Rural Hospitals Experienced More Patient Volume Variability Than Urban Hospitals During The COVID-19 Pandemic,...

Area of Science:

• Health Services Research
• Public Health
• Healthcare Management

Background:

• The COVID-19 pandemic caused unprecedented disruptions to healthcare systems globally.
• Rural hospitals, often operating with fewer resources, may be particularly sensitive to changes in patient volume.

Purpose of the Study:

• To compare patient volume changes in rural versus urban hospitals during the COVID-19 pandemic.
• To identify characteristics of rural hospitals most affected by volume fluctuations.
• To assess the financial implications of volume shifts for rural hospitals.

Main Methods:

• Utilized Healthcare Cost and Utilization Project State Inpatient Databases.
• Compared hospital discharge data from the pandemic period (March 2020-December 2021) with a prepandemic period (January 2017-March 2020).
• Analyzed average daily medical volume changes and their relationship with community COVID-19 transmission levels.

Main Results:

• Rural hospitals exhibited a dose-response relationship between community COVID-19 burden and patient volume changes, with decreases during low transmission and increases during high transmission.
• Approximately 35% of rural hospitals experienced over 20% average daily volume fluctuations, compared to 13% of urban hospitals.
• Rural hospitals with large volume changes were often smaller, government-owned, critical access hospitals with lower operating margins.

Conclusions:

• Rural hospitals were more vulnerable to operational and financial instability due to pandemic-related volume shifts.
• The findings highlight potential long-term sustainability challenges for rural healthcare facilities.
• Attention is needed to support rural hospitals facing significant volume variability.