A Scoping Review of Inpatient Medical and Surgical Quality Outcomes at Critical Access Hospitals

PURPOSE: The landscape of rural health services is threatened with new federal health policies and ongoing hospital closures. Additionally, there is a lack of consensus about the quality of inpatient medical and surgical services provided in rural critical access hospitals (CAHs). Information about quality of care at CAHs may be useful to guide policy decisions that affect their viability and to more cohesively understand outcomes for patients as rural hospital accessibility continues to change. METHODS: We performed a broad search across four medical literature databases for original research articles examining at least one patient quality outcome (e.g., complications, mortality, transfers, or readmissions) in the setting of inpatient care at CAHs. A qualitative analysis generated themes about the quality of care at CAHs. FINDINGS: Our search generated 3128 citations. After screening and full text review, 22 studies (17 original, 5 gray literature reports) were included in our analysis. Studies supported that CAH quality outcomes were equivalent or better than non-CAHs for many common surgical procedures, but there was less agreement about the quality of inpatient medical care provided at CAHs. Treat or transfer decisions, longitudinal change, and health policy are discussed to better contextualize these trends. CONCLUSIONS: The literature regarding quality of care at CAHs presents heterogeneous findings that must be contextualized by patient and study characteristics, longitudinal change, and policy. For selected common inpatient surgeries performed at CAHs, observational evidence suggests comparable short-term mortality and complication rates, in the context of existing case selection and transfer practices.