Determinants of Quality of Care in Rural Communities: How Does The Health Care Infrastructure Affect Quality of Care in Rural America?

Research center:
Lead researcher:
Project completed:
August 2003
The objective of this study is to determine the extent to which health manpower shortages and limited availability of health care resources may affect the quality of care in rural communities. We are developing a multivariate model that will allow us to measure the relationship between access to health care resources and quality of care after controlling for differences in health status and level of out-migration for health care services. Parameter estimates will be used to assess the factors that are most associated with quality of health care services and the magnitude of the effect.

For the purpose of this study, quality will be measured at the population level using AHRQ prevention quality indicators. These indicators use inpatient claims data to measure hospitalizations in a community for conditions that should be treatable on an outpatient basis or that could be less severe if treated early and appropriately. Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases, we profile rural counties performance on each of the 16 indicators that comprise the AHRQ quality indicator set. We characterize the health care infrastructure in each rural community on a number of measures that may include physician-to-population ratio, distance to nearest acute care hospital, nursing beds-to-population ratio, and the availability of selected services (e.g., emergency department, obstetrical services). Data on the health care infrastructure is obtained from the Area Resource File and the Medicare Provider of Services Files.

This study will also provide information on how changes in policies affecting the rural health care infrastructure could further impact rural quality of care. Examples of the types of issues that this study could assist in addressing include USDA ending its participation in the J-1 Visa waiver program and the Rural Health Care Improvement Act.


  • Access To Primary Care and Quality of Care in Rural America
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.