The effect of critical access hospitals on patient outcomes

Rural hospitals play a very important role in their communities and yet they are at risk for closure due to difficult economic conditions. Because of their importance, federal programs such as the Critical Access Hospital Program have been developed to help rural hospitals remain viable. This study evaluated patient care outcomes associated with Critical Access Hospitals in Colorado and compared them to other rural hospitals called Candidate Critical Access Hospitals and Network Urban Partner Hospitals.; The study population was discharged patients from 1998--2002. A matching algorithm captured the complete episode of care for patients that were transferred to another acute care facility from the rural hospitals. Mixture regression models were used to test the hypothesis that in-hospital mortality was associated with hospital type and mixed effects regression models were used to test the hypotheses that LOS and total cost/day was associated with hospital type after adjusting for age, gender, race, payment source, and patient acuity.; When comparing discharged patients from Critical Access Hospitals with other rural hospitals, all discharged patients and Medicare patients had a statistically significant lower total cost/day. All discharged patients from Critical Access Hospitals had a statistically significant lower LOS when compared to other rural hospitals. All discharged patients and Medicare patients had a statistically significant lower LOS when compared to Network Urban Partner Hospitals. Hospital type was not a predictor of mortality when Critical Access Hospitals were compared to other rural hospitals. Critical Access Hospitals had a slightly higher in-hospital mortality rate compared to Network Urban Partner Hospitals when all discharged patients and Medicare patients were studied.; Changes in admitting practices, transfer bias, and the inability to control for case-mix differences between hospital types may be factors that contributed to the higher mortality rate at Critical Access Hospitals.; Critical Access Hospitals are meeting their objectives by providing expanded access to care to their communities. Bed capacity and LOS are managed through the swing beds and patient transfers to Network Urban Partner Hospitals.; This study provides information about Colorado Critical Access Hospitals' patient care outcomes that can be used as a reference point for future studies.