We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




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.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...