• Patient safety outcomes;
  • urban and rural hospitals


Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes.

Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was restricted to hospitals with fewer than 100 beds. Out of 292 hospitals in the sample, 185 were rural hospitals and 107 were urban hospitals. AHRQ Patient Safety Indicators (PSI) were used to examine 9 common patient safety outcomes at these hospitals. The unit of analysis was the patient. Associations between hospital location and patient and hospital characteristics were determined using 1-way analysis of variance (ANOVA) and Pearson chi-square test. Multivariable analysis using generalized estimating equation regression models assessed the relationship between hospital location and PSIs.

Results: Most of the observed rates for the 9 PSIs were higher (indicating worse outcomes) for small urban hospitals than for small rural hospitals. In the multivariable analyses, after adjusting for important patient and hospital characteristics, many of these differences disappeared, except for decubitus ulcer. Small urban hospitals had significantly higher odds for decubitus ulcer than small rural hospitals.

Conclusion: These results deviate from findings in the literature that urban-rural differences in patient safety rates exist. This study highlights the importance of understanding the factors that differ between small urban and small rural hospitals while developing hospital-relevant patient safety interventions at these hospitals.