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CAH Study Author Defends Surprising Data

John Commins, for HealthLeaders Media, April 3, 2013

It's not fake data. These are real people. They are dead. These are Medicare patients, someone's grandmother who died. It is true that administrative data will give you statistically significant results for very small differences because we have millions of people. That is a sample size issue.

But the differences, particularly for acute MI are clinically relevant. It is more than a third higher mortality over the last decade for heart attacks where the rest of the country has been improving care for heart attacks. That is not write-off-able.

Let's stop ignoring these hospitals and see if we can think creatively to help rural patients do better.

HLM: How should CAHs reforms be implemented?

KJ: We need to get the stakeholders from critical access hospitals at the table and hear from them what they need. I'm not the person who will come up with a solution. My guess is that critical access hospitals could lay out for us 'these are the barriers I face in trying to get my patients access to X,Y,Z care and these are the things that could make my job easier.' We should listen to the critical access hospitals and find out how federal and state policies can connect them better and enable them more and give them more resources.

I don't actually care about the hospitals so much. I care about the patients. If your grandmother lives in some rural place you want to know that there is some community institution close to home where she can go if she needs something and where they can make a decision about what is best for her, on whether or not the things she needs can be provided there, and that she can come back there to get whatever she needs when she is done in the big city.

The system as it is now is not very robust for rural patients.


John Commins is a senior editor with HealthLeaders Media.

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6 comments on "CAH Study Author Defends Surprising Data"


Dean Coddington (4/4/2013 at 3:43 PM)
Hi, Having worked with a number of critial access hospitals over the years, they have a different relationship with their communities. Older people, when sick, like to go to a place where they know the staff and where relatives can easily visit them. Therefore, they often resist transfer to nearby tertiary care centers in larger cities. I believe this is a key factor differentiating CAHs. DCC

JKuriyan (4/4/2013 at 10:56 AM)
The result is statistical and it is difficult to grasp the strengths and weaknesses without more details, like error bars and standard deviations. For example, how do the results vary amongst the rural CAHs? Are there urban CAHs that performed as poorly as rural CAHs? The author's recommendation of tele-health tools to bring urban experts to rural areas via the web sounds a little too simple. What's the point if the rural hospitals are not equipped to perform new and complex procedures? Transporitng them to urban hospitals may not be affordable or practical depending on the medical issue. Another example where capitalism struggles to meet medical needs of societies. There are solutions but they are unacceptable to US citizens. So let's move on! I am not sure if this was covered in the last page of the article - a full page Ad blocked it, an unnecessarily intrusive step that insults the readers and the belittles the contribution of the journalist.

Chris (4/4/2013 at 10:37 AM)
Answer to confusedreader, CAH is Critical Access Hospital