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Study: Death Rate Higher in Remote 'Critical Access' Hospitals

A recent study published in the Journal of the American Medical Association reports that remote, rural hospitals experienced higher death rates than others did in the study period, which was between 2002 and 2010. Because these are often considered “critical access” facilities for those who would otherwise be geographically too distant from a hospital to receive adequate emergency medical care, they are paid more by Medicaid and subject to fewer reporting requirements.

How many of these fatalities were cases of wrongful death is not clear. What JAMA did find, however, is that while the mortality rate was improving over the study period in U.S. hospitals as a whole, it was worsening at these remote hospitals.

“This carved-out group of hospitals seems to be falling further and further behind,” said the study’s lead author, a doctor with the Harvard School of Public Health.

The reason for the higher death rates is not entirely clear. It may be that these hospitals are simply too distant — or too few — to meet the emergency medical needs of their patients. Or it may be, as the study’s author suggests, that these isolated hospitals can’t afford the latest technology or dedicated specialists in unusual practice areas, which more urban hospitals can at least share with other facilities.

However, the diseases people are dying from don’t suggest the need for more expensive technology or specialists. According to the study, patients died from heart attacks, heart failure and pneumonia 13.3 percent of the time in isolated rural hospitals in 2010, but only 11.4 percent in others.

A spokesperson for the National Rural Health Association said that “mortality is just one small part of the picture” when judging hospital quality. That may be true, but if those higher mortality rates indicate higher rates or wrongful death due to medical malpractice, the other parts of the picture may not matter.

Source: The St. Paul Pioneer Press, “Study says death rates worse at rural hospitals,” April 7, 2013