A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States

Lutfiyya, M. Nawal; Bhat, Deepa K.; Gandhi, Seema; Nguyen, Catherine; Weidenbacher-Hoper, Vicki; Lipsky, Martin S.

doi:10.1093/intqhc/mzm010

Cited by 77 publications

(59 citation statements)

References 24 publications

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“…Rural hospitals might also less often follow acute myocardial infarction process measures. [34][35][36] The reasons for greater recurrence of pneumonia at rural hospitals are less clear but could relate to worse performance on evidence based care processes, 33 differences in use of resources after acute care, 37 or greater difficulties accessing care. 38 39 Despite these uncertainties, the different composition of readmission diagnoses at these facilities could be useful in guiding disease surveillance after hospital discharge.…”

Section: Implications For Reducing Readmissionsmentioning

confidence: 99%

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Dharmarajan

Hsieh

Lin

et al. 2013

BMJ

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Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions.Design Retrospective cohort study.Setting Medicare beneficiaries in the United States.Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measuresReadmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services' condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers.Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns.Conclusions High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.

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Section: Implications For Reducing Readmissionsmentioning

confidence: 99%

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Dharmarajan

Hsieh

Lin

et al. 2013

BMJ

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“…The negative impact of CAH conversion must thus be driven by the negative perception of quality of treatment in converted hospitals due to the findings in the medical literature (e.g. Joynt et al (2011) and Lutfiyya et al (2007)). Our results show that these findings are confirmed by patient choice data taking into account the heterogeneity of hospitals prior to conversion.…”

Section: Mnl Demand Estimatesmentioning

confidence: 99%

Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare

Gowrisankaran

Lucarelli

Schmidt-Dengler

et al. 2018

Journal of Health Economics

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Abstract This paper seeks to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on rural resident hospital choice and welfare. The Flex program created a new class of hospital, the Critical Access Hospital (CAH), which receives more generous reimbursement in return for limits on capacity and length of stay. We find that conversion to CAH status reduced inpatient admissions by a mean of 5.4%, of which almost all was driven by factors other than capacity. The program increased consumer welfare if it reduced the closure rate by at least 4 percentage points. Terms of use: Documents in EconStor may

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“…12 Some research has indicated the provision of critical care in CAHs is problematic and associated with poor outcomes for patients. 32 One example of strategic efforts to improve patient outcomes is seen in the state of Kansas. The Kansas Critical Care Collaborative (KCCC) surveyed CAHs throughout their state, finding one-third of the responding hospitals had a critical care unit, and 2 had physicians with critical care board certification.…”

Section: Review Of Strategies For Collaborationmentioning

confidence: 99%

Critical Care in Critical Access Hospitals

Seright

Winters

2015

Critical Care Nurse

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What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care. (Critical Care Nurse. 2015;35[5]:62-67)

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A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States

Cited by 77 publications

References 24 publications

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare

Critical Care in Critical Access Hospitals

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