U of M researcher takes issue with Harvard criticism of rural hospitals

Sure, rural hospitals have room to improve, but that's pretty much what they have been doing in recent years, says a team of health researchers taking issue with this month's Harvard study finding that rural hospitals lag behind others in the care they deliver.

Some people took umbrage at the Harvard study, reported in the July 6 issue of the Journal of the American Medical Association.

This week, a team headed by Ira Moscovice at the Rural Health Research Center at the University of Minnesota weighed in, not objecting to the research but suggesting the report's tone was off. For six years, Moscovice and researchers at the University of North Carolina and the University of Southern Maine have tracked data on how well "critical access hospitals" have performed.

These are hospitals with 25 or fewer beds that operate at least 35 miles from neighboring hospitals. In an effort to lend strength to rural health care, they receive federal incentives. But the Harvard study found their care lags when it comes to the treatment of heart attacks, congestive heart failure and pneumonia.

Moscovice's team issued a short response, arguing, among other things that "what the JAMA authors fail to report is how much CAH scores on the process of care measures have improved over time." It notes improvement particularly in the area of care for pneumonia patients.

It also suggests that the Harvard study was making unhelpful comparisons.

"Rather than asking why CAHs aren't more like large tertiary teaching hospitals in Boston, the question that should be asked is, how can CAHs provide the best possible care to patients given their available resources and expertise?"

On the phone just now, Moscovice said the Harvard study was a blessing in disguise because it reminded rural health care providers that they have to continue to improve. "But the glass is 80 to 85 percent full," he said. There's no reason rural patients shouldn't expect some care equal to that found in larger hospitals, but rural hospitals should be evaluated on how well they play their particular roles in the larger system.

Lots of specialists and sophisticated equipment will never be a rural hospital's strong point, for example. So it should be measured not entirely on treatment but also on how well it stabilizes a patient and appropriately transfers him or her.

Not all those measures are easily available, Moscovice noted.

For more on the pressure that the rural health care system is facing in Minnesota, see our Ground Level section on the topic.

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