Table 4.

Association between patient rurality and timeliness indicators for hospice and palliative care use. Note the patient population was limited those who survived the minimum number of days to qualify for the timeliness measure, e.g., at least 90 days survival from diagnosis for palliative care measure (N=16,174) and 3 days for hospice (N=31,123).

Patient Residence	Palliative care at least 90 days before death				Hospice use at least 3 days before death
	Unadjusted		Adjusted		Unadjusted		Adjusted
	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
Metropolitan	1.00 (ref)	-	1.00 (ref)	-	1.00 (ref)	-	1.00 (ref)	-
Micropolitan	0.89 (0.76 – 1.04)	0.15	0.92 (0.78 – 1.09)	0.33	1.03 (0.96 – 1.11)	0.44	0.97 (0.89 – 1.05)	0.44
Small Town	0.82 (0.67 – 1.01)	0.065	0.91 (0.73 – 1.13)	0.40	0.93 (0.85 – 1.02)	0.13	0.87 (0.79 – 0.96)	0.008
Rural	1.17 (0.94 – 1.46)	0.15	1.29 (1.03 – 1.62)	0.027	0.91 (0.81 – 1.02)	0.11	0.86 (0.76 – 0.96)	0.010

OR= odds ratio; CI= confidence interval

Adjusted models included the following covariates: age, sex, race/ethnicity, Medicare/Medicaid full dual eligibility, disease stage (metastatic vs. not), diabetes, previous myocardial infarction, congestive heart failure, stroke or transient ischemic attack, chronic obstructive pulmonary disorder, end-stage renal disease, the composite CMS-Hierarchical Condition Categories risk adjustment score, and ADI.