In 1990, the IOM adopted the following definition of quality of care:

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, 1990, p. 4).

The above definition is consistent with the view that the health care system of the twenty-first century should balance and integrate the need for personal health care with broader communitywide initiatives that target the entire population and the environment (IOM, 2003). Many factors influence the health of individuals and populations, including the environment, social behaviors, and genetic predispositions.

The committee encourages rural communities to build a population health focus into decision making within the health care sector, as well as in other key areas (e.g., education, community and environmental planning) that influence population health. For example, there are many effective interventions available to rural communities to reduce the health burden of diabetes, some best implemented through the personal health care delivery system (e.g., reminder systems to prompt patients and clinicians when annual eye and foot exams are due) and others through communitywide programs (e.g., public policies that favor the provision of more nutritious food in public eating establishments and schools). Making explicit the full range of options available to rural communities to improve personal and population health should lead to more optimal allocation of scarce financial resources. Future work is needed to identify and prioritize the interventions that are available to rural communities to improve health and health care.

Key Finding 1. A wide range of interventions are available to improve health and health care in rural America, but priorities for implementation are not yet clear. The Health Resources and Services Administration is the obvious agency to take the lead in setting priorities, in collaboration with other federal agencies, such as the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention, as well as with rural stakeholders. This would entail systematically cataloguing and evaluating the potential interventions to improve health care quality and population health in rural communities.

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