Tuesday, April 09, 2013

Rural health expert says report on critical-access hospital deaths drew wrong conclusions

The study that found death rates were on the rise for Medicaid patients who have heart attacks, heart failure and pneumonia at critical-access hospitals, which we reported last week, drew the wrong conclusions and should have said that researchers found no difference in survival between hospitals with 25-beds and larger hospitals, Dr. Wayne Myers opines for The Daily Yonder.

Published in the Journal of the American Medical Association, the study found that in 2002, critical-access hospitals had a death rate of 12.8 percent for such ailments, compared to the 13 percent rate at other hospitals. But from 2002 to 2010, mortality rates at critical-access hospitals increased 0.1 percent each year, to 13.3 percent, while the rates at other hospitals fell 0.2 percent each year, to 11.4 percent.

Myers, who was first director of the federal Office of Rural Health, argues that the study used faulty information: "Medicare keeps statistics on deaths at large hospitals for patients being treated for heart attacks, pneumonia or heart failure, but doesn’t track these death statistics for critical-access hospitals. Since they aren’t getting measured, the argument goes, critical-access hospitals don’t perform as well." He also said that most critical-access hospitals don't have intensive care units or keep patients with life-and-death issues, and that often people who have "decided that they are through paying all the human costs of the miracles of modern medicine" make the decision to remain in a critical-access hospital to "stay in familiar surroundings near home and family."

When patients show up at a critical-access hospital with symptoms of heart attack, pneumonia or heart failure, "The emphasis will be on making the diagnosis and arranging a speedy transfer to the regional medical center with its cardiac catheterization facilities," Myers writes. "For a person who wants the best chance of survival the large, regional hospital is the best bet. On the other hand, if it sounds as if the patient is likely to die even with intensive care, the large medical center is likely to resist taking him and risk getting a bad mark on the hospital’s statistics." (Read more)

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