title: Increased patient delays in care after the closure of Martin Luther King Hospital: implications for monitoring health system changes.
abstract: BACKGROUND
  The safety net system remains an important part of the health care system for uninsured and minority populations, however, the closure of safety net hospitals changes the availability of care. Using community-based participatory research methods, we explored the impact of hospital closure among late middle aged and elderly racial/ethnic minorities in South Los Angeles.
  
  
  METHODS
  Telephone survey of participants in both 2008, after hospital closure, and 2003, before hospital closure, who self-identified as African American or Latino, were over the age of 50 and lived in zip codes of South Los Angeles. We developed multiple logistic regression models on imputed data sets weighted for non-response and adjusted for self-reported measures of demographic and clinical characteristics to examine the odds of reporting delays in care.
  
  
  RESULTS
  After adjusting for covariates known to influence access to care and distributed differently in the two survey samples, we found significantly greater delays in care. Following the closure of the Martin Luther King, Jr. safety net hospital, the adjusted odds ratios were 1.70 (95% CI 1.01, 2.87) for delays in care, 1.88 (95% Cl 1.06, 3.13) for problems receiving needed medical care, and 2.62 (95% CI 1.46, 4.67) for seeing a specialist.
  
  
  CONCLUSIONS
  Our survey of older minority adults in South Los Angeles found increased delays in access to care for needed medical services after the closure of Martin Luther King, Jr. Hospital. As health care reform unfolds, monitoring for changes in access to care that may result from new policies will be important to address future disparities, particularly for vulnerable populations.
authors.affiliation: Department of Family and Community Medicine, University of California, San Francisco, USA. odomwalkerk@fcm.ucsf.edu
authors.forename: Kara Odom
authors.initials: KO
authors.lastname: Walker
authors.forename: Mei
authors.initials: M
authors.lastname: Leng
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: Nell
authors.initials: N
authors.lastname: Forge
authors.forename: Leo
authors.initials: L
authors.lastname: Morales
authors.forename: Loretta
authors.initials: L
authors.lastname: Jones
authors.forename: Arleen
authors.initials: A
authors.lastname: Brown
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006271:Health Facility Closure; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D014850:Waiting Lists