246330 Impact of hospital closures on utilization: Examining racial/ethnic differences in visit type in the years following hospital closures

Tuesday, November 1, 2011

Kimberly Enard, PhD, MBA, MSHA , Center for Health Equity and Evaluation Research/Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
Hospitals are critical to delivering and organizing healthcare in the community, yet their viability has been threatened over the past two decades by severe financial, regulatory and operational challenges. The possibility that closures widen racial/ethnic disparities in healthcare access warrants serious examination because communities with high proportions of racial/ethnic minorities are at greatest risk for closures and may have fewer resources to support continuity of care in subsequent years. The purpose of the analyses conducted was to evaluate whether hospital closures have an overall and/or differential effect by race/ethnicity on provider visits (by type). The study utilized Medical Expenditure Panel Survey (MEPS) data from 1996-2003 and community-level data collected from a number of sources, aggregated using FIPS county codes. Outcomes examined were: 1) total visits (VIS), 2) office-based doctor visits (OBDRV), 3) emergency department visits (ERVIS), and 4) inpatient visits (IPV). Data were survey-weighted to account for MEPS complex survey design. The study employed a quasi-experimental multiple time series research design, Poisson modeling and difference-in-difference (DD) and difference-in-difference-in-difference (DDD) equations to estimate the outcomes. The DD estimates evaluated whether hospital closures had an effect on utilization over time within each racial/ethnic group, while the DDD estimates evaluated whether hospital closures had a differential effect over time for racial/ethnic minorities, compared to whites. From 1996-2003, mean utilization was higher in the overall population and for whites than for racial/ethnic minorities across all communities (VIS: overall, 6.1; whites, 6.9; blacks, 4.6; Asians/NHPIs, 3.7; Mexican-origin, 3.4; other Hispanic, 4.8; OBDRV: overall, 3.3; whites, 3.7; blacks, 2.4; Asians/NHPIs, 2.1; Mexican-origin, 2.0; other Hispanic, 2.7; ERVIS: overall, 0.2; whites, 0.2; blacks, 0.2; Asians/NHPIs, 0.1; Mexican-origin, 0.1; other Hispanic, 0.2; IPV: overall, 0.7; whites, 0.7; blacks, 0.8; Asians/NHPIs, 0.4; Mexican-origin, 0.4; other Hispanic, 0.6. When comparing mean utilization at baseline (affected – unaffected) for each race/ethnicity, significant differences were present only for Asian/NHPI VIS (-1.03, p-value <.05) and black OBDRV (0.6, p-value <.05). While there were some significant DD and DDD estimates for some groups from period-to-period, the only significant DD and DDD estimates from 1996 to 2003 occurred for black OBDRV (DD: -0.8, p-value <0.01; DDD: -0.7, p-value <.05). The results suggest that for most racial/ethnic groups, hospital closures did not have a significant impact on utilization for these outcomes during this time period, but more study is needed to evaluate the potential effect of closures on healthcare disparities.

Learning Areas:
Administration, management, leadership
Public health administration or related administration
Public health or related public policy

Learning Objectives:
1. Identify overall and racial/ethnic populations affected by hospital closures 2. Compare overall and racial/ethnic differences in utilization by provider type in populations affected by hospital closures, compared to unaffected populations 3. Discuss policy initiatives that may have impacted utilization overall and for racial/ethnic minorities in the wake of hospital closures

Keywords: Access to Care, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Kellogg Health Scholar Postdoctoral Fellow in the Center for Research on Minority Health in the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center. I recently completed a Ph.D. in health services research with specialization in health policy at UCLA. My dissertation examined whether hospital closures differentially impact access to care for racial/ethnic minorities, compared to non-minorities. Previously, I earned a Master of Business Administration (MBA) and Master of Science in Health Administration (MSHA), with concentrations in marketing, finance and management, and a Bachelor of Arts (BA) in mass communications. Additionally, I am a Fellow in the American College of Healthcare Executives, which signifies that I am board certified in healthcare management. I have nearly 10 years of experience in healthcare management, marketing and business development - primarily developing and implementing communication and outreach initiatives targeted to diverse patient and physician populations while working in the hospital industry - and several years of experience as a journalist. My research interests include the role of perceived and actual bias, stereotyping and discrimination on healthcare behaviors, access and outcomes; the effect of insurance status, type and continuity on healthcare access and quality among vulnerable populations; and research and policy development in the area of community contextual factors, with an emphasis on exploring the role of public-private partnerships in improving access and quality for vulnerable populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Medical Care Poster Session #9: Racial or Ethnic Disparities
See more of: Medical Care