Fewer Clinical Capabilities in Critical Access Rural Hospitals

Rural CAHs have fewer clinical capabilities, poorer performance, and higher mortality rates

TUESDAY, July 5 (HealthDay News) -- Rural critical access hospitals (CAHs) have fewer clinical capabilities, significantly poorer performance on process measures, and higher 30-day mortality rates than non-CAHs for patients with acute myocardial infarction (AMI), congestive heart failure, and pneumonia, according to a study published in the July 6 issue of the Journal of the American Medical Association.

Karen E. Joynt, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues compared the quality of care given to Medicare patients at 1,268 rural CAHs with 3,470 non-CAHs between 2008 and 2009. Participants had primary discharge diagnoses of AMI, congestive heart failure, or pneumonia. Clinical capabilities, performance on processes of care, and 30-day mortality rates, adjusted for age, gender, race, and medical comorbidities, were the main outcomes measured.

The investigators found that, compared with non-CAHs, the CAHs were significantly less likely to have intensive care units, cardiac catheterization capabilities, and basic electronic health records. The performance of processes of care delivered in CAHs was significantly lower for AMI, congestive heart failure, and pneumonia. The 30-day mortality rates were significantly higher for all three conditions for patients admitted to CAHs than those admitted to non-CAHs (adjusted odds ratios: 1.70 for AMI, 1.28 for congestive heart failure, and 1.20 for pneumonia).

"Compared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, congestive heart failure, or pneumonia," the authors write.

One of the study authors disclosed financial ties to the health care industry.

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