In 2001, the Institute of Medicine (IOM) released the report Crossing the Quality Chasm: A New Health System for the 21st Century. Based on a large body of evidence documenting serious shortcomings in the American health care system overall, the IOM report calls for fundamental reform of the U.S. health care system. The report identifies six aims for quality improvement—health care should be safe, effective, patient-centered, timely, efficient, and equitable. Recognizing the magnitude of the changes required to address the quality challenge, the IOM launched the Quality Chasm series. Thus far, eight reports have been produced in this series, addressing various aspects of the agenda for change. This report on rural health care quality is a part of this series.

The IOM Committee on the Future of Rural Health Care was asked to

  • Assess the quality of health care in rural areas.

  • Develop a conceptual framework for a core set of services and the essential infrastructure necessary to deliver those services to rural communities.

  • Recommend priority objectives, and identify changes in policies and programs required to achieve those objectives, including, but not limited to, payment policies and the necessary information and communications technology (ICT) infrastructure.

  • Consider implications for federal programs and policy.

In many respects, rural communities have been on the periphery of discussions of national health care quality. A roadmap for applying the quality agenda now evolving at the national level to sparsely populated areas is needed.


Rural communities likely face the same quality challenge as urban communities. Although the evidence pertaining specifically to rural areas is sparse, what does exist corroborates the general finding that, as documented for the nation overall in the Quality Chasm report, the level of quality falls far short of what it should be.

Some of the quality shortcomings in rural areas stem from the lack of access to “core health care services,” defined for purposes of this report as

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