Hoffman Geoffrey J, Ha Jinkyung, Fan Zhaohui, Li Jun
University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Health Serv Res. 2025 Jun;60(3):e14426. doi: 10.1111/1475-6773.14426. Epub 2024 Dec 30.
To determine whether rural hospital closures affected hospital and post-acute care (PAC) use and outcomes.
Using a staggered difference-in-differences design, we evaluated associations between 32 rural hospital closures and changes in county-level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30-day readmissions and mortality and hospitalizations for a fall-related injury; and (4) population-level hospitalization and death rates.
100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee-for-service Medicare beneficiaries.
We found that hospitals that closed compared to those remaining open served more minoritized, lower-income populations, including more Medicaid and fewer commercial patients, and had lower profit margins. Following a closure, quarterly hospitalization rates (111.6 quarterly hospitalizations per 10,000 older adults; 95% CI: 53.4, 170.9) and average hospital lengths of stay increased (0.34 days; 95% CI: 0.13, 0.56 days). We observed no change in the average distance between patients' residential ZIP code and the hospital used (0.29 miles; 95% CI: -1.06, 1.64 miles); average number of standardized ADL limitations at PAC (0.08 SDs from the pre-closure average; 95% CI: -0.12, 0.28 SDs); or PAC time to start (0.02 days; 95% CI: -1.2, 1.2 days). Among more isolated hospitals, closures were associated with an increase in the likelihood of readmission (0.10 percentage-points; 95% CI: 0.00, 0.19).
Closures were not associated with notably worsened health care access, function, or health, potentially because closures triggered care delivery adjustments involving increased numbers of patients seeking out higher quality care.
确定农村医院关闭是否会影响医院及急性后护理（PAC）的使用情况和治疗结果。
采用交错差分设计，我们评估了32家农村医院关闭与县级层面变化之间的关联：（1）前往医院的行程距离和住院时长；（2）PAC期间的功能受限情况以及从出院到PAC开始的时间；（3）30天再入院率、死亡率以及因跌倒相关损伤导致的住院情况；（4）人群层面的住院率和死亡率。
100%的医疗保险理赔数据以及家庭健康和专业护理机构的临床数据，以识别约300万老年按服务收费医疗保险受益人的出院情况。
我们发现，与仍在营业的医院相比，关闭的医院服务的少数族裔和低收入人群更多，包括更多医疗补助患者和更少商业保险患者，且利润率更低。关闭后，季度住院率（每10000名老年人中有111.6次季度住院；95%置信区间：53.4，170.9）和平均住院时长增加（0.34天；95%置信区间：0.13，0.56天）。我们观察到患者居住邮编与所使用医院之间的平均距离没有变化（0.29英里；95%置信区间：-1.06，1.64英里）；PAC时标准化日常生活活动受限的平均数量（比关闭前平均水平高0.08标准差；95%置信区间：-0.12，0.28标准差）；或PAC开始时间（0.02天；95%置信区间：-1.2，1.2天）。在更偏远的医院中，关闭与再入院可能性增加有关（0.10个百分点；95%置信区间：0.00，0.19）。
医院关闭与医疗服务可及性、功能或健康状况明显恶化无关，这可能是因为关闭引发了护理服务调整，导致寻求更高质量护理的患者数量增加。
