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Letters |

Quality of Care in Critical Access Hospitals

Roseanne Fairchild, PhD, RN, CNE
JAMA. 2011;306(15):1653-1655. doi:10.1001/jama.2011.1489.
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To the Editor: Drs Lipsky and Glasser,1 in their Editorial, framed the unique challenges facing rural CAHs in reference to the study by Dr Joynt and colleagues2 and provided additional context for the reader who may be unfamiliar with important aspects of health care delivery in small, low-volume rural hospitals.

It is important to underscore the contextual presence of self-selection bias for individuals and families living in geographic regions served by CAHs. Scharff3 explained this phenomenon as “a cultural expectation of many rural people to be taken care of by someone they know.” When faced with placing themselves or a loved one in a nearby CAH vs a distant urban hospital, many rural families are more comfortable with the CAH. Reasons for preferring care in a CAH include proximity, safety, familiarity, travel costs, and availability of transportation. Ironically, these contextual drivers unique to rural settings may be perceived both as barriers and facilitators of care.

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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.
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