Worse Outcomes for Patients at Isolated Rural Hospitals

Patients likely to get lower quality of care at rural hospitals

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients at smaller, rural hospitals may not be getting the same quality of care as some of the larger hospitals inside major cities. A study indicates patients at these less accessible hospitals have a greater chance of dying from serious illnesses such as congestive heart failure.

Harvard School of Public Health researchers said the study marked the first national study to examine care at critical access hospitals in rural areas. It revealed that such facilities have fewer clinical capabilities, lower quality of care and worse patient outcomes.

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The study revealed that patients admitted at such facilities had 30 to 70 percent higher odds of dying within 30 days after being admitted for heart attack, congestive heart failure or pneumonia.

The government defines critical access hospitals as geographically isolated facilities with fewer than 25 acute care beds. About 25 percent of U.S. hospitals have received that designation from the Medicare Rural Hospital Flexibility Program of the 1997 Balanced Budget Act. The program, which included payment reform, was created to ensure access to care for those that live in rural areas.

Ashish Jha, senior author on the study and an associate professor in HSPH's department of health policy and management, said she was surprised at the findings, and that the results of the study indicate a need to offer additional aid in helping these hospitals to improve.

Researchers analyzed the records of 2.5 million Medicare fee-for-service beneficiaries at 4,738 hospitals, diagnosed with heart attack, congestive heart failure, and pneumonia between 2008 and 2009.

Compared with other hospitals, critical access hospitals were less likely to have intensive care facilities, advanced cardiac care capabilities, or even basic electronic health records.  About a quarter of the hospitals examined were critical access hospitals.

The findings were published in the Journal of the American Medical Association.

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Review Date: 
July 6, 2011
Last Updated:
July 8, 2011