RT Journal
A1 Lipsky MS, Glasser M
T1 QUality of care in critical access hospitals—reply
JF JAMA
JO JAMA
YR 2011
FD October 19
VO 306
IS 15
SP 1653
OP 1655
DO 10.1001/jama.2011.1491
UL http://dx.doi.org/10.1001/jama.2011.1491
AB 
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.