Thursday, August 4, 2011

Should Rural Health Care Be Equivalent?

"All residents in the United States should have access to safe, high-quality health care and should have confidence in the health care system regardless of where they live."

That is the final statement of the accompanying editorial to the JAMA article documenting superiority in outcomes in urban hospitals vs. critical care access rural hospitals for acute MI, CHF, and pneumonia.  The acute MI study population is slightly more ill at baseline in the rural hospital sample, but the groups are otherwise similar.  Raw mortality is higher for AMI (26.1% vs 23.9% adjusted), CHF (13.4% vs. 12.5%) and pneumonia (13.0% vs. 12.5% [not significant]) favoring urban hospitals.

The key feature - critical access hospitals were less likely to have ICUs, cardiac cath, surgical capabilities, and had reduced access to specialists.  Is it any wonder their outcomes are worse?  As someone who moonlit in one of these hospitals as a resident, I can guarantee the standard of care in a rural setting is lower.

But, coming back to the original supposition - is it realistic to dedicate the funding and resources to bring rural hospitals up to the standard?  To equip far-flung hospitals with the same standard of care as urban settings to cover the remaining 20% of the population is likely simply an unfeasible proposition.  Living in rural areas is simply going to come with the risks associated with unavoidable delays in care and reduced access to specialists and technology.

"Quality of Care and Patient Outcomes at Critical Access Rural Hospitals"
www.ncbi.nlm.nih.gov/pubmed/21730240
"Critical Access Hospitals and the Challenges to Quality Care"
www.ncbi.nlm.nih.gov/pubmed/21730248

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