Urban-Rural Disparities in Health Care Quality for Children with Medical and Social Complexity

In a study of hospitalizations at children’s hospitals, rural-residing children have a higher prevalence of complex chronic conditions, higher inpatient costs, risk of readmissions. In an effort to dig deeper, in 2018, Dr. JoAnna Leyenaar, MD, PhD, MPH, pediatric hospitalist and Vice Chair of Research for the Department of Pediatrics at Dartmouth-Hitchcock Medical Center, made her first request for Colorado All Payer Claims Database (CO APCD) data to evaluate the urban-rural disparities in health care utilization and quality for children with social risk factors and chronic illnesses.

Most recently, Dr. Leyanaar and her team received a limited data set from the CO APCD to identify and determine factors associated with disparities in health care access and outcomes among children in Colorado. The data set provided geocoded information which matches children in the CO APCD to their associated census tract. Using census tracts in addition to CO APCD claims information is beneficial because it enables analysis of social determinants of health through external sources such as the American Community Survey. In addition to social factors, the Dartmouth team is evaluating how far families are traveling to health care facilities, and the timeliness and quality of health care delivery. Ultimately, the team aims to evaluate patient-sharing networks among physicians to determine if network characteristics contribute to urban-rural disparities in quality of care.

Since the initial request in 2018, Dr. Leyenaar has worked diligently to enhance her project, utilizing five years of claims data. In addition to Colorado, data from Massachusetts and New Hampshire have also been included, due their diverse populations. At this time, the project is still underway, with the hope that the research will generate enough evidence-based data to inform next steps to reducing health disparities for children living in rural communities.