might include outreach to school leadership to encourage the removal of soft drink machines and the provision of more nutritious lunches and snacks. In many rural communities, agricultural extensions and rural cooperatives represent an important resource for communicating about and educating the community’s residents in key health issues.

In both cases, the leadership for such efforts must come from the health care sector (see Chapter 4). It is necessary to cultivate a new cadre of health care leaders who will be capable of viewing clinical care within the broader context of population health (Kazandjian, 2003). To support health care leaders in their efforts to focus both the health care sector and the community at large on improving population health, quality measurement and improvement systems must address the full continuum of performance measures, from health care processes to population health status.

To guide its work, the committee developed a framework designed to facilitate a more integrated approach to decision making regarding personal and community health programs and needs. As noted earlier, the Quality Chasm report focuses largely on health care quality within the personal health care delivery system. Using the six quality aims set forth in that report as a fundamental organizing framework, the committee first developed definitions for the aims that address population health. The committee then identified a set of illustrative performance measures and associated strategies for quality improvement at the community level to improve population health. The following discussion illustrates the use of this framework in informing key choices that must be made among rural health care quality improvement strategies. Tables 2-1 through 2-6 list the definitions, performance measures, and strategies for each of the six aims.


At the population level, safety refers to the avoidance of accidents and injuries due to hazards in the community (see Table 2-1). Environmental, occupational, recreational, and other accidents and injuries represent significant problems in rural areas, with large health and health care cost consequences. Currently, investments in programs to address these problems pale in comparison with expenditures for hospital and other health services to treat the consequences of these accidents and injuries. The question is whether this balance of expenditures is appropriate, or more resources should be directed at interventions to improve safety in the workplace and in the community overall.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement