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Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [84]-89).

Thesis (M.A.)--West Virginia University, 2000. / Title from document title page. Document formatted into pages; contains v, 48 p. : ill. (some col.) Includes abstract. Includes bibliographical references (p. 37-39).

Closure of community hospitals directly impacts the health of rural populations and indirectly affects economic growth and access to medical services. The purpose of this doctoral project was to assess the causes and impacts of hospital closures on rural communities. The practice-focused question addressed the implications of hospital closures on individuals and families in rural communities. A systematic review of the literature, based on conflict theory, addressed populations that lack health care facility resources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the selection of 8 journal articles for review. The inclusion criteria for articles encompassed the impact of closure of health care facilities on the rural community and if the information about the causes of closure of health care facilities provided recommendations about hospital closure. The John Hopkins Nursing Evidence-Based Practice Rating Scale framework was used to determine the level and quality of evidence of the journal articles selected for review. Findings indicated that hospital closure has a negative effect on rural residents' health due to prolonged travel time for patients to access care, deterioration of health when access is not possible and increased expenses for services from remote locations. Loss of jobs due to hospital closure results in loss of income and decreased access to affordable care for community members. Findings from this project may be used to promote social change for regional and national stakeholders as the project raises awareness of the need to be diligent in preserving and enhancing health services in rural areas.

A wide range of people are interested in how local factors influence patient choice among hospitals. Administrators need to know why patients are admitted to their hospitals so they can develop more sophisticated marketing of their services in an increasingly competitive environment. Planners concerned with issues of patient accessibility need know the geographic patterns of hospital use To meet these needs, it becomes necessary to develop methods to estimate the probability that patients will be admitted to a particular hospital using models that incorporate location and size of competing hospitals. In this paper, the focus of econometric investigation and prediction is the probability that a patient will select e particular hospital. Four different service areas were delineated and studied in West Virginia to test the Huff Consumer Spatial Behavior model for estimating demand at four hospitals that may be facing closure. It was found that through application of the Huff model that in a small system of hospitals and patients, each patient location (i.e., zip code) will send patients to nearly every hospital. The model predicted sufficient demand for two of the four hospitals studied. Conventional methodologies were then compared to the Huff model. The model did not test for financial feasibility of any of the facilities nor did the model adequately address the issue of how patients select a particular facility. / Master of Science

Over 80 rural hospitals have closed in the United States since 2010, representing about half of all hospital closures during this period, and another 600-700 rural hospitals are at risk of closing shortly. The purpose of this qualitative exploratory multiple case study, which was based on transformational leadership and diffusion of innovation theories, was to gain a common understanding of financial problems and operational inefficiencies that may be impacting rural hospital leaders in the state of Texas. Data collection involved semi-structured interviews with 4 senior healthcare leaders from 3 separate regions in Texas. Data analysis included compiling, sorting, fragmenting, and reassembling of the data into 19 common themes. The 4 most common themes included poor payer mix and uninsured population, inconsistency with evidence-based measures, costs of providing care exceeding reimbursement, and the movement of inpatient procedures to outpatient. The study findings may help advance the practice of leadership in both rural and urban healthcare. This study may contribute to positive social change by creating awareness of how rural hospitals are in danger of closures, and how these closures can affect urban hospitals and overall quality of life for rural Americans.

Thèse (M.A.)--Université Laval, 1999. / Comprend des réf. bibliogr.

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