The effect of rural hospital closures on emergency medical service response and transport times

Abstract

Objective To examine the effect of rural hospital closures on EMS response time (minutes between dispatch notifying unit and arriving at scene); transport time (minutes between unit leaving the scene and arriving at destination); and total activation time (minutes between 9‐1‐1 call to responding unit returning to service), as longer EMS times are associated with worse patient outcomes. Data Sources/Study Setting We use secondary data from the National EMS Information System, Area Health Resource, and Center for Medicare & Medicaid Provider of Service files (2010‐2016). Study Design We examined the effects of rural hospital closures on EMS transport times for emergent 9‐1‐1 calls in rural areas using a pre‐post, retrospective cohort study with the matched comparison group using difference‐in‐difference and quantile regression models. Principal Findings Closures increased mean EMS transport times by 2.6 minutes (P = .09) and total activation time by 7.2 minutes (P = .02), but had no effect on mean response times. We also found closures had heterogeneous effects across the distribution of EMS times, with shorter response times, longer transport times, and median total activation times experiencing larger effects. Conclusions Rural hospital closures increased mean transport and total activation times with varying effects across the distribution of EMS response, transport, and total times. These findings illuminate potential barriers to accessing timely emergency services due to closures.

Risk of hospital insolvency and its relationship with income and borrowings from banks: a case–control study with large-scale financial data in Japan

“…This finding of the importance of profitability in Japanese hospital management is in line with findings from other countries (Kaufman et al 2016;Bai et al 2020;Holmes et al 2013;Ly and Cutler 2018;Pai et al 2017). Likewise in Japan, stakeholders such as hospital managers or owners, bankers, and policy-makers should focus on the financial status of hospitals for providing sustainable healthcare services and securing the local economy (Miller et al 2020;McCarthy et al 2021;Thomas et al 2016;Holmes et al 2006).…”

“…One of the major concerns in recent healthcare management is financial distress among hospitals and subsequent unwilling hospital closure, which affects a wide range of stakeholders, including patients. Hospital closures create potential barriers to accessing emergency services in a timely manner (Miller et al 2020), may force patients in rural areas to drive longer to access services (McCarthy et al 2021), and could disproportionately affect racial and ethnic minorities (Thomas et al 2016). In a community, the volume of patients in hospitals neighboring closed hospitals typically increases (Lee et al 2015;McKay and Dorner 1996), and the closure of a hospital may also reduce per-capita income and increase the unemployment rate (Holmes et al 2006).…”

Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California

“…Increases in EMS response times have been tied to worse clinical outcomes, including increased mortality. 26,27 Kaufman et al estimate that over 1.7 million Americans were affected by rural hospital closures from 2010-2014, a number that continues to increase on an annual basis. 28 The marked disparity we observed in spatial access to emergency surgical care is particularly worrisome for rural residents, placing them at risk for worse clinical outcomes due to delayed intervention alone.…”

Geographic Distribution of Accredited Paramedic Education Programs in the United States

“…There are many disparities in access to emergency medical care between urban and rural settings (34)(35)(36)(37). For the context of this study, the geographic disparities of paramedic education are not likely to be resolved in the near future.…”