Quality

Publications

Listed by publication date. You can also view these publications alphabetically.

2009

• Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
  Date: 02 / 2009
  Author(s): Janet Pagan-Sutton, Lauren Silver, Jyoti Gupta
  Research center: Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Quality
  This report describes four case studies that highlight the strategies employed by QIOs to help small rural hospitals implement successful quality improvement initiatives. These case studies are presented with the goal of describing successful QIO-hospital relationships, where success is measured in terms of quality improvement. These relationships are spotlighted to emphasize the value that rural hospitals derive from the technical assistance offered to CAHs and small rural providers. This study was conducted by staff at Social and Scientific Systems, Inc., under contract to the NORC Walsh Center for Rural Health Analysis.

2008

• Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
  Date: 04 / 2008
  Author(s): Gary Cochran, PharmD, SM, Katherine Jones, PhD, PT, Liyan Xu, MS, Keith Mueller, PhD
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  Citation: This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in the nations smallest hospitals. A key finding is that hospitals with an average daily census of six or more patients were more likely to report having adopted safe medication practices than were hospitals with an average daily census of five or fewer patients. Findings from this research reveal considerable opportunity for improvement in hospitals with 49 or fewer beds to achieve evidence-based standards of medication safety.
  Report Number: Issue Brief 2008-1
  

2007

• Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
  Date: 08 / 2007
  Research center: Upper Midwest Rural Health Research Center
  Topics: Emergency medical services (EMS), Quality
  Reports results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
• Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
  Date: 08 / 2007
  Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu.
• Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
  Date: 06 / 2007
  Author(s): Michelle M. Casey, D. Wholey, Ira Moscovice
  Research center: Upper Midwest Rural Health Research Center
  Topics: Emergency medical services (EMS), Quality
  The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by emailing the author at: mcasey@umn.edu.
• Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
  Date: 05 / 2007
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Policy Brief
  Discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. A full report is also available.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Policy Brief)
  Date: 05 / 2007
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Policy Brief No. 4
  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.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
  Date: 04 / 2007
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 16
  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.
• Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
  Date: 03 / 2007
  Author(s): Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Quality
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State. The quality measures that were tested focused on patients presenting to the emergency department with chest pain/acute myocardial infarction (AMI, or heart attack) or trauma, and patients seen in the emergency department who were transferred to another hospital for care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Hospital Size, Uncertainty and Pay-for-Performance
  Date: 02 / 2007
  Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 3
  Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.

2006

• Prioritizing Patient Safety Interventions in Small Rural Hospitals
  Date: 12 / 2006
  Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702
  Reports the results of a study seeking to determine if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers in small rural facilities in Maine, Minnesota, Montana, North Dakota, Pennsylvania, and Tennessee. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
• Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
  Date: 12 / 2006
  Author(s): Michelle Casey, Michele Burlew
  Research center: Upper Midwest Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 13
  Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
  Date: 11 / 2006
  Author(s): Walter Gregg, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health care financing, Hospitals and clinics, Quality
  Report Number: Policy Brief No. 2
  Overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration (HQID) project.
• Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report)
  Date: 09 / 2006
  Author(s): Walter Gregg, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 2
  Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
• Quality and Performance Improvement Grant Activities Under the Flex Program
  Date: 08 / 2006
  Author(s): Jennifer Lenardson, John Gale
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 12
  Describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Chronic Disease Management Systems (Registries) in Rural Health Care
  Date: 05 / 2006
  Author(s): Anne Skinner, Roslyn Fraser-Maginn, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Chronic diseases and conditions, Quality, Technology
  Report Number: Rural Policy Brief Vol. 11, Number 1 (PB2006-1 )
  A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. The focus of this study was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. Findings show that CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology.
• CAH Participation in Hospital Compare and Initial Results
  Date: 02 / 2006
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 9
  Examines the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia. Although CAHs do not face the same financial incentives as Prospective Payment System hospitals to participate, the Hospital Compare initiative provides an important opportunity for CAHs to assess and improve their performance on national standards of care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
  Date: 01 / 2006
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Report Number: Policy Brief No. 1
  To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available.
• Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
  Date: 2006
  Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Citation: Journal of Rural Health, 22(4), 321-330
  Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
• Rural Healthcare Quality Agenda
  Date: 2006
  Author(s): Mary Wakefield
  Research center: Upper Midwest Rural Health Research Center
  Topic: Quality
  Citation: Journal for Healthcare Quality, 28(5): 2, 57
  An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health.

2005

• Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
  Date: 12 / 2005
  Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Report Number: Working Paper No. 1
  To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
• Comparing Patient Safety in Rural Hospitals by Bed Count
  Date: 2005
  Author(s): Stephenie L. Loux, Susan M. C. Payne, Astrid Knott
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Advances in Patient Safety: From Research to Implementation. (Vols. 1-4), (pp. 391-402). Rockville, MD: Agency for Healthcare Research and Quality.
  Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.

2004

• Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
  Date: 09 / 2004
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 2
  Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
  Date: 09 / 2004
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Briefing Paper No. 3
  Describes the patient safety results from a national phone survey of 474 CAH administrators conducted in 2004. Survey respondents were queried regarding top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. The survey findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously because of the significant number of CAHs which reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Access To Primary Care And Quality Of Care In Rural America
  Date: 06 / 2004
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Quality
  Provides findings from a population-based study addressing the impact of the availability of health care resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services. Report available on request.
• Nursing Homes In Rural And Urban Areas, 2001
  Date: 06 / 2004
  Author(s): Charles D. Phillips, Catherine Hawes, Malgorzata Leyk Williams
  Research center: Southwest Rural Health Research Center
  Topics: Long term care, Quality, Rural statistics and demographics
  Chart book providing descriptive data on the entire population of longer-stay nursing home residents in the country in calendar year 2001 and categorizing them according to the rurality of the nursing home in which they receive care in an effort to address questions related to residents' characteristics and quality of care.
• Measuring Rural Hospital Quality
  Date: 04 / 2004
  Author(s): Ira Moscovice, Douglas R. Wholey, Jill Klingner, Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 53
  This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. A conceptual model is developed for measuring rural hospital quality. Hospital quality measures from national and rural organizations are reviewed for their fit to rural hospitals, with a recommendation for an initial core set of quality measures relevant for rural hospitals with less than 50 beds. Finally, avenues for future quality measure development are suggested.
• Quality Improvement Strategies and Best Practices in Critical Access Hospitals
  Date: 01 / 2004
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Working Paper No. 52
  Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
• Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
  Date: 2004
  Author(s): Laura-Mae Baldwin, Richard F MacLehose, Shelli K Beaver, N Every, Leighton Chan
  Research center: WWAMI Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Journal of Rural Health, 20(2), 99-108
  Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care.
  Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality.
  Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]).
  Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.
• Comparative Performance Data for Critical Access Hospitals
  Date: 2004
  Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale
  Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Citation: Journal of Rural Health, 20(4), 374-382
  Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.

2003

• Environmental Context of Patient Safety and Medical Errors
  Date: 03 / 2003
  Author(s): Douglas Wholey, Ira Moscovice, Terry Hietpas, Jeremy Holtzman
  Research center: Minnesota Rural Health Research Center
  Topic: Quality
  Report Number: Working Paper No. 47
  Explores the environmental context of patient safety and medical errors with specific interest in rural settings. Reviews the patient safety/medical error literature, identifies unique features of rural health care organizations and their environment that relates to patient safety issues and medical errors. Discusses strategies for medical error reduction and prevention in rural health care settings.
• 2003 Index of Hospital Quality
  Date: 2003
  Author(s): Colm O'Muircheartaigh
  Research center: Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Quality
  Published annually by U.S. News & World Report. Describes a series of factors regarding ranking of measuring hospital quality.

2002

• Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses
  Date: 08 / 2002
  Author(s): Astrid Knott, Karen Travers
  Research center: Minnesota Rural Health Research Center
  Topics: Quality, Rural Health Clinics (RHCs)
  Report Number: Working Paper No. 42
  Assesses the potential of a diverse set of Rural Health Clinics to comply with the quality assessment and performance improvement program (QAPI) requirements and the capacity of state agencies to provide RHCs with technical assistance in their QAPI implementation. Finds that more information and guidance on QAPI requirements is needed to make the program a success, and that to make QAPI useful to RHCs, RHCs need technical assistance in all aspects of quality assurance. Also finds that QAPI implementation could hamper care in resource-strapped RHCs if implementation is too costly or if clinics decide to withdraw from the RHC program because of QAPI.

2001

• Improving the Quality of Outpatient Care for Older Patients with Diabetes: Lessons from a Comparison of Rural and Urban Communities
  Date: 08 / 2001
  Author(s): Roger A. Rosenblatt, Laura-Mae Baldwin, Leighton Chan, Meredith A. Fordyce, Irl B. Hirsch, Jerry P. Palmer, George E. Wright, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Chronic diseases and conditions, Quality
  Citation: Journal of Family Practice, 50(8), 676-680
  Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Among the findings: Generalists provided most diabetic care in all locations. Patients living in small rural towns received almost half their outpatient care in larger communities. Patients living in large rural towns remote from metropolitan areas were more likely to have received the recommended tests than patients in all other groups. Patients who saw an endocrinologist at least once during the year were more likely to have received the recommended tests. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.