ArticleHealth affairs (Project Hope)2019
Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation.
Article in Health affairs (Project Hope), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Towards a Quality Care Climate Perspective: A Systematic Review of Associations Among Patient Experience, Patient Outcomes, and Organisational Climate Factors in Hospitals.International journal of environmental research and public health · 2026Pooled it
- The digital divide in adoption and advanced use of electronic health records among US hospitals: rural versus urban disparities from 2008 to 2023.Journal of the American Medical Informatics Association : JAMIA · 2026Article
- Medicare appointment availability and wait times vary considerably across four large US urban markets.Health affairs scholar · 2026Article
- The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review.Medical care research and review : MCRR · 2025Article
- Intelligence Architectures and Machine Learning Applications in Contemporary Spine Care.Bioengineering (Basel, Switzerland) · 2025Review
- Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications.Journal of medical Internet research · 2025Article
- A Policy and Regulatory Framework to Promote Care Delivery Redesign and Production Efficiency in Health Care Markets.The Milbank quarterly · 2025Article
- Negotiated Prices for Care at Independent and System-Affiliated Rural Hospitals.JAMA network open · 2025Article
- Service Changes, Utilization, and Financial Performance After Critical Access Hospitals Join Hospital Systems.Cureus · 2025Article
- An updated model of rural hospital financial distress.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Overcoming Geographic Barriers: Surgical Care in Rural Populations.Clinics in colon and rectal surgery · 2025Review
- Financial Performance Gaps Between Critical Access Hospitals and Other Acute Care Hospitals.JAMA health forum · 2024Article
- Article
- Acquisitions of safety-net hospitals from 2016-2021: a case series.Health affairs scholar · 2024Article
- Health System Integration and Cancer Center Access for Rural Hospitals.The American surgeon · 2024Article
- Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018.The Milbank quarterly · 2023Article
- Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2023Review
- Article
- Access To Oncology Services In Rural Areas: Influence Of The 340B Drug Pricing Program.Health affairs (Project Hope) · 2023Article
- Understanding the Wide-Reaching Impact of Healthcare Merger and Acquisition Activity.International journal of health policy and management · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
More than 100 rural hospitals have closed since 2010. Some rural hospitals have affiliated with health systems to improve their financial performance and potentially avoid closure, but the effects of affiliation on rural hospitals and their patients are unclear. To examine the relationship between affiliation and performance, we compared rural hospitals that affiliated with a health system in the period 2008-17 and a propensity score-weighted set of nonaffiliating rural hospitals on twelve measures of structure, utilization, financial performance, and quality. Following health system affiliation, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits, as well as a significant increase in operating margins (by 1.6-3.6 percentage points from a baseline of -1.6 percent). Changes in patient experience scores, readmissions, and emergency department visits were similar for affiliating and nonaffiliating hospitals. While joining health systems may improve rural hospitals' financial performance, affiliation may reduce access to services for patients in rural areas.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.