Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study

Purpose Recent studies suggest that Federally Qualified Health Centers (FQHC) may be expanding their provision of primary care in rural communities that experience a hospital loss. Whether these trends are different from rural areas not being affected by rural hospital closures is unknown. Methods D...

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Vydáno v:The Journal of rural health Ročník 39; číslo 1; s. 291 - 301
Hlavní autoři: Bell, Nathaniel, Hung, Peiyin, Merrell, Melinda A., Crouch, Elizabeth, Eberth, Jan M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Wiley Subscription Services, Inc 2023
Témata:
Access
access to care
Aged
Case-Control Studies
Closure
community health
Community Health Services
experimental design
Federally Qualified Health Centers
Health
Health care
Health facilities
Health Facility Closure
Health services
Health Services Accessibility
hospital closures
hospitals
Humans
Interrupted Time Series Analysis
Medicaid
Medical personnel
Medicare
Postal codes
Primary care
Proximity
Rural areas
Rural communities
rural health
Rural health care
rural health clinics
Rural Health Services
Services
Time
Time series
time series analysis
Trends
United States
United States
Federally Qualified Health Centers
access to care
hospital closures
rural health
rural health clinics
ISSN:0890-765X, 1748-0361, 1748-0361
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Shrnutí:Purpose Recent studies suggest that Federally Qualified Health Centers (FQHC) may be expanding their provision of primary care in rural communities that experience a hospital loss. Whether these trends are different from rural areas not being affected by rural hospital closures is unknown. Methods Data included Centers for Medicare and Medicaid Services Provider of Services files, the Cecil G. Sheps hospital closure database, and American Community Survey estimates. Changes in straight‐line distances to the nearest FQHC and rural health clinic (RHC) were compared between areas affected and unaffected by a rural hospital closure in a matched case control study design using an interrupted time series model. Findings There was no instantaneous percentage point increase in FQHC (2.41, 95% CI −0.79 to 5.60, P .140) or RHC (3.27, 95% CI −1.12 to 7.67, P .144) access following hospital closures compared to changes in access occurring in other rural areas. On average, rural ZIP codes affected by hospital closures exhibited a 0.84 percentage point increase in FQHC access over time (95% CI 0.40‐1.28, P .000), but similar trends were also found within unaffected ZIP codes classified as small rural areas. Conclusions Rural areas impacted by hospital closures did not experience an increase in proximity to FQHCs or RHCs relative to changes in access occurring in other rural areas. Over time, most rural areas are seeing an increase in access to FQHCs and RHCs. Policies are needed to incentivize primary care providers to target geographic areas experiencing a hospital closure.
Bibliografie:Funding information
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number 7 U1CRH45498‐01‐00, Rural Health Research Grant Program Cooperative Agreement. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.
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ISSN:0890-765X
1748-0361
1748-0361
DOI:10.1111/jrh.12691