Research Alert: February 20, 2019
When a hospital closes in a community, patients needing emergency care may spend more time in an ambulance to receive care in an emergency department (ED). We explored how a hospital closure affects the time a patient travels from an incident location where 9-1-1 was called to the ED in an ambulance.
For those calls defined as rural, the mean transport time prior to a hospital closure was 14.2 minutes, one minute slower than the mean time for all calls. The transport time increased to 25.1 minutes after the hospital closed, a statistically significant increase of 10.9 minutes or a 76.4% increase. In urban ZIP codes there was no change in transport times. Patients 65 years and older living in rural areas had a similar change in transport time as all rural patients. The times increased from 13.9 minutes to 27.6 minutes, a 13.7-minute increase or a 97.9% change.
Our work measures one aspect of how access to emergency care through ambulance services changes for patients when a hospital closes. Our analysis reveals that after a hospital closes, rural patients spend more time in an ambulance than prior to the closure. In addition, they spend more time than urban patients facing closures. Studies have found that communities, rural and urban, where hospitals closed tended to have a higher percentage of elderly and poor residents in addition to higher unemployment rates and a higher percentage of blacks and Hispanics. More than half the hospitals in the country are in rural areas and are the primary source of emergency medical services in these communities. Over the years, policymakers at the local, state, and federal levels have prioritized maintaining local access to emergency services. The 2017 Medicare Payment Advisory Commission (MedPAC) report stressed the need to find more efficient and financially stable ways to deliver emergency services in rural communities.Contact Information:
SuZanne Troske, MS
Rural and Underserved Health Research Center
Additional Resources of Interest:
- Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
- More information about the Rural and Underserved Health Research Center
- More information from the Rural Health Information Hub's topic guides: Community Paramedicine, EMS and Trauma, Healthcare Access, Rural Health Disparities, Rural Health Policy, Transportation to Support Rural Healthcare