Rising death rates at rural hospitals suggest need for improvements

Death rates are rising at rural hospitals that serve many poor and elderly people—and the reason may be their inability to provide the most up-to-date treatment, according to a new Harvard School of Public Health (HSPH) study. Given this finding, HSPH researchers say the hospitals may need further help to provide care for these vulnerable patients. The study appeared in the April 3, 2013 issue of JAMA (Journal of the American Medical Association).

The HSPH researchers—Karen Joynt, instructor of health policy and management; E. John Orav, associate professor of biostatistics; and Ashish Jha, professor of health policy and management—looked at the performance of so-called “critical access hospitals,” which are small, rural hospitals that receive government reimbursements at 101% of costs and are exempted from participation in national quality improvement programs. The federal government began the Critical Access Hospital (CAH) program in 1997 in response to increasing rural hospital closures. Currently, nearly 1 in 4 of the nation’s hospitals are CAHs.

For the JAMA study, the HSPH researchers analyzed data on more than 10 million Medicare beneficiaries—who were admitted either to critical access hospitals or to other acute care hospitals with a heart attack, congestive heart failure, or pneumonia—and compared 30-day mortality rates for each of the three conditions over a nine-year period. A decade ago, mortality rates for each of these conditions were roughly the same at both CAHs and non-CAHs. But between 2002 and 2010, the researchers found, mortality rates at CAHs increased at a rate of 0.1% per year, whereas at non-CAHs they decreased 0.2% per year. By 2010, CAHs had higher overall mortality rates—13.3%, vs. 11.4% at non-CAHs.

Interviewed on MedPage Today, lead author Joynt said the higher death rates of patients at these hospitals aren’t just a hospital problem, but rather a systems problem. “Small rural hospitals are being left behind,” she said. “By creating a separate category for these hospitals, we’ve really left them out of many of the advances in medical care over the past decade, and we need systems-level solutions to help improve healthcare in these rural areas.”

Watch video of Karen Joynt discussing the study on MedPage Today

Read a PBS NewsHour article

Read Ashish Jha’s blog about the JAMA paper

Learn more

Patients at small, isolated rural hospitals in U.S. more likely to receive lower quality of care compared with other hospitals (HSPH release)