Date of Conferral



Doctor of Healthcare Administration (D.H.A.)


Human Services


Dr. David Anderson


Over 440,000 U.S. citizens are dying annually from avoidable, hospital-associated adverse events, with rural inhabitants experiencing more significant health threats than any other group in the United States. The trend of large health systems acquiring and consolidating rural hospitals (RHs) to improve the coordination of clinical care is backfiring, and accumulating patient safety risks. Although arguments for supporting hospital mergers in the past have focused on efficiency and presented a chance for struggling RHs with a financial survival mode, limited research has explicitly examined the impact of rural hospital mergers (RHMs). This study was constructed to explore the relationship between rural communities and hospital mortality through conducting a performance comparison of RHs post mergers. The theoretical perspective for this study was grounded on Donabedian’s quality improvement model. Logistic regression was used to examine various hospital performance measures and to assess the potential association of healthcare transformation changes in structures, processes, organizational culture, and values on clinical outcomes for rural patients post mergers. Unlike previous reports, the results of this study demonstrated that RHMs are correlated with increased clinical care disruptions, as well as higher admissions, and inpatient mortality rates. The results of this study could make substantial contributions to the field of healthcare administration and may result in significant social change through recognizing the rural population as a separate group in research, analyzing patient risks affecting this group, and comparing them with other factors that contribute to the disparity of accessing the quality of care and mortality rates, which will significantly remedy clinical challenges.