Work

Associations between rural hospital closures and acute and post‐acute care access and outcomes

Year: 2024

Type: article

Abstract: OBJECTIVE: To determine whether rural hospital closures affected hospital and post-acute care (PAC) use and outcomes. STUDY SETTING AND DESIGN: Using a staggered difference-in-differences design, we evaluated associations between 32 rural hospital closures and changes in county-level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30-day readmissions and mortality and hospitalizations for a fall-related injury; and (4) population-level hospitalization and death rates. DATA SOURCES AND ANALYTIC SAMPLE: 100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee-for-service Medicare beneficiaries. PRINCIPAL FINDINGS: We found that hospitals that closed compared to those remaining open served more minoritized, lower-income populations, including more Medicaid and fewer commercial patients, and had lower profit margins. Following a closure, quarterly hospitalization rates (111.6 quarterly hospitalizations per 10,000 older adults; 95% CI: 53.4, 170.9) and average hospital lengths of stay increased (0.34 days; 95% CI: 0.13, 0.56 days). We observed no change in the average distance between patients' residential ZIP code and the hospital used (0.29 miles; 95% CI: -1.06, 1.64 miles); average number of standardized ADL limitations at PAC (0.08 SDs from the pre-closure average; 95% CI: -0.12, 0.28 SDs); or PAC time to start (0.02 days; 95% CI: -1.2, 1.2 days). Among more isolated hospitals, closures were associated with an increase in the likelihood of readmission (0.10 percentage-points; 95% CI: 0.00, 0.19). CONCLUSIONS: Closures were not associated with notably worsened health care access, function, or health, potentially because closures triggered care delivery adjustments involving increased numbers of patients seeking out higher quality care.

Source: Health Services Research

DOI: 10.1111/1475-6773.14426

Authors: Geoffrey J. Hoffman, Jinkyung Ha, Zhaohui Fan, Jun Li

Institutions: University of Michigan, Michigan Medicine, Syracuse University

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $3,570