Elderly/Long-term Care

Older and minority elderly are less willing to travel to distant hospitals for care

With growing regionalization of specialized care at major hospitals and more local hospital closures, individuals often have to travel further to hospitals that will provide them with the care they need. Older, minority elderly patients appear less willing to travel the extra distance to these hospitals than other elderly patients, suggests a study by Jayasree Basu, Ph.D., of the Center for Primary Care, Prevention, and Clinical Partnerships at the Agency for Healthcare Research and Quality.

Dr. Basu analyzed data from AHRQ's Healthcare Cost and Utilization Project State Inpatient Database on elderly New York residents who were hospitalized in New York or neighboring states. The study examined the impact of demographics, severity of illness, and other factors on two types of hospital admissions: referral-sensitive admissions, which are fairly discretionary, often elective, high-technology procedures; and ambulatory care-sensitive (ACS) admissions, usually more urgent admissions that are typically preventable with appropriate primary care.

Even after controlling for severity of illness, other patient characteristics, and county factors, patients who were aged 75 and older were less likely to travel than patients 65 to 74 years old. This pattern persisted regardless of the types of medical condition studied. Compared with whites and others, blacks were 60 percent less likely and Hispanics were 55 percent less likely to travel long distances for hospital admissions for ACS conditions. Blacks were also 65 percent less likely than whites to travel far for referral-sensitive admissions. Severity of illness tended to increase distant travel for ACS admissions by about 2 percent in each age group, but was a less significant predictor of travel among blacks and Hispanics than whites.

See "Severity of illness, race, and choice of local versus distance hospitals among the elderly," by Dr. Basu, in the May 2005 Journal of Health Care for the Poor and Underserved 16, pp. 391-405. Reprints (AHRQ Publication No. 05-R054) are available from the AHRQ Publications Clearinghouse.

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