Contextual, Organizational, and Ecological Factors Influencing the Variations in Heart Failure Hospitalization in Rural Medicare Beneficiaries in Eight Southeastern States

  • Thomas T. H. Wan


This chapter reports contextual, organizational, and ecological factors influencing the variations in risk-adjusted hospitalization rates for heart failure (HF) of Medicare patients served by rural health clinics (RHCs) in the eight Southeastern states in the United States. We conducted a longitudinal analysis to show trends and patterns of RHC variations in the race-specific, risk-adjusted rates. There was a steady decline in HF hospital admission rates. A net-period effect of the Affordable Care Act on HF hospital admissions was also observed in both White and African-American groups. The results affirm the importance of considering county characteristics and organizational factors for African-American patients in accounting for the variability in HF hospital admissions. However, for the White patients, the variables measured at the organizational level (such as the dual-eligibility status of Medicare patients and the total FTEs employed by RHCs) were influential and could be considered in the formulation of hospital incentive payment formula in the future.


Rurality Racial disparities Heart failure hospitalization ACA period effect Ecological correlates Rural health clinics Ambulatory care sensitive condition 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Thomas T. H. Wan
    • 1
  1. 1.College of Health and Public AffairsUniversity of Central FloridaOrlandoUSA

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