Inpatient care experiences are better in critical access hospitals than in other hospitals

Prior studies have found that critical access hospitals (CAHs), which serve patients who would otherwise have limited access to hospitals, provide lower-quality clinical care than inpatient prospective payment system (IPPS) hospitals; evidence is limited about the patient experiences they provide. Using linear mixed-effects regression models, we compared patient-mix-adjusted Hospital Consumer Assessment of Hospitals, Providers, and Systems (HCAHPS) survey scores for CAHs and IPPS hospitals and evaluated how much of the observed differences were associated with size, location, and other hospital characteristics. CAH patients were older, more often in the medical service line, had lower educational attainment, and worse self-rated health than their IPPS counterparts. Accounting for such differences, CAH patients had better experiences (+8 points on the 0-100 HCAHPS summary score, where differences >5 are considered large by patient experience heuristics), especially for staff responsiveness, cleanliness, quietness, and discharge information. CAHs do not outperform similarly small IPPS hospitals, which often have different missions (eg, for-profit surgical specialty hospitals). For-profit and teaching status, while uncommon among CAHs, predicted lower CAH HCAHPS performance. Despite the limited services provided by CAHs, their small scale may facilitate positive experiences for patients in areas with limited hospital choices. For-profit and teaching CAHs may benefit from quality-improvement efforts.