Inpatient care in rural hospitals at the beginning of the 21st century

Context: National data documenting the role that rural hospitals play in providing inpatient care to patients both younger than 65 and 65 years and older has previously been unavailable. Purpose: To present descriptive nationally representative data on the numbers and types of inpatients, and the care they received, in rural hospitals. Methods: This study includes inpatient data from the 2001 National Hospital Discharge Survey, a nationally representative survey of short-stay, nonfederal hospitals in the United States. Inpatients in rural hospitals were compared to those in urban hospitals in terms of demographic and clinical characteristics and patterns of utilization. Among the variables examined were age, number and type of diagnoses, avoidable hospitalizations, comorbidity, procedures received, source of payment, average length of stay, and discharge disposition. Findings: Seventeen percent (5.7 million) of hospitalizations were in rural hospitals in 2001 and a similar percent of the US population lived in rural areas. Rural hospitals provided 23 million days of inpatient care and 4.7 million inpatient procedures. Despite the emphasis placed on Medicare's role in supporting rural hospitals, half of rural hospital inpatients were younger than 65 years. Rural hospital inpatients had shorter average stays and received fewer procedures on average. Seven percent of rural hospital inpatients were transferred to other short-stay hospitals. Conclusions: National data on the broad scope of patients served and inpatient services provided by rural hospitals illustrate one important role these hospitals play in serving rural communities.