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Letters |

Quality of Care in Critical Access Hospitals—Reply

Martin S. Lipsky, MD; Michael Glasser, PhD
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1491.
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In Reply: We agree with Dr Fairchild about the importance of evaluating rural CAHs in the context of their resources and community setting. As Fairchild suggests, selection bias and the community setting might account for some of the differences in outcomes reported by Joynt et al.1 Patients at CAHs mirror the demographics of rural communities where residents are older, sicker, and more likely to engage in unhealthy behaviors when compared with their nonrural counterparts. As Fairchild notes, other factors such as cultural expectations may also contribute to differences in outcomes. Although assessing differences in care between rural and urban settings remains challenging, our belief is that research that stimulates thoughtful discussion about quality ultimately leads to better care.


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October 19, 2005
Eric J. Topol, MD; David Blumenthal, MD, MPP
JAMA. 2005;294(15):1897-1898. doi:10.1001/jama.294.15.1897-c.
October 19, 2005
Michael A. Patmas, MD, MMM
JAMA. 2005;294(15):1897-1898. doi:10.1001/jama.294.15.1897-a.
October 19, 2005
Lindsay A. Hampson, BA; Ezekiel J. Emanuel, MD, PhD
JAMA. 2005;294(15):1897-1898. doi:10.1001/jama.294.15.1897-b.
October 19, 2011
Karen E. Joynt, MD, MPH; Yael Harris, PhD, MHS; Ashish K. Jha, MD, MPH
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1490.
October 19, 2011
Ira S. Moscovice, PhD; Michelle M. Casey, MS
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1487.
October 19, 2011
John M. Westfall, MD, MPH; Catherine Battaglia, PhD, RN; Michelle Mills
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1488.
October 19, 2011
Roseanne Fairchild, PhD, RN, CNE
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1489.
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