Abstract P1077: A comparison of outpatient cardiac rehabilitation access between rural and urban counties in Tennessee

Abstract

Background: Longer travel distance and time to outpatient cardiac rehabilitation (OCR) are linked with lower OCR attendance despite OCR being significantly associated with reduced hospital readmission and mortality following a myocardial infarction. With contemporary research on rural-urban differences in proximity to OCR being limited, we examined whether travel distance and time to the closest OCR facility differed between rural and urban Tennessee counties. With there being a known lack of resources throughout the cardiovascular disease care continuum in rural areas, we hypothesized that rural Tennessee counties would have significantly greater travel distance and time to OCR than urban counties. Methods: To identify Tennessee OCR facilities, we supplemented an existing Tennessee Association of Cardiovascular and Pulmonary Rehabilitation OCR listing by data scraping Google Maps using keywords associated with OCR from the literature. Counties with Rural-Urban Continuum Codes 1-3 were classified as urban counties and codes 4-9 denoted rural counties. County-level mean travel distance and time to the closest facility were determined for each county and Wilcoxon rank-sum tests were performed to examine if mean travel distance/time differed significantly by rural/urban county status. Results: Twenty-three out of Tennessee’s 61 OCR facilities (37.7%) were in rural counties. Mean county-level travel distance to closest OCR was 16.6 miles (SD + 10.0 miles) and mean county-level travel time was 27.9 minutes (SD + 13.6 minutes). When examined by rural/urban county status, rural counties had slightly higher median of mean travel distance and time (15.4 miles, 28.9 minutes) compared to urban counties (12.9 miles, 23.2 minutes). However, the p-values for the distance and time comparisons between rural and urban counties were not statistically significant being 0.182 and 0.284 respectively. Conclusions: While <40% of Tennessee’s OCR facilities were in rural counties, this did not correspond with significantly greater travel distance/time in rural versus urban counties, a contrast to what is usually observed for rural-urban distribution of services throughout the cardiovascular disease care continuum. With that said, additional efforts are warranted to help patients with actual or perceived high travel burden navigate the personal and structural factors precluding receiving OCR.