The Article in Brief

Myocardial Infarction Mortality in Rural and Urban Hospitals: Rethinking Measures of Quality of Care

Paul A. James, MD, and colleagues

Background Previous research suggests that rural hospitals give lower quality of care to patients with heart attack (myocardial infarction) than hospitals in urban areas. This study uses unique methods to examine whether patient characteristics (such as age and health) affect rates of death for heart attack patients in rural vs urban hospitals.

What This Study Found Death rates from heart attack were not higher in rural hospitals when patient characteristics were taken into account. Heart attack patients in urban and rural hospitals were significantly different from each other. Patients admitted to urban hospitals were younger and more likely to be male or black, whereas those admitted to rural hospitals were sicker and older than their urban counterparts.

Implications

• In-hospital death rates that do not consider the severity of patient illness may not accurately indicate quality of care of heart attack patients.
• These findings challenge the suggestion that heart attack patients receive worse care in rural hospitals compared with urban hospitals.