Associations between self-reported quality of care and county characteristics are largely similar in rural and urban settings

Abstract

Context: The content and spectrum of rural health care services are different from those in urban areas. The extent to which health care consumers' perceptions of the quality of these services vary across settings and the association of these perceptions with features of rural and urban settings are unclear.

Objective: To determine whether perceptual differences of quality exist and contrast rural/urban associations between contextual characteristics and perceived quality of health care.

Methods: Multilevel, cross-sectional analysis of a state-representative sample of 33 786 adults, stratified by rural/urban status linked with county-level data describing contextual features (eg, health care, economics, and social capital). The dependent variable was respondents' perceived quality of health care received in the past year. Weighted multilevel random intercept models examined the independent association of contextual characteristics with perceived quality.

Results: Overall perceived quality did not differ between rural and urban settings. Similarly, the pattern of associations between perceived quality and contextual characteristics was generally comparable between settings. A notable difference was an association between higher quality with an increasing proportion of hospitals offering more than 25 services in urban areas (beta = .763; P < .05).

Conclusions: Despite rural/urban differences in contextual characteristics with potential influence on health care delivery, overall consumer perception of health care quality was similar in both settings. This suggests that health care managers may be adopting setting-specific strategies to enhance consumer satisfaction despite contextual differences.