Abstract
BackgroundThe aim of this study was to identify the range of ways that safety net hospitals (SNHs) have been empirically operationalized in the literature and determine the extent to which patterns could be identified in the use of empirical definitions of SNHs.MethodsWe conducted a PRISMA guided systematic review of studies published between 2009 and 2018 and analyzed 22 articles that met the inclusion criteria of hospital-level analyses with a clear SNH definition.ResultsEleven unique SNH definitions were identified, and there were no obvious patterns in the use of a definition category (Medicaid caseload, DSH payment status, uncompensated care, facility characteristics, patient care mix) by the journal type where the article appeared, dataset used, or the year of publication.ConclusionsOverall, there is broad variability in the conceptualization of, and variables used to define, SNHs. Our work advances the field toward the development of standards in measuring, operationalizing, and conceptualizing SNHs across research and policy questions.
Highlights
The aim of this study was to identify the range of ways that safety net hospitals (SNHs) have been empirically operationalized in the literature and determine the extent to which patterns could be identified in the use of empirical definitions of SNHs
Identifying the landscape of SNH definitions is of importance because of myriad policies aimed at relieving the financial burden faced by hospitals that serve America’s poorest and sickest communities
Almost half of the articles were published in health services journals (45%), about a third were published in policy-related journals (32%) and a quarter of studies were published in clinical-related journals (23%)
Summary
The aim of this study was to identify the range of ways that safety net hospitals (SNHs) have been empirically operationalized in the literature and determine the extent to which patterns could be identified in the use of empirical definitions of SNHs. There have been calls for an expanded program of research to identify ways to assure the viability and Anecdotally, researchers have operationalized SNHs in their studies in a variety of ways and frequently justified their chosen approach by stating that there is a lack of consensus on how to empirically identify such hospitals [7,8,9,10,11]. It has been suggested that a SNH definition should be chosen based on the empirical or conceptual aims of a given study [6]. This could lead to inter-study variability with respect to hospitals that are considered “safety-net”
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