Study: Some rural hospital care is worse

Plagued by having fewer resources and less access to specialists, many of the nation's small rural hospitals provide worse care than their larger urban counterparts, a new study shows.

The study appeared this week in the Journal of the American Medical Association and examined the ability of critical access hospitals to care for patients suffering heart attacks, congestive heart failure and pneumonia.

"Critical access hospitals" are those with 25 or fewer beds and located at least 35 miles from another hospital. Concerned that rural hospitals were under too much financial pressure, the federal government in 1997 created the designation, which provides greater Medicare reimbursements and helps maintain the health safety net in isolated areas. The move enabled many small hospitals to stay in business.

The study of data from 2008 and 2009 looked at nearly 5,000 hospitals across the country, almost 1,300 of them critical access hospitals. It found the smaller rural hospitals had lower performance on standard "processes of care" and also higher mortality rates for each of the three health conditions.

Chief author Karen E. Joynt, of the Harvard School of Public Health, concluded:

"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain. 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."

The study noted that finding adequate personnel and resources is difficult for small rural hospitals. It suggested that fuller use of electronic health records and advances in telemedicine can help address the problem.

Terry Hill, executive director of the National Rural Health Resource Center in Duluth, called the study a wake-up call for rural health providers, although he noted that other data put rural care in a different light. Surveys that measure patient satisfaction, which also figure into Medicare reimbursement, for example, show rural hospitals often out-achieving urban hospitals.

Hill also said that previous studies showed critical access hospitals doing better than urban hospitals on pneumonia patients. He added that simply being in a rural setting with less access to home care and other factors beyond a hospital's control can affect the numbers in a study like this.

But "it would be a mistake to say we totally reject these findings," Hill said. The research will certainly be a prime topic at a national rural health care conference next week in Maine, he said, and could serve as an impetus to improve data collection as well as health care at rural hospitals.

For more on rural health care and how Minnesotans are dealing with its challenges, see our Ground Level collection of coverage.

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