Effects Of Hospital Closure Research Articles

U.S. Rural Hospital Care Quality and the Effects of Hospital Closures on the Health Status of Rural Vulnerable Populations: An Integrative Literature Review

Introduction. Hospital and emergency department closures are emblematic of America’s changing healthcare delivery system, which often places rural vulnerable communities at further risk for poor health outcomes. Employing the Vulnerable Populations Conceptual Model (VPCM), we aimed to synthesize the existing research addressing care quality in these facilities and the impacts of their closures on affected communities and health status. Materials and Methods. We conducted a modified integrative literature review (outlined by Whittemore and Knafl), comparing and contrasting articles via an organizational matrix. We identified articles through three databases and ancestral searches. We included English-written, peer-reviewed articles published from 2010 forward. We excluded international and nonresearch articles that focused on the closure of specific departments (other than emergency departments). Our final sample included 26 primary research studies (24 quantitative and two qualitative). We scored the articles according to their scientific rigor and data relevance, then deductively coded them according to the VPCM constructs. Results. We identified two overarching themes from the literature: (1) association of rural hospital care and patient health outcomes and (2) access to hospital care-effects of closures and openings on rural vulnerable populations. Subthemes reflected access to care and other resources, relative risks associated with time-sensitive health events, and health outcomes. Discussion and Conclusion. We found that rural hospitals provide access to essential health services and emergency care in these vulnerable, underserved communities. Their loss may increase adverse outcomes in affected communities and the overall health system. However, our review was limited by the retrospective, nonexperimental nature of most included articles, and more data quantifying these effects and the impact of confounding factors are needed. Multidisciplinary stakeholders must jointly address declining access to hospital and emergency care by sustainably addressing social determinants of health, quality assurance, innovative healthcare delivery systems, and rural hospital funding.

Effects of Hospital Closures and Hospital Characteristics on Emergency Department Ambulance Diversion, Los Angeles County, 1998 to 2004

We assess the effects of nearby hospital closures and other hospital characteristics on emergency department (ED) ambulance diversion. The study design was a retrospective, multiple interrupted time series with control group. We studied all ambulance-receiving hospitals with EDs in Los Angeles County from 1998 to 2004. The main outcome measure was monthly ambulance diversion hours because of ED saturation. Our sample included 80 hospitals, of which 9 closed during the study period. There were increasing monthly diversion hours over time, from an average of 57 hours (95% confidence interval [CI] 51 to 63 hours) in 1998 to 190 hours (95% CI 180 to 200 hours) in 2004. In multivariate modeling, hospital closure increased ambulance monthly diversion hours by an average of 56 hours (95% CI 28 to 84 hours) for 4 months at the nearest ED. County-operated hospitals had 150 hours (95% CI 90 to 200 hours) and trauma centers had 48 hours (95% CI 9 to 87 hours) more diversion than other hospitals. Diversion hours for a given facility were positively correlated with diversion hours of the nearest ED (0.3; 95% CI 0.28 to 0.32). There was a significant and positive interaction between diversion hours of the nearest ED and time, suggesting that the effects of an adjacent facility's diversion hours increased during the study period. Hospital closure was associated with a significant but transient increase in ambulance diversion for the nearest ED. The temporal trend toward more diversion hours, as well as increasing effects of the nearest facility's diversion hours over time, implies that the capacity to absorb future hospital closures is declining.

The effects of hospital closure on mental health workers: an overview of employment, mental and physical health, and attitudinal outcomes.

This article examines the physical, psychological, and attitudinal impact of the closure of Central State Hospital (CSH) on its former employees. Eighty-five former CSH employees were interviewed at two points in time, preclosure and postclosure. Data on the psychological and physical health and employment attitudes of workers were collected prior to and eight months after organizational closure. Over time, workers had more positive attitudes about the hospital closure as well as reporting less depression, less work stress, and use of more coping strategies at postclosure. However, at post-closure, they also reported increased work conflict, lower income, and a more pessimistic outlook toward their future. Implications for hospital closure are discussed.

Effects of hospital closure on mortality rates of the over-65 long-stay psychiatric population.

The closure of this 100-year-old hospital has allowed us to look at the effect on mortality of moving the whole over-65 long-stay population to other settings. Our results confirm that there is a slight excess of deaths during and immediately after these moves, but that there is no longer-term effect on mortality rates.

Hospital closure: Phoenix, Hydra or Titanic?

Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case-study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.