Graduate Thesis Or Dissertation
 

Integrated health systems and the impact on rural hospitals and communities

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https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/2b88qf506

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  • PURPOSE Rural hospitals began to make significant changes in the 1990s by becoming integrated with larger health systems. The literature has correlated several key measures that determine the success of integrated health systems. These measures were quality, financial strength, community benefit, physician outcomes, and service changes. The purpose of this study is to determine if these same factors are applicable to rural hospitals that integrated in Oregon. METHODS Introductory letters and surveys were sent to all rural hospital CEOs in the state (N=38). Twenty hospital CEOs responded, nine rural integrated hospitals and eleven non-integrated hospitals. Financial data was gathered from the rural hospitals and from the State of Oregon. Qualitative data was gathered from individual telephone interviews with fifteen of the twenty CEOs. Two sample t-tests were conducted to compare integrated verses nonintegrated hospitals. The following data were reviewed: financial data (net income), community benefit data (charity care, Medicare and Medicaid write-offs), physician data (income changes, number of physicians), and service data (services added, types of services). Paired t-tests were used to compare pre- and post-integration hospitals. FINDINGS The study found that there was greater percentage of charity care provided by integrated rural hospitals than non-integrated rural hospitals. It also found that there was a greater likelihood that integrated hospitals will add urgent care to its service mix after integration. The study found that emergency care physicians in non-integrated rural hospitals had greater income increases than in integrated hospitals. The study did not find there to be any difference in the net income, the Medicare/Medicaid write-offs, the services added, or the number of physicians added, between integrated and non-integrated hospitals. Data an quality measures were not available for comparative analysis. CONCLUSIONS There were not conclusive findings to say that integration has improved the financial performance, the community benefit, the physician access, or the services provided by rural hospitals in Oregon. Additional studies should concentrate on expanding the research to a regional or national level. Also, continuing to work with State and Federal agencies to develop consistent quality measures will benefit this research.
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