Determinants of rural hospital conversion. A model of profound organizational change.

One widely discussed response to the severe problems faced by many rural hospitals is to convert them into organizations that provide health services other than general, acute inpatient care. This study identifies conversions that occurred nationally from 1984 to 1991. The study also empirically examines the determinants of conversion, using rural hospitals that did not convert (between 1984 and 1991) as a comparison group. The authors examine a set of factors that makes radical organizational change necessary (eg, poor performance) and reduces resistance to such change (eg, proximity to other hospitals). Results from discrete-time logistic regression show that converters are more likely than nonconverters to: have poor performance and fewer beds; be located very near to or very distant from similar hospitals; operate in larger communities; devote more of their care to areas other than acute inpatient care; and be members of multihospital systems. Converters also are less likely to be government owned. The need for future research on the effects of conversion is discussed.