White sign covers the existing sign of in front of a hospital and says "This hospital is CLOSED, if this is an emergency call 911." The sign is flanked by shrubs and lamps posts.

In 2019, a PhD student in medical geography at the University of Illinois posted on Twitter about her interest in studying rural hospital closures. An assistant professor from UC Davis DM’ed her to say, we should talk! They met up at a cafe near the AcademyHealth Annual Research Meeting in Washington, D.C. And a speedy 4 years, many datasets, analyses, a move, a new baby later…they finally published the first analysis.

Following up from her previous conceptualization on time as a social determinant of health, Arianna M. Planey uses the cases of access to acute care hospitals in the U.S. South to illustrate the construction of racialized inequities in healthcare.

In addition to grounding the motivation and analysis in the theoretical frameworks of structural racism and access to healthcare, Dr. Planey’s approach shows the benefits of drawing from geography methods to improve health services research, including:

Methodological improvements:

-Use of a validated hospital dataset that accounts for closures and mergers to determine actual losses of sites.

-Use of travel time/distance as an outcome. Most analyses of rural hospital closures, which use ‘container’ methods, e.g. documenting changes in hospital supply by county. In this manuscript, Dr. Planey examines travel time and travel distance. She shows that the impact on travel time and distance is relatively smaller than simply examining gains/losses by county.

-Estimates from the population-weighted centroids of Census tracts, i.e. not the geographic center (commonly used) but rather, based on where people live within the tract.

Examination of both nearest and next-nearest hospital. This is a key consideration in rural hospital analyses, as community members have high rates of hospital bypass- for many reasons, including lack of specialty services and distrust of the nearest facility. For racially minoritized communities, the nearest hospital may not offer the services for linguistically, culturally appropriate care, which can include care that is respectful and trustworthy.

Findings: You can read more, TLDR Black and Latinx communities have longer travel times/distances to next nearest and nearest hospitals, despite being less remote than rural white communities.

And…what? you want to see what the impact is on access to care? Stay tuned….

Planey AM, Planey DA, Wong S, McLafferty SL, Ko MJ. Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018. Milbank Q. 2023 May 15. doi: 10.1111/1468-0009.12655. Epub ahead of print. PMID: 37190885