Rural communities face challenges in accessing hospital services, which may be most pronounced when a hospital closes. However, closure of specific hospital service lines also affects access to care and is understudied. The purpose of this study is to estimate hospital service line closures over time by rurality, hospital type, and community characteristics, and estimate changes in distance to the nearest facilities after a service line closure. This study is national in scope and will use publicly available data to identify service line closures from 2017 to 2023. Aims of this work include:

• Estimate hospital service line closures among acute care hospitals across the U.S. between 2017 and 2023 and by service line.
• Compare frequencies and types of hospital service line closures by rurality and hospital characteristics.
• Estimate associations between hospital service line closures and measures of community characteristics, hospital characteristics, hospital service areas, and geographic indicators.
• Estimate average distances to nearest hospitals with specific service lines after closures at nearby facilities.