Mortality Rates Up in Smaller Hospitals

Mortality rate for heart condition patients at critical access hospitals up since 02

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Though hospitals are the place to receive care fast, smaller hospitals might not be keeping up with the bigger ones. It appears the quality of care delivered does vary between hospitals.

The number of deaths among Medicare beneficiaries in critical access hospitals increased more than the number of deaths in non-critical access hospitals, a recently published study shows.

The increasing deaths among Medicare patients admitted for heart attacks, pneumonia and congestive heart failure demonstrate that new efforts might be needed to help smaller hospitals improve, according to researchers.

"Keep your heart strong - exercise often."

Researchers, led by Karen Joynt, MD, MPH, of the Harvard School of Public Health in Boston, looked at mortality trends in patients receiving care at critical access and non-critical access hospitals.

Critical access hospitals, under Congress' Critical Access Hospital program in response to increasing hospital closures in rural areas, must have no more than 25 beds and be located at least 35 miles from the nearest alternative inpatient care center.

The study included data obtained from the American Hospital Association surveys from millions of patients admitted to US acute care hospitals with Medicare fee-for-service between 2002 and 2010.

During that time span, nearly 2 million patients were admitted into acute care hospitals for heart attacks. Another 4.5 million had congestive heart failure, and 3 million had pneumonia.

Researchers tracked the number of deaths linked with the three conditions within 30 days of being admitted to the hospitals.

In 2002, researchers found that the mortality rate for critical access hospitals was 12.8 percent. Similarly, non-critical access hospitals had a mortality rate of 13 percent.

Each year afterward, the mortality rate increased 0.1 percent in critical access hospitals. At the same time, mortality rate decreased 0.3 percent in non-critical access hospitals each year on average.

By 2010, critical access hospitals had a mortality rate of 13.3 percent compared to 11.4 percent in non-critical access facilities.

Researchers said there are several possible reasons for the worsening mortality rate. For one, critical access hospitals are exempt from reporting performance data to the federal government.

Critical access hospitals also might not have kept up with non-critical access hospitals because of inherent limitations and the changing nature of hospital care.

And characteristics of the populations who visit each of the hospital types might also underlie the differences in mortality rates.

"Constraints on care in isolated rural areas can be substantial, and our findings suggest that the supports contained in the critical access hospital programs have not been adequate to help these hospitals overcome the challenges imposed by caring for this vulnerable patient population in remote settings," researchers wrote in their report.

Researchers noted a few limitations with the study. The included data did not take some of the patients' characteristics and treatment factors into account that might affect the results.

Treatment factors included travel times, availability of care immediately after patients' incidents and follow-ups with appropriate specialists.

The study, funded by the National Heart, Lung, and Blood Institute and the National Institutes of Health, was published online April 2 in the journal JAMA. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
April 6, 2013
Last Updated:
April 9, 2013