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AHA: Critical Access Hospital Study 'Distorted'

Alexandra Wilson Pecci, for HealthLeaders Media, July 13, 2011

A report in a major medical journal is ruffling feathers.

A study about the quality of critical access hospitals published in the Journal of the American Medical Association finds that CAHs have fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with three common conditions, compared to non-CAHs.

Although the authors comment that "CAHs provide much-needed access to care for many of the nation's rural citizens," the study has ruffled a few feathers, at the American Hospital Association, where in a statement, president and CEO Rich Umbdenstock called the study "distorted." The National Rural Health Association was no more favorably impressed and called the report and its findings "deficient."

In a retrospective analysis of 4,738 U.S. hospitals, researchers examined outcomes for Medicare fee-for-service beneficiaries with acute myocardial infarction, congestive heart failure, and pneumonia who were discharged in 2008-2009. It found that patients admitted to CAHs had higher 30-day mortality rates than those admitted to non-CAHs. It also found that compared with other hospitals, CAHs were less likely to have ICUs, cardiac catheterization capabilities, and at least basic EHRs.

According to Ashish Jha, MD, MPH, associate professor of health policy at the Harvard School of Public Health and the senior author on the paper, although CAHs have gotten a lot of attention in terms of funding, they haven't gotten adequate attention in measuring quality.

"Across almost every measure we looked at, the quality of care was not as good; their adherence to clinical guidelines was not as good; patient outcomes were much worse at these hospitals," he said in an interview. "I think the magnitude of the differences were really substantial, suggesting we have a lot of work to do to help these hospitals get better."

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