Keesee Emmaline, Malone Tyler, Gurzenda Susie, Pink George
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Rural Health. 2025 Mar;41(2):e70026. doi: 10.1111/jrh.70026.
Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.
Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.
We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: -0.24, -0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.
Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.
自2005年以来，今年农村医院关闭数量达到194家，这引发了人们对农村医疗服务可及性的担忧。关于医疗机构关闭对当地长期护理部门的影响，人们知之甚少。本分析建立了同一县内农村医院关闭与养老院之间的关系模型。我们探讨了与利用率和居民健康相关的养老院层面的结果。
利用医疗保险和医疗补助服务中心医疗成本报告信息系统、长期护理聚焦数据库以及北卡罗来纳州农村卫生研究项目医院关闭数据集，对2012年至2019年的关闭情况进行了双重差分研究。
我们没有发现证据表明医院关闭会影响非医院型养老院的入住率、医疗保险付费居民比例或居民平均日常生活活动能力得分。然而，关闭后每位居民每年的住院次数下降了0.13次（95%置信区间：-0.24，-0.02），相对于总体均值变化了0.33个标准差。尚不清楚养老院住院次数的减少是否反映了急诊、紧急或择期住院人数的减少。
我们的研究结果在现有医院关闭文献的基础上，突出了医院在农村急性后期和长期护理中未得到充分研究的作用。据我们所知，这是第一项研究医院关闭对养老院影响的研究。在新冠疫情之后，这些发现尤其具有相关性，因为农村长期护理机构和医院都面临着加剧的劳动力和资金挑战。
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