and local governments having knowledge and experience in rural health care quality measurement and improvement.

The agenda of this proposed initiative should include the following:

  • Application of evidence to practice—AHRQ should assume a lead role in adapting clinical practice guidelines developed by professional associations and others to reflect the unique configuration of services, resource constraints, and challenges of rural areas, and 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 public and private stakeholders (e.g., CMS, the Quality Interagency Coordinating Committee, AHRQ, the National Quality Forum, JCAHO, the National Committee for Quality Assurance) on the identification of appropriate standardized measures for rural areas, including (1) a subset of measures from leading measure sets that are applicable to rural areas; (2) where necessary, new rural-specific measures; and (3) standardized population health measures to be piloted in rural areas.

  • Public reporting—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 QIOs 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 QIOSC to focus on application of the above standardized rural 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.


AHQA (American Health Quality Association). 2004 (April 22). AHQA Matters (newsletter) 5(9). Washington, DC: American Health Quality Association.

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