Factors Associated with Provision of Ambulance Services by Rural Hospitals

Funder:	Office of Rural Health Policy (ORHP)
Research center:	North Carolina Rural Health Research and Policy Analysis Center Phone: 919.966.5541
Lead researcher:	Victoria Freeman, DrPH, RN
Contact:	Victoria Freeman, DrPH, RN, 919.966.6168, victoria_freeman@unc.edu
Project funded:	September 2008
Project completed:	August 2010
Topic:	Emergency medical services (EMS)

Rural EMS agencies face continual challenges to ensure a trained workforce to meet the prehospital emergency care needs of their communities. A reliance on volunteer EMTs with decreasing volunteerism in rural areas has forced some EMS agencies to close and others to consider changes in organizational structure and affiliation with other agencies.

Hospital-based EMS/ambulance services could offer many advantages and possible solutions to the problems facing rural EMS today. This two-part project will explore trends in provision of EMS/ambulance services among hospitals and the factors considered by hospital administrators in their decisions to acquire, maintain, or discontinue ambulance service.

In part 1 of the proposed study, secondary data will be used to describe the portion of rural hospitals currently providing EMS/ambulance services, and how that proportion compares to hospitals located in urban areas. The proportion of hospitals that have acquired EMS/ambulance services in the past year and that have discontinued these services will also be identified, as well as characteristics associated with these changes. Information obtained from this classification of hospitals will be used to inform the selection of twelve hospitals for further study using in-depth interviews with hospital administrators and possible others. One hospital in each category (ongoing provision of EMS/ambulance, new provider of EMS/ambulance, and discontinued provision of EMS/ambulance) will be chosen from each US Census region. A structured interview protocol will be developed to explore those factors assumed to be important in a hospital's decision to offer ambulance services, e.g., reimbursement for services, impact on hospital staffing, and availability of ambulance services in the area. In addition, open-ended questions will be included to allow hospital officials to explain in detail other considerations that may not be obvious to the researchers. Results of the study will be used to recommend areas for further research and programs and/or policies to support provision of prehospital emergency care in rural areas.

Publications

• Rural Hospital Support for Emergency Medical Services (Final Report)
  Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
  Report Number: #100
  Date: 11 / 2010
  This study uses Medicare Hospital Cost Reports to identify rural hospitals, with and without Emergency Medical Services (EMS) units, to answer the following questions: what proportion of rural hospitals support or operate EMS units; has this changed in last five years; what are the characteristics of rural hospitals that support or operate EMS; what are the financial investments made by these hospitals in EMS; and what describes the communities in which these hospitals are located.
• Rural Hospital Support for Emergency Medical Services (Findings Brief)
  Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
  Report Number: #99
  Date: 11 / 2010
  This study uses Medicare Hospital Cost Reports to identify rural hospitals, with and without Emergency Medical Services (EMS) units, to answer the following questions: what proportion of rural hospitals support or operate EMS units; has this changed in last five years; what are the characteristics of rural hospitals that support or operate EMS; what are the financial investments made by these hospitals in EMS; and what describes the communities in which these hospitals are located.