America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

SPECIALIZATION OF NURSING HOME CARE AND OUTCOMES -super-1

Implications of nursing home specialization for health outcomes were examined. The formal hypothesis tested in this study was that facilities specializing in the treatment of certain kinds of residents, as reflected in a critical mass of such residents, are more likely to experience better health outcomes over time compared to facilities that do not specialize in the treatment of such residents. Activities of Daily Living (ADLs), survival, and several diagnosis-specific outcomes were analyzed for residents. Multivariate state-dependence and logistic regression models were estimated for residents of six diagnostic sub-groups. Specialization was empirically defined in terms of concentration of residents with certain diagnoses within nursing facilities. Empirical results indicate that specialization has some positive effects on some outcomes. For instance, facilities specializing in the care of Alzheimer's disease patients appear to produce comparatively better outcomes with respect to restraint use and accidents. Residents with diagnoses of hypertension or ischemic heart disease in specialized facilities also fare better in terms of survival. Residents with a diagnosis of cerebrovascular disease in specialized facilities were found to experience worse outcomes with respect to most of the outcomes modeled in this study, however. Overall, specialization only appears to make a difference in the outcomes of residents with certain medical conditions for some health outcomes. Regression results also indicate that basic measures of frailty such as functional deficiencies, incontinence, and behavioral problems largely contribute to detrimental effects irrespective of the diagnostic group or the outcome considered. Copyright 2000 by The Policy Studies Organization.