This timeframe enabled us to examine data from 3 years prior to the initiation of the RHNP through 3 years post-initiation.
For comparison purposes, we selected a random sample of households in the market areas of rural hospitals in RHNP networks (n=810), in other (non-RHNP) networks (n=600), and not participating in networks (n=600).
Based on the existing literature and the experiences of the 13 RHNP networks, we developed several propositions concerning the factors likely to affect the survival of rural hospital networks.
To estimate the effect of network participation on rural hospital financial performance, we used an analytic approach that included a before/after comparison of the financial performance of hospitals participating in RHNP networks with those in two contemporaneous control groups - hospitals in non-RHNP networks and hospitals not participating in any network.
For the analysis of consumer satisfaction, perceptions, and willingness-to-use measures, we examined change scores as a function of whether the resident was in a RHNP or non-RHNP hospital market area and a set of individual, household, geographic area, and local hospital characteristics.
Although not statistically significant, use of the local hospital for hospitalizations during the prior year decreased by 16 percentage points for the residents of non-RHNP network hospital market areas and 7 percentage points for the residents of RHNP hospital market areas relative to the residents of non-network market areas.
Many of the lessons learned from the RHNP evaluation could arguably apply to integrated rural health networks (IRHNs), the organizations that may provide the full range of health services to rural communities in the future.