Quality Through Collaboration The Future of Rural Health (2005) / Chapter Skim
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3 Quality Improvement Activities in Rural Areas
3 Quality Improvement Activities in Rural Areas
Pages 60-77
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From page 60... ...
This approach needs to encompass clinical knowledge and the tools necessary to apply this knowledge to practice, including practice guidelines and computer-aided decision support, standardized performance measures, performance measurement and data feedback capabilities, and quality improvement processes and resources. This chapter examines each of these capabilities, with emphasis on their current state of development in rural health systems and steps that might be taken to enhance quality improvement in rural communities.
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From page 61... ...
, rural communities must establish comprehensive quality improvement programs that include five key components (see Box 3-1)
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From page 62... ...
Moreover, quality improvement knowledge -- including methods of identifying errors and hazards in care; safety design principles, such as standardization and simplification; quality measurement in terms of structure, process, and outcomes; and methods of designing and testing interventions to improve care processes -- is a core competency that all health care professionals should possess (IOM, 2003)
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From page 63... ...
To apply scientific knowledge and practice guidelines in rural communities, some additional work is required. Local protocols, (i.e., stepwise instructions to guide local care delivery)
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From page 64... ...
· Community hub -- Rural hospitals are central and influential organizations in their communities; in many rural communities, the hospital is the largest employer in town. Many rural hospitals are assuming a coordinating role to support the development of more integrated community-based care systems.
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From page 65... ...
. For example, since rural hospitals stabilize and transfer patients more frequently than do urban hospitals, the discharge measures need to be adjusted to better reflect and ensure quality of care in patient transfers.
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From page 66... ...
One alternative is for rural communities to work together in a collaborative fashion to establish communitywide quality improvement programs. These programs might also pool data for all providers in the community and conduct population-based analyses.
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From page 67... ...
Many QIOs have likely chosen to satisfy the requirements of this subtask by addressing racial or ethnic disparities in urban areas, again because those areas are more geographically accessible to QIO staff and are home to large health care organizations that have a greater impact on statewide performance. The American Health Quality Association, a membership association representing QIOs, reports that nearly 20 state QIOs are working with critical access hospitals and ambulatory care providers in rural areas (Personal communication, D
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From page 68... ...
. 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.
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From page 69... ...
. Since many rural hospitals (i.e., critical access hospitals)
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From page 70... ...
Rural providers, like urban, will benefit from these external levers for change as long as the performance measures are reliable and valid and the comparative reports are fair. Further, the conspicuous absence of rural providers from public reports may have the unintended consequence of leading rural residents to assume that local providers are of lower quality than more distant providers, a conclusion not supported by the very limited evidence that is available for assessing differences in quality between rural and urban areas (see Chapter 2)
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From page 71... ...
Also discussed are the quality requirements applicable to rural health clinics. The Medicare Flex program was created in 1997 to provide additional financial support to small rural hospitals designated as critical access hospitals (see Appendix C)
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From page 72... ...
. In fiscal years 2002 and 2003, the SHIP program provided about $15 million each year to rural hospitals to support quality improvement projects and transitional efforts related to the new Medicare Prospective Payment System and the Health Insurance Portability and Accountability Act (NACRHHS, 2003)
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From page 73... ...
. In addition, both JCAHO and the American Osteopathic Association have established special accreditation programs for critical access hospitals (Personal communication, K
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From page 74... ...
As discussed in Chapter 2, the committee is encouraging rural communities to develop communitywide collaborative approaches to prioritizing and addressing both personal and population health issues. Communities that pursue this approach may find it preferable to establish communitywide quality measurement and improvement programs, rather than having each provider setting develop its own approach.
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From page 75... ...
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.
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From page 76... ...
2002. Implementing Quality Assessment and Performance Improve ment Systems in Rural Health Clinics: Clinic and State Agency Responses.
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From page 77... ...
Seattle, WA: WWAMI Rural Health Research Center, University of Washington. Moscovice I, Wholey DR, Klingner J, Knott A
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