Rural and urban residents have similar perceptions of health care quality, despite differences in care delivery

Patient Safety and Quality
Rural and urban residents have similar perceptions of health care quality, despite differences in care delivery

Both urban and rural residents have similar overall perceptions of health care quality, even though the context in which care is delivered and individual-level characteristics of these areas differ, reveals a new study. Lars F. Peterson, M.D., Ph.D., of the Medical University of South Carolina, studied a sample of 11,255 individuals in 48 rural counties, and 28,698 individuals in 40 urban counties of Ohio. He asked participants to rate the overall quality of care they received in the past year. He obtained additional data to determine the characteristics of each community and its health care delivery system.

The context in which health care was delivered differed in rural and urban areas. Compared with urban areas, health care resources in rural areas were characterized by fewer health care providers per capita, a higher proportion of primary care providers, and less managed care penetration. Rural areas also differed from urban areas in individual-level characteristics. For example, they had higher rates of unemployment, lower rates of educational attainment, lower median income, and more individuals with poorer health status.

After adjusting for contextual and individual-level characteristics, there were no significant differences in how rural and urban respondents perceived the quality of care they received. After adjusting for individual-level characteristics, residing in a small rural county nonadjacent to a large urban area was the only characteristic associated with a lower quality rating. Higher care quality was associated with an increasing proportion of hospitals offering more than 25 services in urban areas. This resulted in close to a 1-point increase in perceived quality. The findings suggest that those who have crafted rural and urban health care systems may have anticipated and/or matched the health care needs and expectations of their service populations, concludes Dr. Peterson. His study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00059).

See "Associations between self-reported quality of care and county characteristics are largely similar in rural and urban settings," by Dr. Peterson in the October-December 2009 Quality Management in Health Care 18(4), pp. 257-267.