OBJECTIVES: Differences between metropolitan and non-metropolitan setting in the management of chronic conditions in patients 55 to 64 years of age can result in higher morbidity rates in non-metropolitan areas. We will look at the association between the geographic setting and indicators of care management for visits in this population. METHODS: Data from the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care (outpatient department) surveys were combined for years 2001 to 2004. NAMCS and NHAMCS collect visit data from medical records of randomly selected physician offices, hospital outpatient departments, and hospital emergency departments during randomly selected time periods through the year. A metropolitan area is an urban area with a core population of at least 50000. Visit data were weighted by the inverse of selection probability and used to provide annual average estimates. Visits having diagnoses codes for hypertension, diabetes, COPD, heart disease, stroke, and cancer were selected based on the ICD-9-CM codes. Number of chronic diseases, medications mentioned, therapeutic and preventive services performed, and diagnostic procedures ordered per visit were compared between metropolitan and non-metropolitan settings. SUDAAN software was used to develop a Poison regression model to perform the comparisons. Source of payment, gender, and race for patients were included in the model as covariates. The effect of the number of previous visits on the outcomes will be examined in future. RESULTS: Although rural visits had a higher number of chronic conditions (1.14vs. 1.11, p<.05), they had a smaller number of therapeutic and preventive services performed per visit (1.22 vs. 2.73, p<.01) and had a lower number of diagnostic and screening procedures ordered per visit (2.61 vs. 3.04, p<.05). CONCLUSION: The differences in care management in the years preceding Medicare eligibility could have implications for utilization of services once this population enrolls in Medicare.