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Quality-of-care among Critical Access Hospitals not up to standards
KE Joynt. JAMA. 2011; 305(7):675-681.
Despite the success of the Critical Access Hospitals program, researchers suggest the quality of care provided by the program does not uphold the same standards as non-Critical Access Hospitals, according to new findings published in The Journal of the American Medical Association.
“Although Critical Access Hospitals [CAHs] provide much-needed access to care for many of the nation’s rural citizens, we found that these hospitals, with their fewer clinical and technological resources, less often provided care consistent with standard quality metrics and generally had worse outcomes than non-CAHs,” the researchers wrote.
For the study, Joynt and colleagues assessed 2,351,701 patients discharged with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia from both CAHs and non-CAHs between 2006 and 2008. Researchers compared data on hospital characteristics, demographics, and patient comorbidities between CAHs and non-CAHs. Primary outcome measure was the risk-adjusted odds of 30-day readmission.
Black, elderly Medicare recipients were more likely to be readmitted after hospitalization when compared with whites (24.8% vs. 22.6%; OR=1.13; 95% CI, 1.11-1.14). Readmission rates were higher among those at minority-serving hospitals compared with those from non–minority-serving hospitals (25.5% vs. 22%; OR=1.23; 95% CI, 1.20-1.27), according to the researchers.
“The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients,” they wrote.
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