But Nancy Foster, vice president for quality and patient safety policy at the AHA, says there are several reasons why CAHs are different from their larger counterparts in urban areas.
"It's really understanding the context of the care in critical access hospitals," she said in an interview. "By definition they're not designed to provide some of those more intensive services."
"It's sort of like looking at a dachshund and saying, 'but it's not as tall as a German shepherd.' Of course; it's not supposed to be a German shepherd," she adds. "It's that 'fit-for-use' concept, and critical access hospitals have different purposes than large academic medical centers."
She contends that whether or not a CAH has ICU or cardiac catheterization capabilities is not a fair measure of its quality because those types of services are more often performed at larger hospitals after a patient has been stabilized and transferred. Indeed, according to the AHA's statement about the JAMA study, "the established protocol of CAHs is to transfer patients who may benefit from more aggressive treatment and who are clinically stable enough for transport to larger hospitals that provide some of the more advanced services cited in the report."
But there's also the issue of the poorer outcomes and higher mortality that the study identified. Although the AHA said in its statement that the JAMA study does not count in its performance information "patients who are transferred from the CAH to a larger hospital," Jha contends that's not the case.