ArticleCureus2025
Service Changes, Utilization, and Financial Performance After Critical Access Hospitals Join Hospital Systems.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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
1 citing paper in PubMed.
- A Scoping Review of Inpatient Medical and Surgical Quality Outcomes at Critical Access Hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRural hospitals continue to close at unprecedented rates. Joining a hospital system is one strategy some hospitals have taken to avert closure. The objective of this study was to evaluate changes in services, utilization, and financial performance after a critical access hospital (CAH) joins a hospital system.
methodsThis retrospective cohort study used American Hospital Association Annual Survey data and Centers for Medicare and Medicaid Services Provider of Services and Cost Reports data to evaluate changes after a CAH joined a hospital system between 2011 and 2021. To identify whether service provision by CAHs changes following hospital system affiliation, the proportion of CAHs offering each service before and after joining a system was evaluated. A multivariable, interrupted time series model was utilized to investigate changes in utilization and financial profitability up to five years prior to and after joining a system.
resultsA total of 202 CAHs joining a system during the study period were evaluated. Minimal changes in the types of services offered were identified following system affiliation. Specifically, among the 36 different healthcare services evaluated, 34 did not undergo significant changes upon network membership. After joining a hospital system, there was a reduction in the proportion of Medicaid discharges (7.4% vs. 8.2%, p<0.05), Medicare discharges (51.3% vs. 53.6%, p<0.001), average daily census (15 vs. 18, p<0.05), inpatient days (5,447 vs. 6,346, p<0.05), and total facility admissions (555 vs. 649, p<0.01) at CAHs. An increase of 1.3% in CAH profitability (p<0.001) was observed following hospital system affiliation.
conclusionWhile CAHs appear not to change the services provided after joining a hospital system, a reduction in inpatient utilization and an increase in financial profitability were observed. These findings have important implications for healthcare leaders and policymakers interested in ensuring rural communities maintain access to healthcare.
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