ORGANIZATIONAL ANALYSIS OF RURAL HOSPITAL CONVERSIONS

许多农村医院正在通过转型来应对外部威胁 提供急性住院治疗以外的服务。 这种转换允许 农村社区保持获得某些保健服务的机会 (e.g.,初级保健，紧急护理），同时代表了一个潜在的 关闭一些农村医院的替代办法。 医院改建 与其他管理战略不同，因为它需要一个主要的 医院使命和功能的改变。 基于这个原因， 转换可能是一个困难和危险的变化。 我们现在知道 很少有关于农村医院转换的数量和类型， 关于转化的过程。 拟议的研究有三个目标。 首先，拟议的研究将 确定各类农村医院转制数量超过 使用AHA和HCFA数据对所有农村地区进行了为期九年（1983-1991）的调查， 全国的医院。 第二，研究将具体说明 通过检查医院的变化， 容量（例如，床位数）、财务业绩，以及 组织安排（例如，系统附属关系）。 使用事件 历史分析，转换过程将建模为三个主要 转换类别。 将对这些类别进行比较 以确定在转换如何发生方面是否存在差异。 类似的比较将是非改建的农村医院和关闭的 医院的 最后，研究将探讨国家立法的作用 在转换中，通过检查在这样做的州中的转换数量， 也没有相应的政策。 这些分析将导致农村医院转换的类型学 这是一个基于经验的，并考虑到不同的， 转换的端点（例如，护理水平与 在护理水平）以及过程中的差异， 转换（例如，医院使命的突然变化与增量变化）。 这种类型学将使研究人员和政策制定者能够区分 在各种形式的农村医院转换，并将提供一个基础 未来的研究，以评估转换的后果。

Many rural hospitals are responding to external threats by converting to provide services other than acute inpatient care. Such conversions allow rural communities to maintain access to certain health care services (e.g., primary care, emergency care), while representing a potential alternative to closure for some rural hospitals. Hospital conversion differs from other management strategies because it entails a major change in a hospital's mission and functioning. For this reason, conversion is likely to be a difficult and risky change. We now know very little about the number and type of rural hospital conversions or about the processes involved in conversion. The proposed study has three objectives. First, the proposed study will determine the number of various types of rural hospital conversions over a nine year (1983-1991) period using AHA and HCFA data for all rural hospitals in the nation. Second, the study will specify the processes involved in rural hospital conversion by examining changes in hospital capacity (e.g., number of beds), financial performance, and organizational arrangements (e.g., system affiliation). Using event history analysis, conversion processes will be modeled for three major conversion categories. Comparisons will be made across such categories to determine whether or not differences exist in how conversion occurs. Similar comparisons will be to non-converted rural hospitals and closed hospitals. Finally, the study will explore the role of state legislation in conversion by examining the number of conversions in states that do and do not have enabling policies. These analyses will result in a typology of rural hospital conversions that is empirically-based and that takes into account differences in the endpoints of conversion (e.g., conversion between levels of care vs. within levels of care) as well as differences in the process of conversion (e.g., abrupt vs. incremental change in hospital mission). Such a typology will allow researchers and policy-makers to distinguish among various forms of rural hospital conversion and will provide a basis for future studies to assess the consequences of conversion.