Fig. 2

Summary of findings Legend: This bubble plot summarizes findings by showing the relationships between direction of rural/urban differences (x-axis), outcome (y-axis), certainty of evidence (size of bubbles) and quality of care domain (color of bubbles). Direction of rural/urban difference, ascertained by vote counting, is indicated in four columns: “Fewer/lower” indicates that a majority of studies that looked at a given outcome found fewer patients with dementia or caregivers (or lower results) in the rural group compared to urban group; “No change” indicates that a majority of the studies for a given outcome found no difference in the number of patient or in the results of rural and urban patients or caregivers; “More/higher” indicates that the majority of the studies for a given outcome found more patients with dementia or caregivers (or higher results) in the rural group compared to the urban group; “Mixed findings” indicates that half of the studies found fewer patients/lower results in the rural group and the other half found more patients/higher results in the rural group compared to the urban group for a given outcome. Certainty of evidence, ascertained by GRADE approach, is indicated by the size of the bubble (smallest bubbles indicate very low certainty and largest bubbles indicate high certainty). The superscripts indicate the source of concerns ascertained by GRADE approach: a- indirectedness of research questions; imprecision; b- risk of bias; imprecision; inconsistency; c– risk of bias; indirectedness of research questions; imprecision; d- risk of bias; imprecision; e–imprecision; f- indirectedness of research questions; inconsistency; g- indirectedness of research questions; imprecision; inconsistency; and h- risk of bias; indirectedness of research questions; imprecision; inconsistency. Green bubbles are for outcomes of Access domain, orange for Integration, light blue for Effective Care, purple for Efficient Care, red for Population Health, dark blue for Safety and yellow for Patient-Centered Care