Mortality Rates Higher at Critical Access Hospitals

A new study reveals that mortality rates in critical access hospitals (CAHs) located in rural areas in the United States, have risen in the last decade, while mortality rates in other hospitals have declined.

Researchers at the Harvard School of Public Health (HSPH; Boston, MA, USA) conducted a retrospective observational study using data from Medicare fee-for-service patients admitted to US CAHs with acute myocardial infarction (MI, 1,902,586 admissions), congestive heart failure (CHF, 4,488,269 admissions), and pneumonia (3,891,074 admissions) between 2002 and 2010. The main outcome measures were trends in risk-adjusted 30-day mortality rates for CAHs compared with those for patients receiving care at non-CAHs.

The results showed that CAHs had mortality rates comparable with those of non-CAHs in 2002; but between 2002 and 2010, mortality rates increased 0.1% per year in CAHs, and decreased 0.2% per year in non-CAHs, for an annual difference in change of 0.3%. By 2010, CAHs had higher mortality rates compared with non-CAHs (13.3% versus 11.4%, respectively). The patterns were similar when each individual condition was examined separately, and when CAHs were compared with other small, rural hospitals. The study was published in the April 3, 2013, issue of the Journal of the American Medical Association (JAMA).

“The findings suggest that critical access hospitals have not kept pace with [other] hospitals because of the changing nature of hospital care and the inherent limitations critical access hospitals face in keeping up with new technology,” concluded lead author Karen Joynt, MD, MPH, and colleagues. “New policy initiatives may be needed to help these hospitals provide care for US residents living in rural areas.”

CAHs are at high risk of falling behind with respect to quality improvement, owing to their limited resources and vulnerable patient populations. But in addition to suggesting that CAHs lacked the resources to keep up with other institutions in technology and care quality improvements, the researchers also argue that the critical access program itself might share in the blame.

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