ArticleJAMA2011
Quality of care and patient outcomes in critical access rural hospitals.
Article in JAMA, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 100 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Hospital-Level Care at Home for Acutely Ill Adults in Rural and Ultra-Rural Settings: Proof of Concept
Hospital-Level Care at Home for Acutely Ill Adults in Rural Settings: A Randomized Controlled Trial
Who cites it
100 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Care for Atrial Fibrillation and Outcomes in Rural Versus Urban Communities in the United States: A Systematic and Narrative Review.Journal of the American Heart Association · 2025Pooled it
- Hospital-Level Care at Home for Adults Living in Rural Settings: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A Randomized Clinical Trial.JAMA cardiology · 2021Trial
- Impacts of a Rural Hospital Global Budget Alternative Payment Model on Patterns of Cancer Surgery.Medical care · 2026Article
- Evaluating fifteen years of national policy in Israel to overcome socio-geographic health disparities in Israel's Northern District: a mixed-methods study.International journal for equity in health · 2026Article
- Association between Rurality and Evaluation Start among Referred Patients with End-Stage Kidney Disease.American journal of nephrology · 2026Article
- Article
- Payer mix shifts and profitability at critical access hospitals, 2011 to 2023.Health affairs scholar · 2026Article
- Income and Geographic Disparities in in-Hospital Mortality Following Cardiovascular Procedures: Evidence From the National Inpatient Sample, 2016-2022.Health services research · 2026Observational
- A Scoping Review of Inpatient Medical and Surgical Quality Outcomes at Critical Access Hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Trends and disparities in disseminated intravascular coagulation-related mortality among adults aged 25 and above in the U.S., 1999-2020: CDC WONDER insights.Thrombosis journal · 2026Article
- Alcoholic and non-alcoholic acute pancreatitis mortality in the United States, 2006-2023: A nationwide trend analysis.Scientific reports · 2026Article
- Exploring the drivers of price variation in orthopaedic radical bone tumor resection: A nationwide database study.PloS one · 2026Article
- Article
- Skill mix versus flexibility: Decoding nurse staffing impacts on critical access hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Inpatient care experiences are better in critical access hospitals than in other hospitals.Health affairs scholar · 2025Article
- Service Changes, Utilization, and Financial Performance After Critical Access Hospitals Join Hospital Systems.Cureus · 2025Article
- Examining naloxone access and interest in secondary naloxone distribution on an American Indian Reservation in the Northern Midwest of the United States.Drug and alcohol dependence reports · 2024Article
- Kidney transplant cases in US: study of determinants of variance in hospital charges and inpatient care.Health economics review · 2024Review
- Tracking the Uneven Outcomes of COVID-19 on Racial and Ethnic Groups: Implications for Health Policy.Journal of racial and ethnic health disparities · 2024Article
40 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
contextCritical access hospitals (CAHs) play a crucial role in the US rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for individuals living in rural areas in the United States; however, little is known about the quality of care they provide or the outcomes their patients achieve.
objectivesTo examine the quality of care and patient outcomes at CAHs and to understand why patterns of care might differ for CAHs vs non-CAHs. DESIGN, SETTING, AND PATIENTS: A retrospective analysis in 4738 US hospitals of Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI) (10,703 for CAHs vs 469,695 for non-CAHs), congestive heart failure (CHF) (52,927 for CAHs vs 958,790 for non-CAHs), and pneumonia (86,359 for CAHs vs 773,227 for non-CAHs) who were discharged in 2008-2009.
main outcome measuresClinical capabilities, performance on processes of care, and 30-day mortality rates, adjusted for age, sex, race, and medical comorbidities.
resultsCompared with other hospitals (n = 3470), 1268 CAHs (26.8%) were less likely to have intensive care units (380 [30.0%] vs 2581 [74.4%], P < .001), cardiac catheterization capabilities (6 [0.5%] vs 1654 [47.7%], P < .001), and at least basic electronic health records (80 [6.5%] vs 445 [13.9%], P < .001). The CAHs had lower performance on processes of care than non-CAHs for all 3 conditions examined (concordance with Hospital Quality Alliance process measures for AMI, 91.0% [95% CI, 89.7%-92.3%] vs 97.8% [95% CI, 97.7%-97.9%]; for CHF, 80.6% [95% CI, 79.2%-82.0%] vs 93.5% [95% CI, 93.3%-93.7%]; and for pneumonia, 89.3% [95% CI, 88.6%-90.0%] vs 93.7% [95% CI, 93.6%-93.9%]; P < .001 for each). Patients admitted to CAHs had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI: 23.5% vs 16.2%; adjusted odds ratio [OR], 1.70; 95% confidence interval [CI], 1.61-1.80; P < .001; for CHF: 13.4% vs 10.9%; adjusted OR, 1.28; 95% CI, 1.23-1.32; P < .001; and for pneumonia: 14.1% vs 12.1%; adjusted OR, 1.20; 95% CI, 1.16-1.24; P < .001).
conclusionCompared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.