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Bright Spots

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Rural hospitals are closing at an increasing rate endangering the health of 20% of our population. The Cecil G. Sheps Center for Health Services Research at the University of North Carolina reports that nearly 700 rural hospitals are currently at risk of closing, and 118 rural hospitals have already ceased providing inpatient services from over the last decade. When a rural hospital closes, community members are left without easy access to or are forced to travel great distances for healthcare services. A recent California study demonstrated a 6% increase in mortality when a rural hospital closed (as compared to no impact on mortality when an urban hospital closed). [1]

Current efforts employ a “Find and Fix” tactic to helping vulnerable rural hospitals, a case by case approach with the identification and treatment of common problems. However, our process of helping rural hospitals will not be complete without looking at the other, brighter, half of the equation. We need to identify the culture, the processes, even the specific programs that have allowed for some rural health providers to flourish or communities to successfully reframe access to care.

Bright Spots exist where hospitals have survived and thrived despite adverse circumstances and in communities that have responded to lack of access by developing alternatives to local hospitals. The goal of our Bright Spots study is to find commonalities among facilities/communities that demonstrate positive outcomes and share the common elements that have contributed to the success of these Bright Spots in the current healthcare climate. Lessons learned from our Bright Spots project that can help a community retain access to health care will result in a healthier rural population.

Bright Spot sites will be identified by utilizing the combined experience and tools available to the A&M Community and Rural Health Institute (ARCHI) and the Center for Optimizing Rural Health. The Bright Spots will be selected to ensure a broad range of innovations here in Texas and across the nation. We will also look to compare States that took Medicaid expansion versus those that did not in terms of what innovations can work. ARCHI staff will work with identified practices gathering data and conducting site visits to understand and report on their distinguishing practices. In medicine, a patient case study lists the unique characteristics of a patient, the course of the illness, and response to interventions, which other care providers use to treat similar patients. Our case study will help rural providers ‘treat’ their issues using the shared knowledge of these Bright Spots. Additionally, we identify commonalities across communities and institutions that might be facilitators to high performance.

Our Bright Spot locations will be listed as they are identified and agree to participate.

South Central Foundation/Nuka System of Care – Anchorage, AK

Sakakawea Medical Center – Hazen, ND

Kearny County Hospital – Lakin, KS

Hill Country Memorial – Fredricksburg, TX

Columbus Community Hospital – Columbus, TX

Titus Regional Medical Center – Mt. Pleasant, TX

Audubon County Memorial Hospital – Audubon, IA

Trinity Memorial Hospital District – Trinity, TX

Even as this particular study is completed, the ARCHI team will continue to seek BRIGHT SPOTS as we crisscross the country working with rural communities and their healthcare teams. The ever evolving healthcare environment suggests that continuous search for innovation and design change will be necessary. As these interventions are identified, ARCHI will continue to add to our online information to facilitate idea exchange and adoption of best practices.

[1] Gujral, Kritee and Basu, Anirban, Impact of Rural and Urban Hospital Closures on Inpatient Mortality (August 2019). NBER Working Paper No. w26182. Available at SSRN: