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Comment and Response |

Mortality Trends in Critical Access Hospitals

Ira S. Moscovice, PhD1; Michelle M. Casey, MS1; Jeffrey S. McCullough, PhD1
[+] Author Affiliations
1Rural Health Research Center, University of Minnesota, Minneapolis
JAMA. 2013;310(4):428-429. doi:10.1001/jama.2013.8742.
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To the Editor Dr Joynt and colleagues1 compared mortality trends in critical access hospitals (CAHs) and non-CAHs. Their analysis raises a number of concerns in addition to those raised by Dr Ioannidis.2 These concerns include problems with the study’s data, methods, and interpretation of the results.

The hospital size categories in the study are inappropriate for CAHs, and a number of hospitals were misclassified based on the date of conversion and bed size. In 2002-2003, federal law limited CAHs to 15 beds; since 2004, the limit is 25 beds. However, Joynt et al1 reported that 40 CAHs in 2002 and 63 CAHs in 2010 had between 100 and 399 beds. Thus, a minimum of 5% of CAHs in the analysis were misclassified as being much larger than they were.

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July 24, 2013
Karen E. Joynt, MD, MPH; John E. Orav, PhD; Ashish K. Jha, MD, MPH
1Harvard School of Public Health, Boston, Massachusetts
JAMA. 2013;310(4):430. doi:10.1001/jama.2013.8745.
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