Exhibit 2: Baseline characteristics of affiliating and nonaffiliating rural hospitals.
| Nonaffiliating rural hospitals (n = 994) | Standardized mean difference | ||||
|---|---|---|---|---|---|
| Characteristic | Affiliating rural hospitals (n = 306) | Unweighted | Weighted | Unweighted | Weighted |
| Ownership (%) | |||||
| For profit | 7.8 | 2.8 | 4.3 | 0.19 | 0.13 |
| Nonprofit | 61.8 | 42.3 | 54.4 | 0.40 | 0.15 |
| Government (nonfederal) | 30.4 | 54.9 | 41.3 | −0.53 | −0.24 |
| Mean hospital referral region HHI | 0.139 | 0.124 | 0.131 | 0.16 | 0.08 |
| Mean inpatient days | 14,520 | 12,902 | 15,232 | 0.09 | −0.04 |
| Mean physician or dentist FTEs | 9.5 | 7.4 | 9.7 | 0.12 | −0.01 |
| Mean facility personnel FTEs | 398 | 318 | 404 | 0.22 | −0.02 |
| Joint Commission accreditation (%) | 47.7 | 28.8 | 39.9 | 0.38 | 0.16 |
| AMA medical school affiliation (%) | 10.5 | 8.8 | 10.7 | 0.06 | −0.01 |
| Trauma center level (%) | |||||
| Regional | 2.6 | 0.9 | 1.5 | 0.11 | 0.07 |
| Community | 3.9 | 2.6 | 3.5 | 0.07 | 0.02 |
| Rural | 17.0 | 18.5 | 19.1 | −0.04 | −0.06 |
| Other | 8.2 | 9.8 | 7.3 | −0.06 | 0.03 |
| Mean neighborhood SES indexa | −0.378 | −0.228 | −0.329 | −0.24 | −0.08 |
| Census region (%) | |||||
| Northeast | 12.4 | 7.9 | 13.9 | 0.14 | −0.05 |
| South | 38.6 | 29.1 | 34.7 | 0.20 | 0.08 |
| Midwest | 43.4 | 41.8 | 41.2 | 0.03 | 0.04 |
| West | 5.6 | 21.2 | 10.2 | −0.68 | −0.20 |
| Degree of urbanization (%) | |||||
| Metropolitan | 3.3 | 3.8 | 5.3 | −0.03 | −0.12 |
| Midsize | 42.1 | 29.0 | 38.8 | 0.27 | 0.07 |
| Small town | 36.3 | 40.5 | 36.9 | −0.09 | −0.01 |
| Ruralb | 18.3 | 26.7 | 19.0 | −0.22 | −0.02 |
SOURCE Authors’ analysis of data from the American Hospital Association Annual Survey (2008–17), Healthcare Cost Report Information System (2008–17), Hospital Compare (2011–17), and American Community Survey (ACS) (2008–17). NOTES HHI is Herfindahl-Hirschman Index. FTE is full-time equivalent. AMA is the American Medical Association.
We used data from the ACS to construct an index (presented in units of standard deviations) describing the socioeconomic status (SES) of hospital neighborhoods. This index was constructed at the ZIP code level using six survey items (high school graduation rate, male unemployment rate, median annual household income, percentage of households with incomes below the federal poverty level, percentage of households headed by a woman, and percentage of households receiving public assistance) and the methods in Bird CE, Seeman T, Escarce JJ, Basurto-Dávila R, Finch BK, Dubowitz T, et al. Neighborhood socioeconomic status and biological “wear and tear” in a nationally representative sample of US adults. J Epidemiol Community Health. 2010;64(10):860–5.
Rural hospitals are defined as critical access hospitals or hospitals located in areas with Rural-Urban Commuting Area Codes of 4 or more, which might include hospitals in otherwise metropolitan counties.