A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States

Objective. Two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world's most extensive and expensive healthcare system. This may be especially true for critical access hospitals since these smaller rural-based hospitals often have fewer resources and less funding than larger urban hospitals. The purpose of this paper was to compare quality of hospital care provided in urban acute care hospitals to that provided in rural critical access hospitals. Design. Cross-sectional study analyzing secondary Hospital Compare data. T-test statistics were computed on weighted data to ascertain if differences were statistically significant (P = 0.01). Setting. Centers for Medicare and Medicaid Services hospitals. Participants. US Acute Care and Critical Access hospitals. Main outcome measures. Differences between urban acute care hospitals and rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure and pneumonia. Results. For 8 of the 12 hospital quality indicators the differences between urban acute care and rural critical access hospitals were statistically significant (P = 0.01). In seven instances these differences favored urban hospitals. One indicator related to pneumonia favored rural hospitals. Conclusions. Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.