# The Effects of Changing Health Care Markets on Cardiovascular and Cerebrovascular Care and Outcomes

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $774,972

## Abstract

PROJECT SUMMARY
The health care delivery system is undergoing tremendous changes, with increasing consolidation from
mergers and acquisitions, as well as openings and closings of hundreds of emergency departments and
hospitals. These changes are typically driven more by the market and financial motivations rather than by
identification of need or gaps in access to care. The impact of these changes on access and receipt of high-
quality care are largely unknown.
These changes may be particularly impactful for acute cardiovascular and cerebrovascular (CV) care. Acute CV
events are leading causes of death and disability and patients with acute CV events require timely access to
reperfusion interventions for improved outcomes. The geographic distribution of hospitals, and interactions
between them through patient transfers, are key to ensuring patients’ receipt of high-quality acute CV care.
Mergers and acquisitions of hospitals have potential to improve CV care if they lead to increased investment
and improved specialty care at acquired hospitals or to enhanced transfer protocols with improved access to
tertiary care. Alternatively, they may lead to harm if they result in reduced access to necessary technology in
some communities or inappropriate transfers. The degree of investment versus divestment may vary
depending on the characteristics of the acquired hospital and the community it serves.
Hospital and emergency department openings and closures may also improve or harm CV care. Closures may
reduce access to CV care near where patients live and lead to fatal or disabling delays. Alternatively, closure of
lower quality sites may improve outcomes if patients increasingly receive care at higher volume, higher-quality
tertiary sites without substantially increasing time to treatment. Openings of new sites may also mitigate the
impact of closures if they occur in the same market. However, if openings occur in already well-resourced
markets they may widen existing disparities.
We aim is to quantify the effects of these market changes on CV patient outcomes, understand the underlying
mechanisms, and determine whether they have disproportionate impact on particular patient groups or
communities. In Aim 1, we will focus on mergers and acquisitions, and use a quasi-experimental design in
national Medicare and Medicaid data to examine their impact on receipt of advanced acute care and outcomes
among CV patients, to investigate the mechanisms through which changes occur, and to assess whether there is
differential effect by characteristics of the patient or the acquiring site’s parent organizations. In Aim 2, we will
use similar methods to examine the impact of openings and closings. Understanding the impact of these two
shifts in the health care market on acute CV care and the pathways by which they occur will be key to
identifying interventions and strategies to reduce disparities in CV access and outcomes and to inform policy
related to regulation of heal...

## Key facts

- **NIH application ID:** 10941228
- **Project number:** 1R01AG088829-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** NANCY DEAN BEAULIEU
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $774,972
- **Award type:** 1
- **Project period:** 2024-09-15 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10941228

## Citation

> US National Institutes of Health, RePORTER application 10941228, The Effects of Changing Health Care Markets on Cardiovascular and Cerebrovascular Care and Outcomes (1R01AG088829-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10941228. Licensed CC0.

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