Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
J Rural Health. 2023 Jan;39(1):79-87. doi: 10.1111/jrh.12671. Epub 2022 May 5.
The purpose of this paper is to examine the impact of rural hospital closures on age-adjusted hospitalization rates for ambulatory care sensitive condition (ACSC) and emergency care sensitive condition (ECSC) and associated outcomes, such as length of stay and in-hospital mortality in hospital service areas (HSAs) that utilized the closed hospital.
We used the State Inpatient Data from the Healthcare Cost and Utilization Project for 9 states from 2010 to 2017 and classified admissions as ACSC or ECSC. We compared age-adjusted admission rates and length of stay (LOS) for ACSC and ECSC rates and age adjusted in-hospital mortality rate for ECSC among rural ZIP codes in HSAs with a closure to rural ZIP codes in HSAs without closures. We used propensity score-weighted regression analysis and event study design.
Findings suggest that ACSC admission rates started to increase right before the closure. However, this increase levels off 2 years after closure. LOS for ACSC significantly decreased almost a year after closure. ECSC admissions showed a significant decrease for a few quarters 1 year before the closure.
Rural hospital closures were associated with increase in ACSC admissions right before closure and for nearly 2 years post closure as well as decrease in ECSC admissions before closure. As rural hospitals continue to close, efforts to ensure communities affected by these closures maintain access to primary health care may help eliminate increases in costly preventable hospital admissions for ACSC while ensuring access for emergency care services.
本文旨在研究农村医院关闭对门诊医疗敏感条件（ACSC）和急诊医疗敏感条件（ECSC）的年龄调整住院率以及相关结果（如住院时间和院内死亡率）的影响，这些结果发生在使用关闭医院的医院服务区（HSA）。
我们使用了 2010 年至 2017 年来自医疗保健成本和利用项目的 9 个州的州住院数据，并将入院分类为 ACSC 或 ECSC。我们比较了 HSA 中关闭医院的农村邮政编码与没有关闭医院的 HSA 中的农村邮政编码的 ACSC 和 ECSC 年龄调整入院率和住院时间（LOS）以及 ECSC 的年龄调整院内死亡率。我们使用倾向评分加权回归分析和事件研究设计。
研究结果表明，ACSC 入院率在关闭前开始增加。然而，这种增加在关闭后 2 年趋于平稳。ACSC 的 LOS 在关闭后几乎一年内显著下降。ECSC 的入院人数在关闭前一年的几个季度显著下降。
农村医院关闭与关闭前 ACSC 入院人数的增加以及关闭后近 2 年的增加以及关闭前 ECSC 入院人数的减少有关。随着农村医院继续关闭，努力确保受这些关闭影响的社区能够继续获得初级卫生保健服务，这可能有助于消除因 ACSC 而导致的昂贵可预防住院人数的增加，同时确保获得急诊护理服务。
