Exploring the Relationship Between Critical Access Hospitals and Rural County Health

Critical Access Hospitals (CAHs) were developed as a model to improve the access and availability of hospital services in rural counties. There has been limited research on clinical outcomes to evaluate the impact of CAHs since they were authorized through the Balanced Budget Act. This study evaluates CAH’s performance on clinical outcomes, and compares health outcomes between rural counties with CAHs and rural counties without established federally supported hospitals. The American Hospital Association’s (AHA) Annual Survey Database was used to identify CAHs within rural counties and their characteristics. The County Health Rankings (CHR) data were used to quantify health outcomes by county. US rural counties with CAHs versus remaining US rural counties without CAHs were correlated with measures of Clinical Care (p < 0.001). US rural counties with CAHs presented greater health status with regard to All Health Outcomes, p < 0.0001; Length of Life, p < 0.0001; Quality of Life, p < 0.0001; All Health Factors, p < 0.0001; Health Behaviors, p < 0.0001; Social and Economic Environment, p < 0.0001 and Physical Environment, p < 0.0001, than compared to US rural counties without CAHs. Rural counties serviced by CAHs demonstrate better overall health status scores, on several CHR metrics, as compared to rural counties without CAHs. The only exception to this conclusion being that rural counties without CAHs performed superiorly in the CHR metrics related to primary care and mental health services, demonstrating capacities in which CAHs could improve the impact on health in the counties they serve.