Statement of the problem: Public reporting of quality measures has expanded to include process and outcome measures in a variety of healthcare settings, including hospitals, nursing homes and home health agencies. Many small rural hospitals participate in public reporting, and a number of measures address conditions commonly treated by rural hospitals, such as pneumonia and heart failure. However, low volume remains a problem, especially for calculating outcome measures such as mortality and readmission rates for rural providers.

Project goals: The first year of this project focused on modeling alternative ways of identifying high quality rural hospitals and analyzing factors related to quality in rural hospitals. The second year will examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.

Methods: This two-year project employs descriptive and multivariate analyses using several large longitudinal national databases, including Hospital Compare inpatient measures (2004-2009), HCAHPS (2008-2009), Medicare inpatient claims (1998-2009), Nursing Home Compare (2003-2010), Home Health Compare (2004-2010), and AHA Annual Survey data (1998-2009).

Anticipated Publications or Products: A final report and policy briefs, a peer-reviewed journal manuscript, and abstracts for presentations at regional and/or national conferences.

Publications

• Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 01/2015
  This study's purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.
• Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures
  Policy Brief
  Upper Midwest Rural Health Research Center
  Date: 07/2012
  As a part of a larger project that examined alternative ways of identifying high quality rural hospitals, this report assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals.