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Patients with acute myocardial infarction have higher mortality rates in rural hospitals than in urban hospitals, suggesting substandard quality of care in the rural setting. We examined characteristics of patients experiencing myocardial infarction and used an instrumental variable technique to adjust for unmeasured confounding when comparing mortality rates for these hospitals.

Myocardial Infarction Mortality in Rural and Urban Hospitals: Rethinking Measures of Quality of Care