Karen E. Joynt|E. John Orav|Ashish K. Jha
Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non–Critical Access Hospitals, 2002-2010
critical access hospitals cahs provide inpatient care americans living rural communities hospitals high risk falling behind respect quality improvement owing limited resources vulnerable patient populations fared patient outcomes past decade unknownto evaluate trends mortality patients receiving care cahs compare trends patients receiving care noncahsretrospective observational study using data medicare feeforservice patients admitted us acute care hospitals acute myocardial infarction 1902586 admissions congestive heart failure 4488269 admissions pneumonia 3891074 admissions 2002 2010trends riskadjusted 30day mortality rates cahs acute care us hospitalsaccounting differences patient hospital community characteristics cahs mortality rates comparable noncahs 2002 composite mortality across 3 conditions 128 vs 130 difference 03 95 ci 07 02 p 25 2002 2010 mortality rates increased 01 per year cahs decreased 02 per year noncahs annual difference change 03 95 ci 02 03 p 001 thus 2010 cahs higher mortality rates compared noncahs 133 vs 114 difference 18 95 ci 14 22 p 001 patterns similar individual condition examined separately comparing cahs small rural hospitals similar patterns foundamong medicare beneficiaries acute myocardial infarction congestive heart failure pneumonia 30day mortality rates admitted cahs compared admitted acute care hospitals increased 2002 2010 new efforts may needed help cahs improve