A Comparison of Quality of Care in Critical Access Hospitals and Other Rural Hospitals

Authors

  • Marianne Baernholdt University of Virginia
  • Jessica Keim-Malpass University of Virginia
  • Ivora D Hinton University of Virginia
  • Guofen Yan University of Virginia
  • Marilyn Bratt Marquette University

DOI:

https://doi.org/10.14574/ojrnhc.v14i2.328

Abstract

Purpose:

The United States has about 2100 rural hospitals. Approximately 1300 are Critical Access Hospitals (CAHs) with 25 beds or less. CAHs receive cost-based reimbursement through the federal Flex program with the goal to improve quality and access to health care. Reports on quality of care (QOC) and factors that influence quality in CAHs are mixed. This study compared QOC and factors that influence QOC in CAHs and other rural hospitals.

Sample: 385 staff nurses in 6 CAHs and 9 other rural hospitals in North Carolina and Virginia.

Method:

Descriptive cross-sectional design using nurse surveys aggregated to the hospital level, data from provider of services file, and the United States Department of Agriculture, Economic Research files. Variables on community, hospital, and nursing unit characteristics, the nurse work environment, nurse rated QOC and community perception of hospital quality were compared using t-test or chi-square.


Findings:
There were no differences in the majority of factors influencing QOC. A culture of safety, the nurse work environment, and QOC were rated high in all hospitals. Compared to other rural hospitals CAHs tend to be located in communities with better economic status and their nurses had more years of nursing experience. More nurses in CAHs felt their community recognized their hospital as a good place for minor health issues and would recommend the hospital to family and friends.

Conclusions:

The high ratings of QOC were accompanied with the presence of safety cultures and work environments rated as highly as in Magnet hospitals. The lower poverty levels in communities with CAHs suggest possible community financial benefits from CAHs. More studies are warranted to explore these relationships. Further reporting to public quality indicator databases by all CAHs should be encouraged and QOC measures relevant for small rural hospitals should be developed.

 

DOi:  http://dx.doi.org/10.14574/ojrnhc.v14i2.328


Author Biographies

  • Marianne Baernholdt, University of Virginia

    Marianne Baernholdt, PhD, MPH, RN

    Associate Professor, University of Virginia

    Director of Global Initiatives, SON

    School of Nursing and Department of Public Health Sciences

  • Jessica Keim-Malpass, University of Virginia

    Jessica Keim-Malpass, PhD, RN

    Assistant Professor

    University of Virginia, School of Nursing

  • Ivora D Hinton, University of Virginia

    Ivora D. Hinton, PhD

    Coordinator of data analyses and interpretations

    University of Virginia, School of Nursing

  • Guofen Yan, University of Virginia

    Guofen Yan, PhD

    Associate Professor

    University of Virginia, Department of Public Health Sciences

     

  • Marilyn Bratt, Marquette University

    Marilyn Bratt PhD, RN

    Associate Professor

    College of Nursing, Marquette University

    marilyn.bratt@marquette.edu

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Published

2014-10-16

Issue

Vol. 14 No. 2 (2014)

Section

Articles

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