Measuring Quality Performance in CAHs

Funder:	Office of Rural Health Policy (ORHP)
Research center:	Minnesota Rural Health Research Center Phone: 612.624.6151
Lead researcher:	Ira Moscovice, PhD , 612.624.8618, mosco001@umn.edu
Research staff:	Michelle Casey, MS
Project funded:	September 2006
Project completed:	September 2009
Topics:	Critical Access Hospitals and Rural Hospital Flexibility Program Quality

The purpose of the project is to:

• Update our estimates of the proportion of CAHs that are participating in Hospital Compare,
• Update our previous analysis of the key factors related to CAH participation in Hospital Compare, and determination of how many CAHs have sufficient sample sizes to calculate accurate rates for specific measures;
• Using an additional year of data, compare the available quality measure results for all participating CAHs with relevant subgroups of hospitals (e.g., other rural hospitals, urban hospitals);
• Analyze trends over time for CAHs with sufficient sample sizes in 2004 and 2005; and
• Explore additional sources of quality data for CAHs, including data from QIO 8th Scope of Work activities and state inpatient discharge data for CAHs.

The project will use secondary data from CMS on CAH participation in Hospital Compare and the AHA annual survey and Area Resource File on hospital characteristics that may affect CAH participation. A qualitative component of the project will obtain information on other factors that may influence CAH participation in the Hospital Quality Alliance, such as the level of state support for CAH quality improvement activities. Possible sources for this information include a survey of CAHs and phone interviews with key informants in selected states that with exemplary CAH participation.

We will determine how many CAHs have sufficient sample sizes (e.g., more than 25 cases) to calculate rates for specific measures with reasonable accuracy. We will compare the quality measure results for participating CAHs with relevant hospital subgroups. We will also analyze trends over time for CAHs with sufficient sample sizes in 2004 and 2005. Strategies for increasing CAH participation in Hospital Compare will be identified based on the data analysis, input from the Flex Monitoring National Advisory Committee, and the qualitative component of the project.

This project will also explore additional sources of quality data for CAHs, including inpatient hospital discharge data from states that participate in the State Inpatient Databases (SID) component of AHRQ's Healthcare Cost and Utilization Project (HCUP) and data from QIO 8th Scope of Work activities. The products of this project will include a briefing paper and an article that will be submitted to a peer-reviewed journal.

Publications

• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Report Number: Flex Monitoring Team Briefing Paper No. 16
  Date: 04 / 2007
  Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Policy Brief)
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Report Number: Flex Monitoring Team Policy Brief No. 4
  Date: 05 / 2007
  Policy brief examining the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.