Rural Hospital Closures, Hospital Spatial Accessibility, and Preventive Care Receipt in the US South: A
Arrianna Marie Planey1, Sandy Wong2, Fikriyah Winata3
1UNC Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina, Chapel Hill, McGavran-Greenberg, Chapel Hill, NC, USA. amplaney@email.unc.edu.
Background:
Rural hospital closures have accelerated since 2010, disproportionately affecting primary care health professional shortage areas (HPSAs). Rural hospital closures are associated with increased patient travel burdens, and reduced primary care physician supply. Less is known about associations between closures and primary care utilization among rural residents.
Objective:
This study evaluates preventive healthcare receipt among rural-dwelling adults in the wake of hospital closures.
Design:
Generalized linear mixed models (GLMMs) were used to examine associations between hospital closures, spatial accessibility to hospitals, primary care practitioner shortage, and receipt of preventive care among adults.
Subjects:
Residents in 4275 rural Census tracts, within 720 counties in the US South MAIN MEASURES: Outcomes included the following: tract percentage of: adults who received a routine preventive care in the previous year; women age ≥ 65 who received preventive services; men age ≥ 65 who received preventive services; cholesterol screening receipt among adults (≥ 18 years). Model covariates included county-level count of hospital closures from 2010 to 2018, travel time and distance to the two nearest hospitals, and county Health Professional Shortage Area (HPSA) designation.
Key Results:
Approximately 10% of tracts were in closure counties, and 26% were in counties adjacent to closure counties. Mean travel time and distance to the nearest and second nearest hospital were 15.9 miles (22.8 min) and 26.4 miles (35.4 min), respectively. Location in a county with two hospital closures was negatively associated with receipt of preventive services among older adults (women -4.9, 95%CI -7.6 to -2.4; men -3.8, 95%CI -6.6 to -0.9).
Conclusions:
Given the high prevalence of chronic conditions and disproportionate risk of hospital closure in the US South region, policymakers and health systems need to bolster primary care service networks amid ongoing hospital closures.
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