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The Effects of Hospital Closure on the Local Utilization of Total Joint Replacement The Queens Experience
Insights
New York hospital closures impacted lower extremity joint replacement use, especially in urban areas. However, utilization returned to pre-closure trends, indicating resilience in patient access to care.
Area of Science:
- Health Services Research
- Healthcare Management
- Orthopedic Surgery
Background:
- 31 hospitals closed in New York State since 2000, primarily due to financial instability.
- Closures disproportionately affected hospitals in lower socioeconomic status areas.
- The New York State Department of Health (Berger Commission) identified excess hospital capacity as a contributing factor.
Purpose of the Study:
- To assess the impact of hospital closures on lower extremity total joint replacement utilization.
- To examine the accessibility of specialized high-volume centers for patients in affected areas.
Main Methods:
- Utilized the Statewide Planning and Research Cooperative System (SPARCS) database.
- Analyzed trends in lower extremity total joint replacement utilization in areas adjacent to closed hospitals.
- Compared utilization trends with regional and pre-closure data.
Main Results:
- A temporary decrease in lower extremity total joint replacement utilization was observed near closed hospitals.
- Utilization rates quickly returned to pre-closure trends.
- The effect was more pronounced in urban areas, likely due to transportation challenges.
Conclusions:
- Hospital closures in New York had a transient impact on joint replacement utilization.
- Patients, particularly in urban settings, faced temporary access challenges.
- Healthcare systems demonstrate resilience in maintaining access to essential procedures despite closures.
Abstract:
Since 2000, 31 hospitals have closed in New York State. This has primarily been due to the financial difficulties endured by these institutions, many of which were located in areas inhabited predominantly by patients of lower socioeconomic status. Additionally, recommendations by the NYS Depart- ment of Health (Berger Commission) cited excess hospital capacity as a driver for the struggles of the healthcare delivery system in New York, forcing financially stable in - stitutions to close their doors as well. Data has shown that outcomes are improved when complex procedures, such as joint arthroplasty, are performed at high volume hospitals. However, for patients in the outer boroughs of NYC, travel to these specialized centers may be too expensive and physi- cally difficult for poor patients with severe osteoarthritis. Using the SPARCS database, we identified a temporary decrease in utilization of lower extremity total joint replace - ment in the areas immediately adjacent to closed hospitals. This does not appear to have a lasting effect as illustrated by quick return back to pre-closure trends and further in- crease when compared with regional trends. This effect is more pronounced in urban areas where public transportation and traffic are more of an issue for patients, making it more difficult to travel with the goal of seeking care elsewhere.
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