵盖2010年至2022年期间。每种HHA的数据分为城市和农村类别。我们采用面板数据分析来检验乡村对家庭医疗质量的影响，特别关注入院率和急诊室(ER)就诊率。使用Wilcoxon检验评估城市和农村HHA之间的差异，结果通过线和点图和热图可视化，以全面说明趋势和差异。
结果：在面板数据分析中，乡村性被证明是住院率和ER就诊率的最重要变量。从2010年到2022年，与农村HHA相比，城市HHA的住院率和急诊室就诊率一直显着降低。纵向,城乡HHA住院率的差距正在缩小，虽然急诊室就诊率差距越来越大。2022年，以农村地区比例较高为特征的山区HHA的住院率和急诊室就诊率高于其他地区。
结论：本研究强调了家庭医疗质量方面持续存在的城乡差距。该分析强调，持续需要采取有针对性的干预措施，以解决家庭医疗保健提供方面的差距，并确保城乡地区公平获得优质护理。我们的发现有可能为政策和实践提供信息，促进长期护理系统的公平和效率，为了更好的健康结果在整个美国。
方法：本研究分析了医疗保险和医疗补助服务中心（CMS）网站上列出的HHA数据，涵盖2010年至2022年期间。每种HHA的数据分为城市和农村类别。我们采用面板数据分析来检验乡村对家庭医疗质量的影响，特别关注入院率和急诊室(ER)就诊率。使用Wilcoxon检验评估城市和农村HHA之间的差异，结果通过线和点图和热图可视化，以全面说明趋势和差异。
结果：在面板数据分析中，乡村性被证明是住院率和ER就诊率的最重要变量。从2010年到2022年，与农村HHA相比，城市HHA的住院率和急诊室就诊率一直显着降低。纵向,城乡HHA住院率的差距正在缩小，虽然急诊室就诊率差距越来越大。2022年，以农村地区比例较高为特征的山区HHA的住院率和急诊室就诊率高于其他地区。
结论：本研究强调了家庭医疗质量方面持续存在的城乡差距。该分析强调，持续需要采取有针对性的干预措施，以解决家庭医疗保健提供方面的差距，并确保城乡地区公平获得优质护理。我们的发现有可能为政策和实践提供信息，促进长期护理系统的公平和效率，为了更好的健康结果在整个美国。
