Effect of locale on health status and direct care time of rural versus urban home health patients

J Nurs Adm. 2001 May;31(5):244-51. doi: 10.1097/00005110-200105000-00004.


Objective: The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time.

Background: Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients.

Methods: Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home.

Results: The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment.

Conclusions: Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Episode of Care
  • Female
  • Health Services Research
  • Health Status*
  • Home Care Services / statistics & numerical data*
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prospective Payment System
  • Residence Characteristics / statistics & numerical data*
  • Retrospective Studies
  • Rural Health Services / statistics & numerical data*
  • Time and Motion Studies
  • Urban Health Services / statistics & numerical data*
  • Washington
  • Workload*