Quality Through Collaboration The Future of Rural Health (2005) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-18
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From the Native American Indian tribes and Hispanic communities of the southwest, to the African American communities of the Mississippi Bayou, to the Amish settlements of Pennsylvania, to the European descendants of the Great Plains, rural communities are home to many of the earliest Americans, as well as more recent immigrants. Rural communities are heterogeneous in other ways as well, differing in population density, remoteness from urban areas, and economic and social characteristics.
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Thus far, eight reports have been produced in this series, addressing various aspects of the agenda for change. This report on rural health care quality is a part of this series.
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Unless action is taken now, the future burden of chronic disease in many rural communities will be enormous. The IOM committee developed a five-pronged strategy to address the quality challenges in rural communities: · Adopt an integrated, prioritized approach to addressing both personal and population health needs at the community level; · Establish a stronger quality improvement support structure to assist rural health systems and professionals in acquiring knowledge and tools to improve quality; · Enhance the human resource capacity of rural communities, including the education, training, and deployment of health care professionals, and the preparedness of rural residents to engage actively in improving their health and health care; · Monitor rural health care systems to ensure that they are financially stable and provide assistance in securing the necessary capital for system redesign; and · Invest in building an ICT infrastructure, which has enormous potential to enhance health and health care over the coming decades.
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This would entail systematically cata loguing and evaluating the potential interventions to improve health care quality and population health in rural communities.
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Congress should provide the appropriate author ity and resources to the Department of Health and Human Services to support comprehensive health system reform demonstrations in five rural communities. These demonstrations should evaluate alter native models for achieving greater integration of personal and popu lation health services and innovative approaches to the financing and delivery of health services, with the goal of meeting the six quality aims of the Quality Chasm report.
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The Department of Health and Human Services should establish a Rural Quality Initiative to coordinate and acceler ate efforts to measure and improve the quality of personal and popu lation health care programs in rural areas. This initiative should be coordinated by the Health Resources and Services Administration's Office of Rural Health Policy, with guidance from a Rural Quality Advisory Panel consisting of experts from the private sector and state and local governments having knowledge and experience in rural health care quality measurement and improvement.
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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.
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Workforce programs such as the Health Resources and Services Administration's (HRSA) funding of Area Health Education Centers, Health Education and Training Centers, and Geriatric Education Centers should explicitly target rural localities, and broaden their scope beyond physician supply to include midlevel providers in specialties in short supply in rural areas (e.g., mental health and substance abuse services and emergency care)
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A rural health professions mentoring program might be established to expose rural students to potential careers in health care. Changes are also needed in health professions education programs.
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· Make greater effort to recruit faculty with experience in rural practice, and develop rural-relevant curricula addressing areas that are key to improving health and health care, including the five core competencies (i.e., providing patient-centered care, working in inter disciplinary teams, employing evidence-based practice, applying qual ity improvement, and utilizing informatics) , the fundamentals of population health, and leadership skills.
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In the health care sector overall, a great deal of experimentation is currently under way to identify ways of better aligning payment incentives with the quality aims, and rural communities should be part of these efforts. At the same time, it is important to recognize that, historically, rural health care systems have been financially fragile, and many still have small operating margins, making it difficult for them to participate in innovative efforts intended to stimulate fundamental redesign of the delivery system.
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The report should detail specific actions that should be taken, if needed, to ensure sufficient financial stability for rural health care delivery systems to undertake the desired changes described in this report. The IOM committee also wants to draw special attention to the very limited availability of mental health and substance abuse services in many rural communities, which is likely attributable in part to a lack of adequate funding.
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However, many rural communities are unprepared to participate fully in the information age, having little or no access to the Internet and populations with minimal ICT experience. Most rural health care systems are in critical need of financial and technical assistance to establish electronic health records (EHRs)
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· The Office of Rural Health Policy should be designated as the lead agency for coordination of rural health input to the Office of the National Coordinator for Health Information Technology. In provid ing this input, the Office of Rural Health Policy should seek the expert advice of the Department of Health and Human Services' Ru ral Task Force.
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Most rural health care is provided in small ambulatory practice settings and small hospitals, many of which are financially fragile and have limited access to capital for investing in EHRs. Rural health systems are also more dependent than urban systems on public payment programs, such as Medicaid, safety net grant programs for community and rural health clinics, and Medicare.
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· The Health Resources and Services Administration should de velop a strategy for transitioning community health centers, rural health clinics, critical access hospitals, and other rural providers from paper to electronic health records. · The Centers for Medicare and Medicaid Services and the state governments should consider providing financial rewards to provid ers participating in Medicare or Medicaid programs that invest in electronic health records.
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The federal government should establish a Rural Quality Initiative to assist rural communities and providers in acquiring the knowledge and tools needed to improve quality. Steps should be taken immediately to ensure that rural communities are not left behind in the many quality-related initiatives, including standardized performance measurement, public reporting, and pay-for-performance programs.
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2003. Fostering Rapid Advances in Health Care: Learning from System Demonstrations.
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