CAH Study Author Defends Surprising Data

In an interview, Karen E. Joynt, MD, MPH, the lead author of a study suggesting that mortality rates in critical access hospitals are getting worse, offers her interpretation of the research findings.

6 comments on "CAH Study Author Defends Surprising Data"
Dean Coddington (4/4/2013 at 3:43 PM)

Hi, Having worked with a number of critial access hospitals over the years, they have a different relationship with their communities. Older people, when sick, like to go to a place where they know the staff and where relatives can easily visit them. Therefore, they often resist transfer to nearby tertiary care centers in larger cities. I believe this is a key factor differentiating CAHs. DCC
JKuriyan (4/4/2013 at 10:56 AM)

The result is statistical and it is difficult to grasp the strengths and weaknesses without more details, like error bars and standard deviations. For example, how do the results vary amongst the rural CAHs? Are there urban CAHs that performed as poorly as rural CAHs? The author's recommendation of tele-health tools to bring urban experts to rural areas via the web sounds a little too simple. What's the point if the rural hospitals are not equipped to perform new and complex procedures? Transporitng them to urban hospitals may not be affordable or practical depending on the medical issue. Another example where capitalism struggles to meet medical needs of societies. There are solutions but they are unacceptable to US citizens. So let's move on! I am not sure if this was covered in the last page of the article - a full page Ad blocked it, an unnecessarily intrusive step that insults the readers and the belittles the contribution of the journalist.
Chris (4/4/2013 at 10:37 AM)

Answer to confusedreader, CAH is Critical Access Hospital
A Davis (4/4/2013 at 9:45 AM)

Dr. Joynt appears to have done a good job defining a problem, but her discussion regarding possible solutions demonstrates a lack of understanding of the rural lifestyle and experience and an associated urban-centric arrogance. As is very common in medicine, she appears to confuse technology with skill while failing to appreciate the extent to which either drives the practice of physicians in different locales. Dr. Joynt appears aware that rural physicians are often substantially overextended in terms of both the number of patients seen and the number of skills required to handle the variety. But she rather blithely promotes telemedicine - an umbilical cord to academic medicine - as the solution, without acknowledging that this technology, while promising, remains relatively unproven. Of course, there is no mention of the profitability of telemedicine for the academic center, but one can't help but question not only the extent to which her recommendations are simply self-serving, but also the degree to which they help perpetuate and perhaps worsen the very problems of CAHs which she exposes. Rather than engaging in telemedicine, it would make more sense for academic physicians to head for the countryside and practice real, rural medicine from time to time. The educational exposure of rural physicians to the "experts" would assist them in overcoming knowedge deficits which may accumulate over time, and the reciprocal exposure to the academics might help them integrate their hyper-specialized knowledge more widely into the population. Bringing the anonymity and carelessness of urban medicine to the cornfields is not a useful or appealing response to the article. Perhaps the author should consider bringing the humanity and care of the cornfields to the attention of the academic elites - it might give them a more humane perspective on what is very rapidly becoming an inhumane technological and business-driven endeavor.
james (4/3/2013 at 4:11 PM)

This is not surprising. Medicine, like all other things is a business enterprise and like any other enterprise, rural areas get short changed. Rural areas are not where the money is. Even in the social arena, rural people are considered to be of less value. How many times have you heard the term 'country hicks' or 'fly over country' ?? Having spent half my life living in a rural mountain area, I have heard these terms many times from urban dwellers traveling through our area or 'slumming' as some urbanites have stated. Class snobbery was always present. There were many times that we would have to travel 40 or 50 miles or more to obtain some product or service that wasn't financially feasible for a company to invest in our area. Even fuel for our vehicles was a problem. The closest service was 15 miles down the mountain. Moving closer to the services would just reverse the problem, long commutes to work and the urban areas needed the products that we supplied, it was just the rural people that society didn't need as shown by this article, we are a problem...
confused reader (4/3/2013 at 3:19 PM)

What is CAH? Why the author did not explain this in the begining of the news to make it easier to read?


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