Reimagining and reinvesting in rural hospital markets

Carroll, Caitlin; Planey, Arrianna Marie; Kozhimannil, Katy B.

doi:10.1111/1475-6773.14047

Cited by 10 publications

(4 citation statements)

References 70 publications

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“…Areas of inadequate access to maternity care are created through systems and policies that deplete community resources. Hospital and maternity unit closures [8,9], obstetric workforce shortages [8,9], inadequate Medicaid reimbursement rates [9,10], and systemic racism and classism [11], have contributed to the increase in more counties with low or no access to care. One-third of all U.S. counties are maternity care deserts, and 60% are in rural areas [7].…”

Section: Discussionmentioning

confidence: 99%

Navigating Geographical Disparities: Access to Obstetric Hospitals in Maternity Care Deserts and across the United States

Fontenot,

Brigance,

Lucas

et al. 2024

Preprint

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BACKGROUND Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care “deserts." These areas, exacerbated by hospital closures and workforce shortages, heighten risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. METHODS The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017–2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. RESULTS The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. CONCLUSIONS Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.

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Section: Discussionmentioning

confidence: 99%

Navigating Geographical Disparities: Access to Obstetric Hospitals in Maternity Care Deserts and across the United States

Fontenot,

Brigance,

Lucas

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Areas of inadequate access to maternity care are created through systems and policies that deplete community resources. Hospital and maternity unit closures [ 8 , 9 ], obstetric workforce shortages [ 8 , 9 ], inadequate Medicaid reimbursement rates [ 9 , 10 ], and systemic racism and classism [ 11 ], have contributed to the increase in more counties with low or no access to care. One-third of all U.S. counties are maternity care deserts, and 60% are in rural areas [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States

Fontenot,

Brigance,

Lucas

et al. 2024

BMC Pregnancy Childbirth

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Background Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care “deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. Methods The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. Results The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. Conclusions Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.

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“…Instead of focusing on health care‐specific interventions, we may need to consider policies that go beyond the hospital and focus more on drivers of upstream rural community solvency like expanded job opportunities or improvements in economic opportunity for rural residents. Bolstering rural communities may be the key to bolstering rural hospitals and health‐care systems 6 …”

mentioning

confidence: 99%

“…Bolstering rural communities may be the key to bolstering rural hospitals and health-care systems. 6 What about the consequences for patient outcomes when rural hospitals close? The story is also not clear there.…”

mentioning

confidence: 99%

Causes and consequences of rural hospital closures

Chatterjee

2022

Journal of Hospital Medicine

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Causes and consequences of rural hospital closuresRural hospitals and health-care systems have been in a slow-burning crisis for decades. Since 2010, over 130 rural hospitals have closed. 1 Over the same period, rural adults have experienced higher rates of mortality from heart disease, cancer, unintentional injury, and stroke relative to urban adults. 2 This dual challenge of declining access and diminishing health status for rural populations has presented one of the most formidable policy challenges for US health care. In this issue of theJournal of Hospital Medicine, new study by Ramedani et al. 3 begins to chip away at this challenge by asking, what happens to local "bystander" hospitals after a rural hospital closes? This question is important: if bystander hospitals are overwhelmed by increased occupancy rates after a local hospital closes, there may be consequences for patient care due to facility strain. The authors compare the number of hospital admissions and emergency department visits at hospitals within 30 miles of 53 rural hospital closures, pre-and postclosure. They find that admissions at local hospitals increased by 1.2 percentage points in the 2 years following closure.The effect sizes are reassuring though difficult to generalize across all rural hospitals given the heterogeneity in size and service capabilities.

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Reimagining and reinvesting in rural hospital markets

Cited by 10 publications

References 70 publications

Navigating Geographical Disparities: Access to Obstetric Hospitals in Maternity Care Deserts and across the United States

Navigating Geographical Disparities: Access to Obstetric Hospitals in Maternity Care Deserts and across the United States

Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States

Causes and consequences of rural hospital closures

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