Psychometric development and validation of the Hospital Resilience Index
Authors: Lirk Philipp , Janjua Haroon , Rogers Michael , Flynn Stephen , Kuo Paul , Pietrobon Ricardo 
Published: March 2023

Importance

Throughout the past decades, the United States healthcare system has seen increased efforts to promote resilience to external or internal stressors. However, measuring outcomes remains a challenge, mainly because most indices rely on markers that need to be gathered from different data sources. An alternative would be to use readily available large-scale data. The American Hospital Association (AHA) annual survey gathers over 1,000 data points from more than 6,000 hospitals. The RAND corporation provides information on the financial health and viability of hospitals and health care systems.

Objective

Our study aimed to establish and psychometrically validate a new Hospital Resilience Index.

Design

We took the two databases as primary data sources, and defined hospital closure as the main negative outcome. We performed descriptive statistics, and regression analysis of the databases.

Main outcomes and Measures

Likelihood of hospital closure.

Results

Our findings show that a combination of eleven variables is strongly associated with the likelihood of hospital closure. These factors mirror smaller hospital size, lack of ancillary functions, staffing structure of the hospital, size of facilities, number of surgeries performed, Medicare discharges, operating expenses, and medical school affiliation as a teaching hospital. We further classified hospitals with a low HRI (<25) or high HRI (>25). In this setup, we found that both hospitals with a low HRI and hospitals that would subsequently close were characterized by smaller patient census, smaller numbers of surgeries, fewer beds, a smaller staff, and a lower operating margin.

Conclusions and Relevance

Together, these factors would point to a higher resilience to external stressors in larger, more expanded hospitals and healthcare systems, offering a broad range of services, and having a higher operating margin. The higher tiers of the healthcare system therefore seem to have more resilience, but the recent Covid-19 pandemic exhibited how much all tiers in the system are needed to respond to extraordinary crises such as pandemics or large natural disasters. Future research should seek to determine whether tracking the HRI over time may be a tool to identify hospitals at risk of closure.

Key points

Question

Can existing databases (e.g., American Hospital Association) be used to quantify resilience of a hospital, and predict closure?

Findings

In this study, we combined data from the American Hospital Association Database, and the RAND corporation database to create a Hospital Resiliency Index, with the hard outcome of hospital closure. A combination of eleven variables characterized hospitals which would subsequently close, mostly pointing towards smaller, rural hospitals.

Meaning

Our study is the basis for potential monitoring of hospital resilience using data readily available for every U.S. hospital on an annual basis, to allow for identification of at-risk hospitals over time.