Mortality rates at rural hospitals unusually high

Mortality rates at rural hospitals unusually high

Death rates for medicare beneficiaries being treated at critical access hospitals in rural areas increased from 2002 to 2010, while rates in other hospitals fell, according to new research published in JAMA.

The analysis, led by Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, examined data from over 10 million Medicare patients who experienced a heart attack, pneumonia, or congestive heart failure between 2002 and 2010.

For those given treatment at critical access hospitals (hospitals that give inpatient care to people living in rural areas), the 30-day mortality rates rose during this time period, compared with patients treated at other acute care hospitals.

According to background information in the article:

"More than 60 million Americans live in rural areas and face challenges in accessing high-quality inpatient care. In 1997, the U.S. Congress created the Critical Access Hospital (CAH) program in response to increasing rural hospital closures. Hundreds of hospitals have joined the program over the past decade - by 2010, nearly 1 in 4 of the nation's hospitals were CAHs.... These hospitals are at high risk of falling behind with respect to quality improvement, owing to their limited resources and vulnerable patient populations. How they have fared on patient outcomes during the past decade is unknown."

The researchers executed a study to measure trends in mortality among patients being treated at critical access hospitals and compared them with those among patients getting care at non-CAHs.

The study consisted of data from Medicare fee-for service patients receiving care from U.S. acute care hospitals between 2002 and 2010 who had:

  • a heart attack - 1,902,586 admissions
  • congestive heart failure - 4,488,269 admissions
  • pneumonia - 3,891,074 admissions
In 2010, nearly 28% of U.S. hospitals giving acute care to Medicare patients and reporting to the American Hospital Association were CAHs.

The investigators revealed that there were variances in trends in 30-day mortality rates over time between non-CAHs and CAHs for the three medical issues measured.

The authors explained:

"When a composite across the 3 conditions was formally tested, adjusting for teaching status, ownership, region, rurality, poverty, and local physician supply, composite baseline mortality was similar between CAHs and non-CAHs (12.8 percent vs. 13.0 percent).

However, between 2002 and 2010, mortality rates increased at CAHs at a rate of 0.1 percent per year, whereas at non-CAHs they decreased 0.2 percent per year, for a difference in change in mortality of 0.3 percent per year. Thus, by 2010, CAHs had higher overall mortality rates (13.3 percent vs. 11.4 percent). In total, CAH admissions were associated with 10.4 excess deaths per 1,000 admissions during the study period."

Despite the fact that CAHs had greater mortality rates by 2010 for all the medical issues analyzed, the absolute variance was only 1.8%.

Trends were similar for each of the three conditions individually. Similar trends were also found when comparing CAHs with other small, rural hospitals.

The researchers concluded, "Given the substantial challenges that CAHs face, new policy initiatives may be needed to help these hospitals provide care for U.S. residents living in rural areas."

In 2009 the Centers For Medicare & Medicaid Services officially recognized the Joint Commission's Critical Access Hospital Accreditation. This allowed many seniors to have access to care in rural towns and cities.

Zithulele - A Rural Healthcare Success Story (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice