communication, D. G. Schulke, September 17, 2003). QIOs with very small rural populations would be required to work with other stakeholders to try to address the needs of rural beneficiaries. In states with very large rural populations, a separate rural subtask would be redundant, since these states are already focusing a large proportion of their resources on rural areas as a means of improving statewide averages on quality indicators.

The committee supports the creation of separate subtasks for rural disparities and for racial and ethnic disparities. Inequities in health, health care, and quality improvement in both areas need to be addressed.

Concern has also been raised that many QIOs, given their limited focus on rural areas, lack the knowledge, experience, and tools necessary to offer technical assistance to rural providers. CMS has addressed the need for specialized knowledge and expertise in other areas through the creation of Quality Improvement Organization Support Centers (QIOSCs). One option for dealing with this issue would be to create a QIOSC specific to rural health, which could play a lead role in the development of rural-specific quality measures, educational programs, and improvement tools and approaches. This QIOSC should build on the collaborative effort already under way between the QIOs in Minnesota and Utah/Nevada to field test a set of rural-relevant hospital quality measures.

Public Reporting Programs

In recent years, both the public and private sectors have launched numerous public reporting initiatives. The Department of Health and Human Services has reporting initiatives focused on the nation as a whole and on states and on health plans and providers (USDHHS, 2001). In addition, many private-sector reporting efforts are sponsored by purchasers, providers, and accreditation entities. Of particular importance are the efforts of The Leapfrog Group, whose members include 150 public- and private-sector organizations that provide health benefits. Following is a brief summary of some of the more significant efforts under way:

  • National Healthcare Quality Report (NHQR)—In December 2003, the Agency for Healthcare Research and Quality (AHRQ) released the first NHQR, providing the country with a snapshot of quality for the nation as a whole (AHRQ, 2003b). The report includes quality measures pertaining to each of the six quality aims, as well as measures applicable to many leading chronic conditions. A companion report, the National Disparities Report,



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