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Iowa rural hospital heart attack death
rates not higher
Newswise — Contrary to some previous studies,
rural hospitals in Iowa do provide quality care for patients with
heart attacks and do not have higher death rates when compared to
urban hospitals, report University of Iowa researchers.
The study, which was based on data from 119
urban and rural hospitals in Iowa, used a different, more sensitive
analytic method than previous research approaches. The findings
appear in the March/April issue of the Annals of Family Medicine.
Rating hospitals' quality of care for diseases
such as heart attacks is a rising trend in the United States.
However, the ratings need to be accurate, said Paul James, M.D.,
professor and head of family medicine in the UI Roy J. and Lucille
A. Carver College of Medicine.
"Traditional methods of analysis indicated that
rural hospitals have higher death rates for heart attack care than
do urban hospitals, but we suspected there were problems with that
data," said James, who also holds the Iowa Academy of Family
Physicians Endowed Chair in Rural Medicine.
"The older approaches did not take certain
biases, or confounding factors, into consideration, and so comparing
rural to urban hospitals was like comparing apples to oranges. We
used an approach that allowed us to study patients that were
comparable who attended rural and urban hospitals," he added.
The team used year 2002 and 2003 Iowa State
Inpatient Datasets, which included information on 12,191 admissions
for people age 18 older diagnosed primarily with a heart attack.
Rural hospitals can provide some life-saving
measures and have the role of triaging heart attacks cases, which
could result in a patient being transported to an urban hospital.
Yet, in some cases, a patient's family may, in consultation with a
physician at a rural hospital, choose not to send a family member
who has had a heart attack to an urban hospital. For example, if the
patient is elderly and has other, complicated health conditions, the
family may want the person to stay closer to home and support
networks.
Thus, the UI study attempted to control for the
finding that the sickest heart attack patients may stay at rural
hospitals while the healthiest are transferred to an urban hospital.
"Some patients with heart attacks have
complicated conditions, such as a 90-year-old man who also has
dementia and lung disease. In such cases, based on patient
preferences, it may be appropriate for that patient not to be
transferred to a large, urban hospital," James said.
"Our study took into consideration that the
traditional techniques to measure hospital heart attack care were
not properly sensitive to the type of patients admitted to the rural
hospitals and did not take into account the important role that
physicians play in directing patients from a rural hospital to a
more advanced, urban hospital," James added.
James said that rating hospitals is becoming
more common due to federal government and Medicare/Medicaid emphasis
on paying hospitals for performance.
"Some agencies judge the quality of a hospital
based on mortality rates without understanding the factors that
contribute to those rates. Quality indicator ratings are not the
be-all and end-all, especially if the analysis does not
appropriately measure all factors," James cautioned. "One needs to
take into account many factors such as surrounding community,
location and purpose of the hospital."
While the UI study was limited to Iowa
hospitals, investigators aim next to analyze a nationwide hospital
dataset or datasets from other states.
In addition to James, the study team included
Pengxiang Li, research assistant in health management and policy in
the UI College of Public Health, and Marcia Ward, Ph.D., UI
professor of health management and policy and a member of the Center
for Research in the Implementation of Innovative Strategies in
Practice at the Veterans Affairs Iowa City Health Care System.
The study was funded in part by a grant from
the Agency for Healthcare Research and Quality, part of the U.S
Department of Health and Human Services.
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