Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non-Critical Access Hospitals, 2002-2010

被引：66

作者：

Joynt, Karen E. ^{[1
,3
,5
]}

Orav, E. John ^{[2
,4
]}

Jha, Ashish K. ^{[1
,4
,5
]}

机构：

[1] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA

[2] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

[3] Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Boston, MA 02115 USA

[4] Brigham & Womens Hosp, Div Gen Internal Med, Boston, MA 02115 USA

[5] VA Boston Healthcare Syst, Boston, MA USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 309卷 / 13期

基金：

美国国家卫生研究院;

关键词：

30-DAY MORTALITY; MYOCARDIAL-INFARCTION; QUALITY; CARE; OUTCOMES; COSTS;

D O I：

10.1001/jama.2013.2366

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Importance Critical access hospitals (CAHs) provide inpatient care to Americans living in rural communities. These hospitals are at high risk of falling behind with respect to quality improvement, owing to their limited resources and vulnerable patient populations. How they have fared on patient outcomes during the past decade is unknown. Objective To evaluate trends in mortality for patients receiving care at CAHs and compare these trends with those for patients receiving care at non-CAHs. Design, Setting, and Patients Retrospective observational study using data from Medicare fee-for-service patients admitted to US acute care hospitals with acute myocardial infarction (1 902 586 admissions), congestive heart failure (4 488 269 admissions), and pneumonia (3 891 074 admissions) between 2002 and 2010. Main Outcome Measures Trends in risk-adjusted 30-day mortality rates for CAHs and other acute care US hospitals. Results Accounting for differences in patient, hospital, and community characteristics, CAHs had mortality rates comparable with those of non-CAHs in 2002 (composite mortality across all 3 conditions, 12.8% vs 13.0%; difference, -0.3% [95% CI, -0.7% to 0.2%]; P=.25). Between 2002 and 2010, mortality rates increased 0.1% per year in CAHs but decreased 0.2% per year in non-CAHs, for an annual difference in change of 0.3% (95% CI, 0.2% to 0.3%; P<.001). Thus, by 2010, CAHs had higher mortality rates compared with non-CAHs (13.3% vs 11.4%; difference, 1.8% [95% CI, 1.4% to 2.2%]; P<.001). The patterns were similar when each individual condition was examined separately. Comparing CAHs with other small, rural hospitals, similar patterns were found. Conclusions and Relevance Among Medicare beneficiaries with acute myocardial infarction, congestive heart failure, or pneumonia, 30-day mortality rates for those admitted to CAHs, compared with those admitted to other acute care hospitals, increased from 2002 to 2010. New efforts may be needed to help CAHs improve. JAMA. 2013;309(13):1379-1387 www.jama.com

引用

页码：1379 / 1387

页数：9

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