title: Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
abstract: The aim of the study was to examine whether Critical Access Hospitals (CAHs), the predominant type of hospital in small and isolated rural areas, perform better than, the same as, or worse than Prospective Payment System (PPS) hospitals on measures of quality.
  
  
  
  The Healthcare Cost and Utilization Project State Inpatient Databases and American Hospital Association annual survey data were used for analyses. A total of 35,674 discharges from 136 nonfederal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included 6 bivariate indicators of adverse events (including complications) of surgical care developed from the Agency for Healthcare Research and Quality's Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status.
  
  
  
  Compared with PPS hospitals, CAHs are significantly less likely to have any observed (unadjusted) adverse event on 4 of the 6 indicators. After adjusting for patient mix and hospital characteristics, CAHs perform better on 3 of the 6 indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one.
  
  
  
  The study suggests there are no differences in surgical patient safety outcomes between CAHs and PPS hospitals of comparable size. This reinforces the central role of CAHs in providing quality surgical care to populations in rural and isolated areas, and underscores the importance of strategies to sustain rural surgery infrastructure.
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Nabil
authors.initials: N
authors.lastname: Natafgi
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Jure
authors.initials: J
authors.lastname: Baloh
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Paula
authors.initials: P
authors.lastname: Weigel
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Fred
authors.initials: F
authors.lastname: Ullrich
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D016009:Chi-Square Distribution; D006297:Health Services Accessibility / Q000592:standards; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D061214:Patient Safety / Q000592:standards* / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States
keywords: critical access hospitals; patient safety; quality of care; surgical care