Using a novel integration of spatial analysis, multi-level modeling, and difference-in-difference tests, we proposed to 1) investigate whether safety-net providers were more likely to defray the demand for services due to their proximity to hospitals that closed and 2) quantify the impact of hospital closures on rural mortality rates. The proposal aimed to fill gaps in prior work by providing national estimates of impacts of hospital closures for rural populations due to changes to potential demand for services as well as in changes in health outcomes. Our study findings provided new information on the cascading effect of increasing transportation times, social and economic conditions, and reduced access to healthcare providers on population health outcomes within rural communities.

Publications

• Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
  Journal Article
  Rural and Minority Health Research Center
  Date: 07/2022
  In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.
• Changes in Access to Nearest Federally Qualified Health Centers and Rural Health Clinics Among Rural ZIP Codes That Did and Did Not Experience a Hospital Closure, 2006-2018
  Policy Brief
  Rural and Minority Health Research Center
  Date: 10/2022
  This brief explores changes in geographic accessibility within rural ZIP codes throughout the U.S. to Federally Qualified Health Centers and Rural Health Clinics, between 2016 and 2018.
• Changes in Socioeconomic Mix and Health Outcomes in Rural Counties With Hospital Closures, 2005-2018
  Policy Brief
  Rural and Minority Health Research Center
  Date: 09/2021
  This brief examines the trend of hospital closures between 2005 and 2018 across definitions of rurality. Social, economic, and health structure trends at the county level across the contiguous United States were the study's focus.