{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:39Z","timestamp":1789995759632,"version":"4.0.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":99,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01\u2010HS028606\u201001A1"],"award-info":[{"award-number":["R01\u2010HS028606\u201001A1"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R0\u20101DK137466"],"award-info":[{"award-number":["R0\u20101DK137466"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["L60MD020984"],"award-info":[{"award-number":["L60MD020984"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The landscape of rural health services is threatened with new federal health policies and ongoing hospital closures. Additionally, there is a lack of consensus about the quality of inpatient medical and surgical services provided in rural critical access hospitals (CAHs). Information about quality of care at CAHs may be useful to guide policy decisions that affect their viability and to more cohesively understand outcomes for patients as rural hospital accessibility continues to change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a broad search across four medical literature databases for original research articles examining at least one patient quality outcome (e.g., complications, mortality, transfers, or readmissions) in the setting of inpatient care at CAHs. A qualitative analysis generated themes about the quality of care at CAHs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Our search generated 3128 citations. After screening and full text review, 22 studies (17 original, 5 gray literature reports) were included in our analysis. Studies supported that CAH quality outcomes were equivalent or better than non\u2010CAHs for many common surgical procedures, but there was less agreement about the quality of inpatient medical care provided at CAHs. Treat or transfer decisions, longitudinal change, and health policy are discussed to better contextualize these trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The literature regarding quality of care at CAHs presents heterogeneous findings that must be contextualized by patient and study characteristics, longitudinal change, and policy. For selected common inpatient surgeries performed at CAHs, observational evidence suggests comparable short\u2010term mortality and complication rates, in the context of existing case selection and transfer practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70176","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T07:25:21Z","timestamp":1780903521000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Scoping Review of Inpatient Medical and Surgical Quality Outcomes at Critical Access Hospitals"],"prefix":"10.1111","volume":"42","author":[{"given":"Kaja M.","family":"Aagaard","sequence":"first","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke C.","family":"Bredbeck","sequence":"additional","affiliation":[{"name":"Gunnison Valley Health  Gunnison Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Westfall","sequence":"additional","affiliation":[{"name":"High Plains Research Center  Yuma Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ringel","sequence":"additional","affiliation":[{"name":"Brush Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan  Ann Arbor Michigan USA"},{"name":"Center for Healthcare Outcomes and Policy University of Michigan  Ann Arbor Michigan USA"},{"name":"Taubman College of Architecture and Urban Planning University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin B.","family":"Dimick","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan  Ann Arbor Michigan USA"},{"name":"Center for Healthcare Outcomes and Policy University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Kaboli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Carver College of Medicine University of Iowa  Iowa City Iowa USA"},{"name":"Office of Rural Health US Department of Veterans Affairs  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4219-3766","authenticated-orcid":false,"given":"Cody Lendon","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan  Ann Arbor Michigan USA"},{"name":"Center for Healthcare Outcomes and Policy University of Michigan  Ann Arbor Michigan USA"},{"name":"UM National Clinician Scholars Program University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"National Rural Health Association \u201cAbout Rural Health Care \u201d accessed September 29 2025 https:\/\/www.ruralhealth.us\/about\u2010us\/about\u2010rural\u2010health\u2010care."},{"key":"e_1_2_10_3_1","volume-title":"2024 National CAH Quality Inventory & Assessment National Report","author":"Lahr M.","year":"2025"},{"key":"e_1_2_10_4_1","unstructured":"CMS \u201cCritical Access Hospitals \u201d accessed September 7 2025 https:\/\/www.cms.gov\/medicare\/health\u2010safety\u2010standards\/certification\u2010compliance\/critical\u2010access\u2010hospitals."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.902"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.8739"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1488"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.1224"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.13518"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.14945"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_12_1","unstructured":"Agency for Healthcare Research and Quality \u201cExamples of Hospital Quality Measures for Consumers \u201d accessed September 4 2025 https:\/\/www.ahrq.gov\/talkingquality\/measures\/setting\/hospitals\/examples.html."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2018.0050"},{"key":"e_1_2_10_15_1","unstructured":"M.Casey \u201cCritical Access Hospital Year 5 Hospital Compare Participation and Quality Measure Results \u201d2010 https:\/\/www.flexmonitoring.org\/sites\/flexmonitoring.umn.edu\/files\/media\/CAH_year_5_hospital_compare_participation_bp_2025.pdf."},{"key":"e_1_2_10_16_1","unstructured":"M.Casey \u201cCritical Access Hospital Year 6 Hospital Compare Participation and Quality Measure Results \u201d2011 https:\/\/www.flexmonitoring.org\/sites\/flexmonitoring.umn.edu\/files\/media\/CAH_year_6_hospital_compare_participation_bp_2025.pdf."},{"key":"e_1_2_10_17_1","unstructured":"M.CaseyandP.Hung \u201cCritical Access Hospital Year 7 Hospital Compare Participation and Quality Measure \u201d2012 https:\/\/www.flexmonitoring.org\/sites\/flexmonitoring.umn.edu\/files\/media\/cah_year_7_hospital_compare_participation_and_quality_results_2025.pdf."},{"key":"e_1_2_10_18_1","unstructured":"M.CaseyandP.Hung \u201cCritical Access Hospital Year 8 Hospital Compare Participation and Quality Measure Results \u201d2013 https:\/\/www.flexmonitoring.org\/sites\/flexmonitoring.umn.edu\/files\/media\/cah_year_8_hospital_compare_participation_and_quality_results_2025.pdf."},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.09.122"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.5694"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.5618"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002216"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.2366"},{"key":"e_1_2_10_24_1","unstructured":"M. G.Klug A.Knudson andK.Muus \u201cGeographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals \u201d2010 https:\/\/rhrc.umn.edu\/wpcontent\/files_mf\/readmissions_finalreport_110310.pdf."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.9935"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475\u20106773.2007.00731.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.665646"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.045"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001458"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006754"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12176"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.12.011"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.12.002"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10609"},{"key":"e_1_2_10_35_1","volume-title":"MBQIP Quality Measures National Annual Report\u20142023","author":"Lahr M.","year":"2025"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.5694"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.1845"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005772"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.82619"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748\u20100361.2003.tb00571.x"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.06.009"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12163"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2025.00640"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.0447"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.1956"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2026.9217"},{"key":"e_1_2_10_47_1","unstructured":"Becker's Hospital Review \u201cPrivate Equity Firms Own at Least 130 Rural Hospitals: 8 Things to Know \u201d January 27 2023 accessed October 19 2025 https:\/\/www.beckershospitalreview.com\/finance\/pe\u2010firms\u2010own\u2010at\u2010least\u2010130\u2010rural\u2010hospitals\u20108\u2010things\u2010to\u2010know\/."},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01102"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.23147"},{"key":"e_1_2_10_50_1","unstructured":"\u201cConsolidated Appropriations Act of 2021 Pub L No. 116\u2013260 134 Stat 1182 \u201d2020 https:\/\/www.congress.gov\/116\/plaws\/publ260\/PLAW\u2010116publ260.pdf."}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70176","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70176","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70176","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:10:48Z","timestamp":1789992648000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":49,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/jrh.70176"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70176","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-12-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70176"}}