Small, rural hospitals with 'critical access' designation have poorer patient outcomes and lower quality of care, study finds

A study has found that small, rural hospitals with the "critical access" designation have poorer patient outcomes and lower quality of care.

The analysis, performed by researchers at the Harvard School of Public Health, focused on nearly 1,300 critical access hospitals, a designation is given to facilities that have 25 or fewer acute-care beds and are more than 35 miles away from another hospital. In return for such concessions as limiting patient stays, CAHs get extra Medicare and Medicaid reimbursements. The Rural Assistance Center reports there are 30 CAHs in Kentucky.

The study looked at the outcomes of Medicare patients who have congestive heart failure, heart attacks and pneumonia. For all three conditions, CAHs performed at a lower standard. For patients treated for heart attacks, CAHs provided care in keeping with Hospital Quality Alliance standards 91 percent of the time, compared to 98 percent at other hospitals. The difference was even larger for patients with congestive heart failure patients (80.6 percent vs. 93.5 percent) and smaller "but still significant" for pneumonia (89.3 percent vs. 93.7 percent), the report says.

Patients at CAHs were also more likely to die. They had higher 30-day risk-adjusted mortality rates for all three conditions than patients admitted to other hospitals. The study also found CAHs behind in the implementation of electronic health records, 6.5 percent to nearly 14 percent.

"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain," the study authors write. "Although 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." (Read more)