Hospital Closure Research Articles

Hospitals Are Closing in Tennessee: Investigating the Effect of Closures on Contraceptive Access and Short-Interval Birth [ID 2683524

INTRODUCTION: Access to maternity care (MC) and providers are important factors for contraception access and health outcomes for pregnant-capable individuals. After a series of hospital closures in Tennessee in the last decade, this study investigated the relationship between maternal county of residence and short-interval birth (SIB) rates statewide. METHODS: Tennessee birth certificate data for 2015–2020 from the Tennessee Department of Health was coded using March of Dimes 2022 definitions of access to MC overall, a hospital with obstetric (OB) care or birth center, and an OB provider (per 10k births) based on maternal county of residence. Short-interval birth was defined as birth interval 6–23 months. Nulliparous births and those with missing last living birth interval were excluded. Analysis was completed in SPSS 29.0, and Pearson χ2 tests compared SIB proportions between MC access groups. RESULTS: Overall, 269,908 births were analyzed. Of these, 78.1% maternal counties of residence had full MC access, 13.9% had low access, and 8.0% resided in a MC desert. Short-interval births were highest (24.4%; CI, 23.8–25.0) in MC deserts followed by areas with full access (23.7%; CI, 23.5–23.9) and low access (22.4%; CI, 22.0–22.8) (P<.001). Those with no access to an OB provider had highest rates of SIB (24.3%: CI, 23.7–24.8) compared to other categories (P<.001). CONCLUSION: Lacking access to maternity care likely corresponds with lacking access to contraception and higher rates of SIB in Tennessee. Prenatal and postpartum contraception counseling are important components of care for all individuals but especially those without acceptable access to OB providers and hospitals.

Overcoming Geographic Barriers: Surgical Care in Rural Populations

AbstractThis chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay of challenges within rural hospital infrastructure, workforce shortages, and patient factors emphasizing financial strain, closure of rural hospitals, and limited access to specialty providers and resources. Current evidence focuses on volume–outcome relationships, the safety of common surgical care at rural hospitals, and the impact of rural hospitals joining larger health systems. Strategies to optimize care delivery include site-of-care optimization, improved care coordination, dissemination of specialty expertise, and policy programs to support the rural workforce. Recent federal policies, including the rural emergency hospital program, underscore the delicate balance between sustaining essential local health care services and the financial realities of rural health care delivery. We then conclude with evidence-based strategies to bridge the urban-rural health care gap, ensuring equitable access to high-quality surgical care regardless of geographic location.

Secondary Ambulance Transfers During the Mass-Casualty Terrorist Attack in Israel on October 7, 2023.

On October 7, 2023, Israel experienced the worst terror attack in its history - 1,200 people were killed, 239 people were taken hostage, and 1,455 people were wounded. This mass-casualty event (MCE) was more specifically a mega terrorist attack. Due to the overwhelming number of victims who arrived at the two closest hospitals, it became necessary to implement secondary transfers to centers in other areas of the country. Historically, secondary transfer has been implemented in MCEs but usually for the transfer of critical patients from a Level 2 or Level 3 Trauma Center to a Level 1 Center. Magen David Adom (MDA), Israel's National Emergency Pre-Hospital Medical Organization, is designated by the Health Ministry as the incident command at any MCE. On October 7, in addition to the primary transport of victims by ambulance to hospitals throughout Israel, they secondarily transported patients from the two closest hospitals - the Soroka Medical Center (SMC; Level 1 Trauma Center) in Beersheba and the Barzilai Medical Center (BMC; Level 2 Trauma Center) in Ashkelon. Secondary transport began five hours after the event started and continued for approximately 12 hours. During this time, the terrorist infiltration was still on-going. Soroka received 650 victims and secondarily transferred 26, including five in Advanced Life Support (ALS) ambulances. Barzilai received 372 and secondarily transferred 38. These coordinated secondary transfers helped relieve the overwhelmed primary hospitals and are an essential component of any MCE strategy.

К вопросу о правовом статусе психоневрологических интернатов и правах проживающих в них пациентов в свете новелл Конституции и законодательства об охране психического здоровья граждан

The article is devoted to the study of individual novelties of federal legislation concerning the legal status of inpatient psychiatric care institutions, as well as the rights and restrictions of persons living in them in inpatient conditions against the background of the ongoing process of deinstitutionalization of psychiatric care. The authors cite statistics on the closure of large psychiatric hospitals, the emphasis is on the replacement of psychiatric social services, which affects the availability and quality of medical services received by patients. It is noted that when analyzing certain upcoming novelties of the Law of the Russian Federation No. 3185-1 of July 2, 1992 “On psychiatric care and guarantees of citizens' rights in its provision”, one has to face formulations subject to scientific understanding, assessment of possible risks of these innovations.

Abstract P224: Rural Hospital Closures Are Associated With Increased Mortality From Ischemic Heart Disease: A County-Level Analysis

Objective: Ischemic heart disease remains the leading cause of death in the United States; yet mortality from heart disease is geographically heterogeneously distributed. From 2011 - 2020, several hospitals across the US have closed. In this study we will investigate the impact of hospital closure on county level disease-specific mortality data. We hypothesize that rural hospital closures will be associated with increased risk of mortality from ischemic heart disease. Methods: The CDC-Wonder database, an online outcomes reporting system was queried for county level, ischemic heart disease specific mortality in Texas - the state with the largest number of hospital closures. Demographic, socioeconomic, and comorbidity information was collated from the County Health Ranking project. Hospital closure data was obtained from the Sheps Center for Health Services Research. Counties were grouped by Health Service Area (HSA) and were considered affected if any county in the HSA was affected by a hospital closure. A difference in difference analysis with unbiased staggered adoption was performed with a multivariate linear model. 4 counties with multiple hospital closures in the time frame were excluded from analysis. Results: Over a 10-years (2011 - 2020) 247,712 deaths were recorded as related to ischemic heart disease in Texas. Difference-in-difference analysis with all counties did not demonstrate a significant treatment effect of hospital closure (ATT = - 0.01, p = 0.71). Restricting comparisons to rural hospitals demonstrated a significant effect of rural hospital closures as compared to other rural counties (ARR = 0.119, p = 0.04). There was so significant effect in comparison of non-rural counties with hospital closures. Conclusions: These results demonstrate the disproportionate impact of hospital closure on rural health outcomes. As compared to patient-level analysis relying on hospital discharge data, this country level analysis captures non-hospital deaths and elucidates the true human cost of hospital closure.

Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries

In recent years, the number of Catholic hospitals has grown, raising concerns about access to contraception. The association between living in an area in which the closest hospital is Catholic and the probability of postpartum contraception and subsequent deliveries is unknown. To assess whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries. This cohort study used data from the Healthcare Cost and Utilization Project's State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states (California, Florida, Georgia, Missouri, Nebraska, Nevada, New York, South Carolina, Tennessee, Vermont, and Wisconsin). Female patients with a delivery from 2016 to 2019 who lived within 20 miles of a nonfederal acute care hospital were included, with patients followed up for 1 to 3 years. Coarsened exact matching was used to match patients based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code-level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Data were analyzed from April 2022 to November 2023. Residence in a zip code in which the closest hospital was Catholic. Probabilities of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years. The sample consisted of 4 101 443 deliveries (1 301 792 after matching), with 14.5% of patients living in exposed zip codes (ie, where the closest hospital was Catholic). Living in exposed zip codes was associated with a 21.26-percentage point (pp) increase in the probability of delivery at a Catholic hospital (95% CI, 19.50 to 23.02 pp; 237.3% relative to the mean in unexposed zip codes; P < .001). Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp (95% CI, -1.14 to -0.76 pp; P < .001) and the probability of sterilization in the year after discharge further decreased by 0.21 pp (95% CI, -0.29 to -0.13; P < .001). Subsequent deliveries within 3 years increased 0.47 pp (95% CI, -0.03 to 0.97 pp; 2.3% relative to the mean in unexposed zip codes; P = .07). This cohort study finds that living in a zip code in which the closest hospital was Catholic was associated with a modest decrease in the probability of postpartum surgical sterilizations and a modest increase in the probability of subsequent deliveries.

Associations of U.S. hospital closure (2007-2018) with area socioeconomic disadvantage and racial/ethnic composition

PurposeTo examine whether hospital closure is associated with high levels of area socioeconomic disadvantage and racial/ethnic minority composition. MethodsPooled cross-sectional analysis (2007–2018) of 6467 U.S. hospitals from the American Hospital Association’s Annual Survey, comparing hospital population characteristics of closed hospitals to all remaining open hospitals. We used multilevel mixed-effects logistic regression models to assess closure as a function of population characteristics, including area deprivation index ([ADI], a composite measure of socioeconomic disadvantage), racial/ethnic composition, and rural classification, nesting hospitals within hospital service areas (HSAs) and hospital referral regions. Secondary analyses examined public or private hospital type. ResultsOverall, 326 (5.0%) of 6467 U.S. hospitals closed during the study period. In multivariable models, hospitals in HSAs with a higher burden of socioeconomic disadvantage (per 10% above median ADI ZIP codes, AOR 1.05; 95% CI, 1.01–1.09) and Black Non-Hispanic composition (highest quartile, AOR 4.03; 95% CI, 2.62–6.21) had higher odds of closure. We did not observe disparities in closure by Hispanic/Latino composition or rurality. Disparities persisted for Black Non-Hispanic communities, even among HSAs with the lowest burden of disadvantage. ConclusionsDisproportionate hospital closure in communities with higher socioeconomic disadvantage and Black racial composition raises concerns about unequal loss of healthcare resources in the U.S.

The Basaglia Law. Returning dignity to psychiatric patients: the historical, political and social factors that led to the closure of psychiatric hospitals in Italy in 1978.

Law no. 180 of 1978, which led to the closure of psychiatric hospitals in Italy, has often been erroneously associated with one man, Franco Basaglia, but the reality is much more complex. Not only were countless people involved in the movement that led to the approval of this law, but we should also take into account the historical, social, and political factors that came into play. The 1970s in Italy were a time of change and political ferment which made this psychiatric revolution possible there and nowhere else in the world.

Abstract TMP18: Real-World Challenges in US Thrombectomy Transfers: Difficulty Finding an Accepting Hospital, Prolonged Travel, and Differing Perceptions of Transfer Requirements

Introduction: Transfers can improve access to endovascular thrombectomy (ET). However, benefit is highly time-dependent and transferred patients experience poorer outcomes. We assessed perceptions of transfers processes between sending and receiving hospitals. Methods: We utilized an ongoing 2023 nationwide US electronic survey of hospitals that treat stroke patients with revascularization therapy and have publicly available contact information. Respondents were stroke directors or coordinators. Survey items analyzed included questions on certification status, transfer processes, volumes, times, delays, and requirements for transfers. We performed cross-sectional analyses of hospitals that send/receive ET transfers. We used descriptive statistics and chi-squared tests to compare sending and receiving cohorts. Results: Of 144 responding hospitals at the time of analysis, 70.1% (n=101) receive and 29.9% (n=43) send ET transfers. Most (76.2%) receiving hospitals are comprehensive stroke centers and most (95.3%) sending hospitals primary stroke centers (p&lt;0.05). Only 39.5% of sending hospitals send ≥20 transfers annually vs. 64.4% of receiving hospitals that receive ≥20. More than 1/2 send/receive transfers to/from facilities &gt;60 miles away, and 50% pass a closer capable hospital en route. Average door-in-door out time is &gt;90 minutes for 51.2% of sending hospitals, and 35.0% spend &gt;50% of this time on non-care coordination. Concerningly, 34.9% of sending hospitals are sometimes/always unable to find an accepting hospital. Perceptions of requirements for transfer vary between receiving and sending hospitals: 30.7% vs. 76.7% require large vessel occlusion confirmation, 1% vs. 14% perfusion imaging and 14.9% vs. 32.6% an available bed prior to transfer (p&lt;0.05). Conclusion: In this real-world sample, transfers are common, perceptions of requirements for transfer differ, and there are actionable delays. Concerningly, sending hospitals are often unable to find an accepting hospital and closer hospitals are frequently passed en route. Future interventions could standardize and provide oversight of regional stroke systems of care.

The trend of mortality rates following hospitals downgrading and closures due to outbreak of COVID-19 in Fars province: A comparative cohort study.

Hospitals are one of the most important healthcare centers for providing the patients with different medical needs. Several different factors might cause hospitals to downgrade their services or departments or close down overall. One of the most multifaceted reasons for hospital downgrading or closure is infectious disease outbreaks. In this regard, we aimed to evaluate the effects of hospital closure and downgrading due to the COVID-19 pandemic on the mortality rate of the people residing in Fars province, Iran. We gathered mortality information, including the cause of death, age, sex, place, and time of death of all deceased cases occurring during a period of 3 years, from February 20, 2018 to March 2021 from the forensic medicine and also the Department of Biostatistics in Shiraz University of Medical Sciences. A total of 71,331 deaths have been reported since 2018 through the first quarter of 2021, with 57.9% of total mortality cases attributed to male gender. The total mortality counts ranged from 4229 to 9809 deaths per quarter, from which the minimum rate was reported in the first quarter of 2018 and the maximum in the fourth quarter of 2020. Based on the causes of death, diseases of the circulatory system were shown to be the all-time most frequent cause of death, accounting for a total of 42.8% of recorded deaths, followed by neoplasms (9.77%) and diseases of the respiratory system (9.45%). Although the large number of deaths at the time of the pandemic are immediately due to COVID-19 infection, deaths due to a notable number of other causes have had a significant increase which, along with the specific trend of place and causes of death, shows that the downgrading and closure of hospitals have had a significant impact on overall population mortality.

The effect of public hospital closure on the death of long-term inpatients in Korea.

This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea. To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis. An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals. The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Disaster-related deaths with alcohol-related diseases after the Fukushima Daiichi nuclear power plant accident: case series.

The health of patients with mental disorders, such as alcohol-related diseases, often deteriorates after disasters. However, the causes of death among those with alcohol-related diseases during and after radiation disasters remain unclear. To minimize and prevent alcohol-related deaths in future radiation disasters, we analyzed and summarized six cases of alcohol-related deaths in Minamisoma City, a municipality near the Fukushima Daiichi nuclear power plant. Patients were generally treated for alcohol-related diseases. In one case, the patient was forced to evacuate because of hospital closure, and his condition worsened as he was repeatedly admitted and discharged from the hospital. In another case, the patient's depression worsened after he returned home because of increased medication and drinking for insomnia and loss of appetite. The overall findings revealed that, in many cases, evacuation caused diseases to deteriorate in the chronic phase, which eventually resulted in death sometime after the disaster. To mitigate loss of life, alcohol-related diseases must be addressed during the chronic phases of future large-scale disasters, including nuclear disasters.

The Impact of COVID-19 on Assisted Reproductive Technology (ART) in Indonesia: A Systematic Literature Review

The COVID-19 pandemic in Indonesia put pressure on assisted reproductive technology (ART) practices. Travel restrictions and hospital closures reduced access to ART which are located mostly in capital cities. Thus, investigating how the pandemic affected Indonesian ART services is crucial. This study reviewed literature using PRISMA method. PICO Model criteria were used to search articles. During the COVID-19 Pandemic. Papers were obtained from Google Scholar, ResearchGate, and Cerdika databases. Researchers searched journals spanned between 2022 – 2024 for “COVID-19” and limited the publication year to 2020 – 2021, the year of pandemic. The results of the study show that the COVID-19 pandemic had a significant effect on Indonesia’s use of ART. It was more challenging to reach and use ART therapies with travel restrictions and health facility closures. Nonetheless, most fertility clinics had changed their health standards in response to the circumstances. The recommendations point to more investigation to better understand how the pandemic had affected ART services and to create fresh approaches to deal with the evolving pandemic scenario. We suggest that more hospitals and primary health care institutions have a better standard for ART in a significant force situation. Also, multiply the services in more locations; thus, if travel restrictions happen in some circumstances, the patient still gets to the services closest to their house.

Treatment of mentally disordered offenders in Italy: prisons and REMS

In Italy, the treatment of dangerous patients found not guilty by reason of insanity (NGRI) underwent a radical reform in 2014 with the Law 81, that promulgated the closure of secure hospitals, Ospedali Psichiatrici Giudiziari (OPG), that provided psychiatric care within a secure setting. OPG were replaced by new psychiatric facilities called Residence for the Execution of a Security Measure (REMS) which currently host NGRI patients who cannot be sent to prison. Eight years after the creation of the REMS, many questions still need to be addressed in relation to their functions, limitations, and cooperation with the other services. This article describes the process of deinstitutionalisation of psychiatric care in Italy over the past forty years, which culminated in the creation of the REMS. The functioning of the REMS and some of the issues that have emerged since their creation are explored, and possible solutions are proposed. Finally, the impact of the 2014 reform on psychiatric care in Italian prisons is highlighted.

U.S. REMOTE CANCER CARE FOR OLDER ADULTS: A SYSTEMATIC REVIEW AND SOCIAL NETWORK ANALYSIS

Abstract Telemedicine and telehealth services are a promising solution for older cancer patients who are susceptible to infectious diseases, like COVID-19, and travel a longer distance to their closest hospital. To provide all-inclusive oncology care, understanding social disparities in access to remote cancer care is crucial. Yet, little is known about the accessibility of these technologies among US cancer patients in later life. The present study aimed to evaluate the main sociocultural factors associated with older patients of virtual oncology care interventions in the US. This systematic review explored the literature on telemedicine for geriatric oncology and patients’ accessibility to remote health technologies. PubMed, CINAHL, Scopus, and Web of Science databases were searched. Using Bibliometrix, Science of Science (Sci2) Tool, and Gephi, Social Network Analysis (SNA) was conducted to identify the central and intermediate factors linked to remote cancer care for older US adults. Among 427 retrieved articles, 19 articles, published between 2003 and 2023, met the eligibility criteria. The selected studies were focused on rural cancer patients (20%) and telehealth during COVID-19 outbreaks (20%), followed by lifestyle interventions (15%), ehealth literacy (10%), prostate or breast cancer (5%), older sexual minority men with prostate cancer (5%), and patients’ race, age, and region (5%). Findings also highlighted that gender, digital health literacy (technology readiness), and location are the key determinants of telemedicine access and use among older US cancer patients. Multiple socio-demographic aspects of older patients need to be considered for implementing equitable access to remote oncology care.

CONSIDERING HOSPITAL CLOSURES IN ALABAMA: NATIONAL POLICY IMPLICATIONS

Abstract Hospital closures have increased over the past 10 years nationally, particularly in rural areas and states that did not receive Medicaid expansion funds (American Hospital Association). These closures can impact older adults health care, employment opportunities, and mortality rates. Recently, the Alabama Hospital Association reported that 12 hospitals are at risk of closing. For this study, we evaluated the locations of hospital closures since 2009 in Alabama to understand gaps geographically in healthcare. We obtained information about current hospitals through Alabama Department of Public Health (ADPH). We searched for news articles to obtain a list of hospitals, which closed between 2009 and 2020. Next, we obtained data from the ADPH on the mortality rates by county and year. We also obtained information about the finances of hospitals in Alabama and classified hospitals with 20% losses as potentially at risk. Using GIS, we mapped areas of hospital closures and at risk hospitals as well as the location of current hospitals as of 2020. We chose to average mortality rates from 2009 to 2019 (pre-COVID) and map these by county. Since 2009, Alabama has closed 13 hospitals: with two reopening at a later date. Based on GIS, we found potential health care gaps in several rural areas and in Southwest Alabama, or the Black Belt area, which has a high rate of poverty, and poor health outcomes. The mean mortality rate for rural counties was significantly higher than urban populations between 2009-2019 t(54)=4.8, p&amp;lt;.0001. Policy implications will be discussed.

How to Turn Around a (F)ailing Hospital or Health System

Hospital and health system bankruptcies and closures continue to rise in the United States. Turnarounds of healthcare organizations at risk or already in insolvency present daunting challenges that require new leadership. There are at least four key components necessary for a successful turnaround: (1) unwavering support of the governing board and key stakeholders for the new management team; (2) the right timing to start the turnaround process; (3) appointment of a transformational Chief Executive Officer (CEO) who epitomizes the modified democratic management model; the new leader should preferentially hold dual MD and MHA/MBA degrees to understand both medicine, the core business, and economics, the other nucleus for the organization’s survival; (4) a convincing and inspiring strategy that is based on both financial and operational data and includes elements of the blue and red ocean strategies to accomplish a successful turnaround. From the financial perspective, cash management, expense reduction, and revenue improvement plans must be developed and executed immediately. From the workforce perspective, the new CEO must, from the very beginning, provide regular, honest, and uplifting communication messages to turn internal skepticism to belief and to motivate and inspire all employees. Lastly, to guarantee the sustainability of a successful turnaround, all strategic measures must be re-evaluated on a regular basis with a low threshold to adapt to new changes in order to stay ahead of the competition

Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis.

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

Rural hospital and obstetric unit closures as social determinants of racial and ethnic maternal health disparities: A scoping review.

To synthesize literature examining (1) rural hospital or obstetric unit closures as a social determinant of maternal/infant health outcomes and (2) closures as a social determinant of racial/ethnic disparities in maternal/infant health outcomes. Scoping review. MEDLINE, OVID/Embase and CINAHL were searched systematically to identify sources from 31 July 2003 to 31 July 2023. The Arksey and O'Malley methodology for scoping reviews was used. Four studies from the United States and Australia documented the impact of rural hospital or obstetric unit closures on maternal/infant health outcomes, such as increased births in hospitals without obstetric units, out-of-hospital births or babies born before arrival, preterm birth, infant mortality and sociocultural risks that contribute to clinical risk. No eligible studies investigated hospital or obstetric unit closure as a social determinant of racial disparities in rural maternal/infant health outcomes. Despite significant racial and ethnic rural maternal health disparities, associations between rural closures and maternal health outcomes for racial and ethnic minorities are understudied. More research is needed to understand the extent to which rural closures, a social determinant of health, could disproportionately, negatively affect the health of racially and ethnically minoritized women. Rural women have a greater risk of maternal and infant mortality and morbidity compared with urban women, and the impact of rural closures on racial and ethnic maternal health disparities is not well documented. Research about the impact of rural closures on maternal health disparities could inform policy to assure essential obstetric care is available for rural populations globally. Findings provide a call to action for research to understand relationships between rural closures and racial and ethnic maternal health disparities, which is especially important for serving rural Non-Hispanic Black and American Indian/Alaska Native women. No patient or public contribution.

Patient Outcomes After Long-Term Acute Care Hospital Closures

Long-term acute care hospitals (LTCHs) are common sites of postacute care for patients recovering from severe respiratory failure requiring mechanical ventilation (MV). However, federal payment reform led to the closure of many LTCHs in the US, and it is unclear how closure of LTCHs may have affected upstream care patterns at short-stay hospitals and overall patient outcomes. To estimate the association between LTCH closures and short-stay hospital care patterns and patient outcomes. This retrospective, national, matched cohort study used difference-in-differences analysis to compare outcomes at short-stay hospitals reliant on LTCHs that closed during 2012 to 2018 with outcomes at control hospitals. Data were obtained from the Medicare Provider Analysis and Review File, 2011 to 2019. Participants included Medicare fee-for-service beneficiaries aged 66 years and older receiving MV for at least 96 hours in an intensive care unit (ie, patients at-risk for prolonged MV) and the subgroup also receiving a tracheostomy (ie, receiving prolonged MV). Data were analyzed from October 2022 to June 2023. Admission to closure-affected hospitals, defined as those discharging at least 60% of patients receiving a tracheostomy to LTCHs that subsequently closed, vs control hospitals. Upstream hospital care pattern outcomes were short-stay hospital do-not-resuscitate orders, palliative care delivery, tracheostomy placement, and discharge disposition. Patient outcomes included hospital length of stay, days alive and institution free within 90 days, spending per days alive within 90 days, and 90-day mortality. Between 2011 and 2019, 99 454 patients receiving MV for at least 96 hours at 1261 hospitals were discharged to 459 LTCHs; 84 LTCHs closed. Difference-in-differences analysis included 8404 patients (mean age, 76.2 [7.2] years; 4419 [52.6%] men) admitted to 45 closure-affected hospitals and 45 matched-control hospitals. LTCH closure was associated with decreased LTCH transfer rates (difference, -5.1 [95% CI -8.2 to -2.0] percentage points) and decreased spending-per-days-alive (difference, -$8701.58 [95% CI, -$13 323.56 to -$4079.60]). In the subgroup of patients receiving a tracheostomy, there was additionally an increase in do-not-resuscitate rates (difference, 10.3 [95% CI, 4.2 to 16.3] percentage points) and transfer to skilled nursing facilities (difference, 10.0 [95% CI, 4.2 to 15.8] percentage points). There was no significant association of closure with 90-day mortality. In this cohort study, LTCH closure was associated with changes in discharge patterns in patients receiving mechanical ventilation for at least 96 hours and advanced directive decisions in the subgroup receiving a tracheostomy, without change in mortality. Further studies are needed to understand how LTCH availability may be associated with other important outcomes, including functional outcomes and patient and family satisfaction.