The agenda of this proposed initiative should include the following:

  • Applying evidence to practice—The Agency for Healthcare Research and Quality should assume a lead role in developing educational programs and tools to assist rural communities in applying evidence to practice.

  • Standardized measure set for rural communities—The Rural Quality Advisory Panel should work collaboratively with stakeholders from both the public and private sectors on the identification of appropriate standardized measures for rural areas, including: (1) measures from leading measure sets that are applicable to all geographic areas; (2) where necessary, new measures to reflect aspects of care processes that are rural-specific; and (3) standardized population health measures to be piloted in rural areas.

  • Public reporting—Centers for Medicare and Medicaid Services (CMS) and the Rural Quality Advisory Panel should work collaboratively to ensure that rural providers are included in public reporting initiatives and that public reports for rural providers make fair and meaningful comparisons.

  • Community-based technical assistance—CMS should ensure that the Quality Improvement Organizations devote resources to rural areas commensurate with the proportion of Medicare beneficiaries in a state that reside in rural areas. Consideration should be given to establishing a Quality Improvement Organization Support Center to focus on application of the above standardized quality measures to rural areas. The Office of Rural Health Policy should convene a series of regional conferences for Critical Access Hospitals, rural health clinics, community health centers, and other providers to share quality improvement processes and techniques.

  • Data repository—CMS should expand its data repositories to include rural-specific quality data so that rural providers have access to both urban and rural data for benchmarking purposes.


Human resources are critical to every rural community’s efforts to improve individual and population health. Human resources include health care professionals, both those in practice and those in training, as well as the population at large in the community.

The IOM committee believes that a renewed and vigorous effort must be made to enhance the health professions workforce in rural areas. This effort should focus on enhancing the quality improvement knowledge and skills of practicing professionals and the supply and preparedness of future professionals working in rural areas.

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