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Comment & Response
July 24/31, 2013

Mortality Trends in Critical Access Hospitals—In Reply

Author Affiliations
  • 1Harvard School of Public Health, Boston, Massachusetts
JAMA. 2013;310(4):430. doi:10.1001/jama.2013.8745

In Reply Dr Moscovice and colleagues and Dr Westfall and colleagues make several important points with which we agree. First, regarding misclassification, we suspect that the higher number of beds than anticipated were due to beds that do not count toward the 25-bed limit, such as psychiatric, rehabilitation, observation, and labor and delivery beds. If CAHs are matched against much larger hospitals because of their size classification in the American Heart Association survey, it certainly would have biased our results. However, it was out of this concern that we adjusted for number of beds rather than size category, and unless CAHs were systematically overreporting their beds in a way that is different from non-CAHs, we suspect any bias is likely to be small.