Rural hospital closures and nursing home outcomes

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-04-26 DOI:10.1111/jrh.70026

Emmaline Keesee MSPH, Tyler Malone PhD, Susie Gurzenda MS, George Pink PhD

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Abstract

Purpose

Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.

Methods

Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.

Findings

We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: –0.24, –0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.

Conclusions

Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.

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农村医院关闭和养老院的结果

自2005年以来，今年关闭的农村医院达到194家，这引起了人们对农村卫生保健服务的关注。人们对设施关闭对当地长期护理部门的影响知之甚少。该分析模拟了同一县农村医院关闭与养老院之间的关系。我们探讨养老院水平的结果相关的利用和居民健康。方法：医疗保险中心；使用医疗补助服务医疗成本报告信息系统、LTCFocus和NC农村卫生研究计划医院关闭数据集对2012年至2019年的关闭进行差异中差异研究。我们没有发现证据表明医院关闭影响非医院养老院的入住率、医疗保险支付居民的比例或居民平均ADL评分。然而，每位住院医师每年的住院次数在关闭后下降了0.13次（95% CI: -0.24, -0.02），与大平均值相比变化了0.33个标准差。目前尚不清楚疗养院住院人数的减少是否反映了急诊、紧急或选择性住院人数的减少。结论：我们的研究结果建立在现有的医院关闭文献的基础上，强调了医院在农村急性后和长期护理中的作用。据我们所知，这是第一个研究医院关闭对养老院影响的研究。这些发现在2019冠状病毒病之后尤其重要，因为农村长期护理机构和医院都面临着加剧的劳动力和资金挑战。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.