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• W2518702984 abstract "The Veterans Health Administration (VHA) is assessing alternative strategies for delivering high-quality healthcare to Veterans in areas served by small VA hospitals. To assist in these efforts, the Office of Policy and Planning (OPP) commissioned the VA Evidence-based Synthesis Program (ESP) Coordinating Center to conduct an evidence brief evaluating the size thresholds needed for small general medical/surgical hospitals to maintain safe and high-quality care by comparing small hospitals with larger ones.Another approach would be to compare the effect on health outcomes and safety of small VHA hospitals to that of alternative resources. In its assessment of the viability of and need for existing small VA hospitals, the VHA plans to take into account the healthcare service capacity of surrounding community resources. The literature on the effects of closing an existing hospital may provide information on important factors to consider in these assessments. Characteristics and location of nearby facilities, and patient clinical and demographic factors may affect the quality of care provided to Veterans in areas with small hospitals that have been closed or that are under consideration for closure. Because the scope of the previous review on hospital size and quality did not include this body of evidence, we recommended a critical review of hospital closure literature to better understand these factors.Most research on hospital closure concerns either the factors that are associated with the decision to close a hospital, or the effects of hospital closure on measures of access to care such as distance to the nearest healthcare facility. Several factors have been identified as being associated with the decision to close a hospital, most related to financial concerns or inefficiency. Rural hospitals are not found to be more at risk of closure when controlling for these other factors, but the effect of a hospital closure may be greater in a rural community.Closing small hospitals in rural areas can increase travel time to the nearest facility, while patients in urban areas are less likely to experience increases in travel time after a hospital closure., A recent study conducted simulations of closures of nine Japanese hospitals serving patients requiring hemodialysis. Five rural public hospitals and four urban public hospitals were chosen for the model. The total capacity of the urban (324 beds) and rural (319 beds) hospitals was similar. Patients in rural areas had longer commuting times than those in urban areas (median 15 vs. 7 minutes; P<0.001). The model simulated the closure of each rural hospital, each urban hospital, all rural hospitals, all urban hospitals, and shifting capacity of the urban hospitals to the rural hospitals. Simulation results showed that if public hospitals in rural areas were closed, the equity of commuting times among patients worsened much more than if urban public hospitals of similar capacity were closed. The equity did not change when capacity of the urban hospitals was shifted to the rural hospitals. Closure of any one of the five rural hospitals increased the number of patients with a longer commuting time, but closure of all four urban hospitals did not affect commuting times. Closing of even the smallest rural facility (total capacity 15) affected equity of commuting times more than closure of the large urban hospitals. In a study of hospital emergency department closures in California, including 785,385 patient records, only a small proportion of patients (10% of the sample) experienced an increase in distance to the nearest emergency department as a result of a hospital closure, and among them, most had less than a one-mile increase. The median increase in distance was 0.8 miles (range 0.1 to 33.4 miles). Another U.S. study looked at the effect of increased driving time to the nearest emergency department over a 10-year period (1995-2005). Patients who experienced the largest increases in driving time were mostly in rural communities. These patients also had more limited access to other hospitals, with the average number of hospitals within a 10-mile radius only 1.03 compared to 2.57 in the control group." @default.
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• W2518702984 date "2013-06-01" @default.
• W2518702984 modified "2023-09-28" @default.
• W2518702984 title "Evidence Brief: Effects of Small Hospital Closure on Patient Health Outcomes" @default.
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