Tomorrow a Nationally respected Medical Journal (the Journal of the American Medical Association) is issuing a report on “Quality of Care and Patient Outcomes in Critical Access Hospitals.” The report uses a scientific approach to determining if there is a difference between critical access hospitals (CAHs, such as Mendocino Coast District Hospital) and non-Critical Access Hospitals when it comes to quality. The report provides evidence that when looking at Nationally recognized hospital quality data, that critical access hospitals consistently come in with lower quality scores than non-critical access hospitals. I have 2 reactions to the report. First, I think that the report misses the boat by not recognizing that there are some fundamental differences between CAH hospitals and non-CAH hospitals. The most major difference is that the CAHs exist in smaller rural markets with much less availability of physicians, specialist physicians and advanced clinical capabilities (such as cardiac catheterization labs). Also, critical access hospitals are focused on keeping only those patients that can be treated safely in a smaller hospitals and transfering the more acutely ill patients to larger hospitals. In the JAMA study, patients that were transfered to a larger hospital were excluded from some of the analysis. So my first reaction is that quality in critical access hospitals needs to be measured differently than quality in urban hospitals. My second reaction is that our hospital, Mendocino Coast District Hospital, compares very well to the National database that the JAMA article uses. The data that they are using is available to anybody with a computer and internet access. It’s available on a website called “Hospital Compare” on the Medicare site, http://www.hospitalcompare.hhs.gov/ We have an ICU here, which is a big advantage for a critical access hospital (only 30% of them do, according to the report). And in the areas of “processes of care” and “clinical outcomes” we compare pretty well. In those 2 areas on the Medicare Hospital Compare website, we report and we consistently show as being comparable to larger hospitals. The one caveat that I would point out is that, due to our low numbers, many of our scores have a footnote number 1. Footnote number 1 says “the number of cases is too small to be sure how well a hospital is performing.” So, in other words, even though the report says that our numbers are good, it is also saying that small numbers are unreliable.
My conclusions from reading the JAMA article are that (1) there needs to be more study on what constitutes high quality in critical access hospitals and (2) Mendocino Coast District Hospital is doing all of the right things to ensure that we are providing a high quality of care here on the Mendocino Coast.