To the Editor: Dr Joynt and colleagues asserted that little is known about the quality of care provided by critical access hospitals (CAHs), small rural hospitals with 25 or fewer beds.1 Since 2006, 5 annual national reports on CAH quality have been produced and widely disseminated.2 These reports document the substantial progress in quality improvement that CAHs have made over time. The most recent trend analysis, for example, shows that CAH scores on each of the pneumonia measures increased between 9 and 22 percentage points between 2005 and 2009.2
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