Hospital Closure Research Articles

Psychometric development and validation of the Hospital Resilience Index

BackgroundThroughout the past decades, the United States healthcare system has seen increased efforts to promote continuity of operations in response to external or internal stressors. There is no marker to characterize this facet of health system resilience. The two databases which may contain the most relevant data are the American Hospital Association (AHA) annual survey, which gathers over 1000 data points from more than 6000 hospitals, and the RAND corporation, which provides information on the financial health and viability of hospitals and health care systems. In that sense, AHA focuses more on organizational and practice issues, while RAND will cover more economic factors. Our study aimed to develop and psychometrically validate a new Hospital Resilience Index (HRI).MethodsWe took the AHA and RAND databases as primary data sources, and defined hospital closure as the main negative outcome indicating failed resilience. We performed descriptive statistics, and regression analysis of the databases.ResultsOur findings show that a combination of eleven variables is strongly associated with the likelihood of hospital closure. These factors mirror smaller hospital size, lack of ancillary functions, staffing structure of the hospital, size of facilities, number of surgeries performed, Medicare discharges, operating expenses, and medical school affiliation as a teaching hospital. We further classified hospitals with a low HRI (< 25) or high HRI (> 25). In this setup, we found that both hospitals with a low HRI and hospitals that would subsequently close were characterized by smaller patient census, smaller numbers of surgeries, fewer beds, a smaller staff, and a lower operating margin.ConclusionsTogether, these factors would point to a higher resilience to external stressors in larger, more expanded hospitals and healthcare systems, offering a broad range of services, and having a higher operating margin. The higher tiers of the healthcare system therefore seem to have more resilience, but the recent Covid-19 pandemic exhibited how much all tiers in the system are needed to respond to extraordinary crises such as pandemics or large natural disasters. Future research should seek to determine whether tracking the HRI over time may be a tool to identify hospitals at risk of closure.

Hospital closure in urban and rural areas and patients’ welfare

The hospital sector is frequently subject to reconfigurations, with some departments closing and new ones opening. Using a conditional logit model based on observed patient choices, we quantify the effects of a hospital department closure on the welfare of elective hip replacement patients in England. We simulate eight separate closures of the provider with lowest quality, as measured by one of four quality measures: revisions, emergency readmissions, 30-day mortality, change in the Oxford Hip Score, in urban and rural areas. The average reduction in welfare for patients who attended the closed hospital is equivalent to having to travel between two and ten additional kilometres for treatment, compared to their average travel distance, pre-closure, of 17.4 kilometres. The reduction in patient welfare is generally more pronounced when closing a hospital in a rural area (about 50% higher when quality is measured by the Oxford Hip Score and emergency readmissions).

Access to Healthcare and Voting: The Case of Hospital Closures in Rural America

We investigate how hardships affect rural politics, considering the case of hospital closures. In the last two decades, more than two hundred rural hospitals have closed their doors or drastically reduced their services. Drawing from resource models of voting, our hypothesis is that personal- and community-level deprivations brought about by hospital closures should reduce election turnout. Empirical tests pair geographic information on the location of open and closed hospitals with data from state voter files to create a panel of over 10 million rural residents for the 2016, 2018, and 2020 national elections. Results show that individuals whose nearest hospital closed prior to the proximate election were less likely to vote than their unaffected counterparts. These effects are strongest for older and lower-income residents, but they decay over time so that voting likelihood resembles a pre-closure baseline within 12 months.

Respiratory Isolation for Tuberculosis: A Historical Perspective.

Although tuberculosis is an ancient disease, recognition of its airborne route of transmission, with implications for respiratory isolation, is only relatively recent. Since the time of Hippocrates, the dogma among health practitioners was that the disease was hereditary or that it could be contracted by inhaling "miasma", or corrupted air. Consequently, isolation of patients was not routine practice, and, in fact, patients with scrofula (morbus regius, or "king's evil) sought to be cured by the "royal touch" throughout the middle ages. The sanatorium, which emerged in the mid-19th century, initially served as a place of healing, where patients could receive the appropriate diet, rest therapy, graduated exercise, and abundant fresh air. Major scientific breakthroughs, including Robert Koch's 1882 discovery of the tubercle bacillus as the disease's etiological agent and early 20th century experimental evidence that the organism could be transmitted via expectorated droplet nuclei, helped to reinforce the important public health role of sanatoria and tuberculosis hospitals in preventing disease transmission through isolation. The advent of highly efficacious and oral antitubercular regimens in the mid-20th century and the concurrent declining incidence of the disease contributed to the closure of tuberculosis sanatoria and hospitals in the US and western Europe. Over the past several decades, tuberculosis treatment in the US has been conducted in the outpatient setting under the supervision of local public health departments. Patients receiving treatment are required to remain in respiratory isolation in the home until they are deemed noninfectious based on multiple sputum samples. This historical review demonstrates that despite changing medical knowledge, drug therapies, and social conditions over time, the role of isolation remains an important topic of debate in the treatment of patients with pulmonary tuberculosis.

A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018.

This paper provides an examination of: (1) the frequency and net rates of change for general pediatric inpatient (GPI) unit closures and openings nationally and by state; (2) how often closures or openings are caused by GPI unit changes only or caused by hospital-level changes; and (3) the relationship between hospital financial status and system ownership and GPI unit closures or openings. This study used the Health Systems and Providers Database (2011-2018) plus 3 data sources on hospital closures. We enumerated GPI unit closures and openings to calculate net rates of change. Multinomial logistic regressions analyzed associations between financial distress, system ownership, and the likelihood of closing or opening a GPI unit, adjusting for hospital characteristics. Across the study period, more GPI units closed th opened for a net closure rate of 2.0% (15.7% [638 of 4069] closures minus 13.7% [558 of 4069] openings). When GPI units closed, 89.0% (568 of 638) did so in a hospital that remained operating. Hospitals with the most financial distress were not more likely to close a GPI unit than those not (odds ratio: 1.01 [95% confidence interval: 0.68-1.50]), but hospitals owned by systems were significantly less likely to close a GPI unit than those not (odds ratio: 0.66 [95% confidence interval: 0.47-0.91]). Overall, more GPI units closed than opened, and closures mostly involved hospitals that otherwise remained operational. A hospital's overall financial distress was not associated with GPI unit closures, whereas being owned by a system was associated with fewer closures.

An interview with Pennsylvania State representative Tarik Khan, PhD, FNP-BC.

Nurse practitioners (NPs) take on diverse and essential roles. In an exclusive interview, Representative Tarik Khan, PhD, FNP-BC, highlights the impact NPs can have in the political arena. Transitioning from an NP to a legislator in Pennsylvania, Dr. Khan's journey reflects his commitment to health care reform, driven by hospital closures, lack of patient care access, and the COVID-19 pandemic. Elected in 2022, Dr. Khan leverages his health care background to address a wide range of legislative issues, passing significant bills. He advocates for NPs to engage politically, emphasizing their unique perspective and problem-solving skills. Dr. Khan's story underscores the transformative potential of NPs in shaping public policy and advancing systemic change.

CYBERSECURITY IN CLINICAL PRACTICE

Cybersecurity is a concern for patient safety. Recent cyberattacks on healthcare facilities around the world have exposed the risks to patients: from treatment delays due to hospital and clinic closures, to the threat harm from personal data theft, to patient death. The recent Covid-19 pandemic has further increased cyberattacks against healthcare organizations. Frontline healthcare workers are often warned about the dangers of poor data management and advised to take precautions to ensure data security. However, many workers are overwhelmed by conflicting administrative priorities, cybersecurity risks go unnoticed.

Guest editorial: A preface to the closure of Cawston Park Hospital

Guest editorial: A preface to the closure of Cawston Park Hospital

Hybrid emergency care at the home for patients – A multiple case study

IntroductionHealthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients’ home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients’ emergency care needs in their homes, with a focus on the METs reasoning and actions.MethodsUsing a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 – January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method.ResultThe result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks.ConclusionWhen launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Birthing Unit Closures: Impacts and Opportunities in Iowa

Objective and ApproachIowa, US has experienced the closure of 41 birthing units in local hospitals since 2000, which is nearly 50% of previously available units. Public health concern about access to prenatal care and birthing support in this predominately rural state has raised attention to the value of using integrated administrative data to understand impacts and direct needed resources. This presentation will showcase a series of analyses using vital statistics birth records, hospital closure records, and statewide home visiting records to understand (a) closure impacts on relevant subgroups and (b) opportunities to strengthen outcomes through service improvements. Results suggest indirect relationships between hospital closure and child/mother outcomes through impacts on prenatal care. Some mothers (e.g., mothers with low maternal education, older mothers, and mothers with previous children) were more susceptible to negative impacts on prenatal care. Data about mother connections with other public service systems (e.g., Medicaid or WIC) suggested buffering effects for some women who were at risk for birthing unit closure impacts. Subsequent phases of research have used integrated administrative data to highlight hospital closure areas where women differentially experienced more positive outcomes to inform community outreach and identification of effective intervention efforts. Conclusions and ImplicationsThis research highlights the value of longitudinal administrative data utilized to address policy-relevant topics in public health. Results suggest opportunities to expand and replicate rural health practices that are working to mitigate risk in geographic areas where women face challenging access to a birthing hospital.

Institutional Shutter: Depardon and the Basaglias

This essay discusses Italy’s famous deinstitutionalization movement in the 1970s through the material culture of photography. I focus on film and photographs that provide stunning evidence of the aftermath of the closure of psychiatric hospitals in Italy. The “tearing down” of asylum walls that occurred within reform movements of the 1970s, famously led by Franco and Franca Basaglia, is analyzed by mobilizing photographs in and of Italian hospitals taken by the French photographer Raymond Depardon, whose photographs prove the failure of reform through clothes, games, and objects of restraint. Depardon’s practice offers an opportunity for understanding the habitus that drove the institutional shutter in Trieste, Collegno, and Venice.

Obstetric outcomes among rural parturients across US urban and rural hospitals.

The objective of this study is to evaluate severe maternal morbidity (SMM) of rural parturients delivering at rural compared to urban hospitals in the US. We identified patients aged 18-40 years in a multi-institutional claims database who lived in a rural ZIP code and delivered at a rural or urban hospital between October-December of 2015 and October-December of 2022. The primary outcome was SMM, and the secondary outcome was SMM exclusive of blood transfusions. We combined exact ZIP code matching and propensity score matching to compare SMM risk among patients living in the same rural community and delivering in urban as compared to rural hospitals. A total of 214 296 patients from 571 ZIP codes were identified, including 47% delivering at rural facilities and 53% delivering at urban facilities. The SMM rate was 1.1% (0.3% excluding blood transfusions). After matching, urban versus rural delivery was associated with increased odds of SMM other than blood transfusion (odds ratio 2.44; 95% confidence interval 1.81-3.28), but was not associated with differences in risk of any SMM. There was no evidence of reduced SMM for rural patients delivering at an urban rather than a rural hospital. SMM exclusive of blood transfusions was increased for rural patients delivering at urban hospitals after matching on ZIP code and predictors of urban hospital delivery. Our findings undermine the assumption that delivery at a rural facility has inherently greater risks relative to delivery at an urban facility. As some health systems face challenges to maintain rural labor and delivery units, patient safety must be considered if confronted with the possibility of unit or hospital closures.

Effects of rural hospital closures on nurse staffing levels and health care utilization at nearby hospitals.

Our study examines the causal effect of rural hospital closures on nearby hospitals' nurse staffing levels and health care utilization. We use data from the 2014-2019 American Hospital AssociationSurvey on nurse staffing level outcomes including licensed practical or vocational nurses (LPNs), registered nurses (RNs), and advanced practice nurses (APNs); and health care utilization outcomes, including inpatient and outpatient surgical operations and emergency department (ED) visits. Using propensity score matchingand difference-in-differences (DID) methods, we find that rural hospital closures lead to an average increase of 37.3% in the number of nurses in nearby rural hospitals during the 4years following the closure. This increase is found across all categories of nurses, including LPNs, RNs, and APNs. We also find a substantial increase in the provision of inpatient and outpatient surgical operations but there is no change in ED visits. We do not find any effects for nearby urban hospitals. Our study suggests that a large proportion of the nursing workforce relocates to nearby hospitals after a rural hospital closure, which mitigates the negative consequences of such closures and allows these nearby hospitals to provide a larger volume of highly profitable services.

Where and what separates rural from urban hospital closures?

Despite the recent closure of several high-profile metropolitan hospitals, investigations into risk factors for metropolitan hospital closures have been limited. The goal of this study wasto describe metropolitan hospitals that closed and compare them to metropolitan hospitals that remain open and micropolitan and rural hospitals that closed using American Hospital Association Annual Survey Data from 2010 to 2021. We independently verified hospitals reported as closed in the Annual Survey and examined the hospital characteristics associated with closure using bivariate statistics and logistic regression. We found that metropolitan hospitals that closed (n = 142) were more likely to be for-profit (66.9% vs. 29.7%, p < .0001;adjusted odds ratio [AOR]:3.05, 95% confidence interval [CI]: 1.93, 4.81) and to come from a state that did not expand Medicaid (45.1% vs. 29.4%, p < .0001; AOR: 1.66, 95% CI: 1.16, 2.38). Policies tailored to metropolitan hospitals should be developed to identify at-risk hospitals and mitigate the effect of closures on patients, clinicians, and other stakeholders.

California Bill Would Tighten Oversight on Private Equity Hospital Purchases

No abstract available. Article truncated after 150 words. According to Medscape California lawmakers are considering a bill that would tighten oversight of private equity and hedge fund buyers of hospitals and healthcare facilities (1). Private equity investment in hospitals and physician groups has been under scrutiny in recent months after a slew of high-profile failures, including bankruptcies and hospital closures. California lawmakers have drafted a bill that would require private equity firms and hedge funds to give the state attorney general written notice before purchasing a healthcare facility or provider group. The attorney general would have to approve the transaction. Buyers would also be required to submit written notice to any federal or state agency as required by law within 90 days of the transaction, and the attorney general could extend that period. The bill gives the attorney general the power to halt an acquisition if there is a "substantial likelihood of anticompetitive effects" or if it would …

How far is too far? Rural hospital closures and emergency room travel distances

In the past decade, rural hospital closures have been occurring at an increasing pace. This paper explores historical key health policies that resulted in hospital bed growth over the past 75 years and the subsequent factors that have resulted in hospital closures, particularly in rural locations. These closures have reduced the number of licensed hospital emergency rooms available in rural locations and have resulted in new challenges for emergency medical service providers attempting to transport rural residents over increased distances for emergency care. Today’s healthcare literature does an excellent job of documenting the increased rate of rural hospital closures and explores the subsequent increases in emergency room travel distances and access issues for emergency services consumers living in rural areas that have experienced hospital closures. This paper examines hospital emergency room closures from 2014 to 2023 in rural Missouri. The paper then goes beyond a retrospective review of closed rural Missouri hospitals and mapping of hospital locations to establish a process for identifying rural Missouri hospitals at risk of closure in 2024 and beyond, mapping the potential impact on emergency room travel distances should these hospital closures actually occur. The model presented in the research is designed to be easily utilised by regional health planners, helping them to identify potential hospital closures and communicate the potential healthcare access impact to community stakeholders.

Is more better? A multilevel analysis of percutaneous coronary intervention hospital openings and closures on patient volumes.

It is unknown how changes in the percutaneous coronary intervention (PCI) "built environment" have impacted PCI volumes at the community, hospital, and patient levels. This study sought to determine how PCI hospital openings and closures effect community- and hospital-level PCI volumes as well as the likelihood of receiving PCI at a low-volume hospital. We conducted a retrospective cohort study of 3,966,025 Medicare Fee-For-Service patients in 37,451 zip codes and 2564 U.S. hospitals who underwent PCI from 2006 to 2017. We conducted community-, hospital-, and patient-level analyses using ordinary least squares regressions with fixed effects to determine changes in PCI volumes after PCI hospital openings or closures. Between 2006 and 2017, a total of 17% and 7% of patients lived in communities that experienced PCI hospital openings and closures, respectively. Openings were associated with a 10% increase in community PCI volume, a 2% increase in the share of elective PCI, and a doubling in the likelihood of receiving PCI at a low-volume hospital. In communities with low baseline PCI capacity, openings were associated with a 12% increase in community PCI volume, and in high-capacity communities, an 8% increase. PCI closures were associated with a 9% decrease in community PCI volume in high-capacity communities but no measurable change in low-capacity communities. PCI service expansion is associated with increased PCI at low-volume hospitals and a greater number of elective procedures. Increased governmental oversight may be necessary to ensure that openings and closures of these specialized services yield the desired benefits.

The media's coverage and framing of hospital reforms: The case of Germany

Abstract Aim In Germany, a long-lasting debate about the need for a hospital reform, including centralisation, now resulted in reform plans. As cutbacks to essential services such as hospitals are an emotional topic, the public should be properly informed, which is a central role of the media. Based on a media analysis of a large-scale hospital reform in Denmark, showing that the media’s reporting might have had an agenda-setting effect, we analysed the media’s coverage and framing of restructuring the hospital landscape in German newspapers. Subject and methods A systematic search identified relevant articles in national and regional newspapers. The coverage between January 2018 and January 2023 was analysed regarding quantity and main theme (agenda-setting). Each article’s title and main text were analysed for tone and whether it focused on episodic (single events) or thematic (broader context) framing. Results A total of 705 newspaper articles (592 regional, 113 national) were included. Both regional and national newspapers mainly used episodic framing. Regional newspapers mostly reported on single closures of hospitals or departments. The tone of the title and main text in national newspapers was mainly negatively depicted, which applied to less than half of the articles in regional newspapers. These differences were, however, not statistically significant. Conclusion Results indicate higher agenda-setting effects in regional compared to national newspapers. However, the overall high amount of episodic framing can result in less attribution of responsibility to policy-makers, thereby conserving the status quo. To succeed, a media strategy might help to raise problem awareness among the public.

Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States

BackgroundAccess to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care “deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities.MethodsThe research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances.ResultsThe mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities.ConclusionsOur study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.

Discussion of federal policies affecting broadband expansion and telehealth in Appalachia

Background There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. Objectives The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. Methods A search of PubMed was conducted in January 2023, using the search words, “policy”, “telehealth”, “broadband”, and “Appalachia”. Findings New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. Conclusion This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth.