To the Editor Patients living in rural communities require reliable data to make
decisions about where to seek care when faced with a serious illness. Unfortunately, Dr Joynt and
colleagues1 made a significant error in their methods by not
accounting for the large and growing number of patients who present to an ED at a CAH, receive
high-quality care, and are transferred to an urban tertiary care hospital directly from the ED. In
fact, developing strong partnerships with urban hospitals is a prerequisite for acquiring and
maintaining CAH status.
Westfall JM, Ringel M, Gardner J. Mortality Trends in Critical Access Hospitals. JAMA. 2013;310(4):429-430. doi:10.1001/jama.2013.8739