Quality: Rural Health Research Products & Journal Articles

2023

Diabetes Prevalence and Monitoring in Nonmetropolitan and Metropolitan Areas Within a Commercially Insured U.S. Population
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2023
This study used recent claims data, from services received between 2018 and 2020, to examine the prevalence of diabetes and to determine if patients with diabetes are more or less likely to receive annual hemoglobin A1c screening.

2022

Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
Journal Article
Rural and Minority Health Research Center
Date: 11/2022
Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.
Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
Policy Brief
WWAMI Rural Health Research Center
Date: 05/2022
This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.
Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.

2021

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
Journal Article
Maine Rural Health Research Center
Date: 09/2021
This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
High-Functioning Rural Medicare ACOs – A Qualitative Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
This brief identifies common success factors among four high-performing rural Medicare Accountable Care Organizations.
Barriers to Health Care Access for Rural Medicare Beneficiaries: Recommendations From Rural Health Clinics
Policy Brief
University of Minnesota Rural Health Research Center
Date: 01/2021
This brief presents findings from an online survey of Rural Health Clinics describing barriers for Medicare patients in accessing healthcare services and recommendations for how to improve access to care for Medicare beneficiaries in rural areas.

2020

Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2020
There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
Factors Affecting the Likelihood of a Hospitalization Following a Diabetes-Related Emergency Department Visit: A Regional and Urban-Rural Analysis
Journal Article
Southwest Rural Health Research Center
Date: 05/2020
This study examines place-based and individual-level predictors of diabetes-related hospitalizations using 2009-2014 data from the National Inpatient Sample. Our findings indicate a higher incidence of these hospitalizations in residents of noncore areas in the South and Midwest, racial and ethnic minorities, and the uninsured population.

2019

Quality Measures for Critical Access Hospital Swing Bed Patients
Policy Brief
University of Minnesota Rural Health Research Center
Date: 10/2019
This study identified measures to be used to assess the quality of care provided to Critical Access Hospital (CAH) swing bed patients with the goal of having these measures endorsed by the National Quality Forum and used by policymakers to help assess the value of CAH swing beds.
Primary Care Clinician Participation in the CMS Quality Payment
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2019
Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.

2018

Changes to the Merit-Based Incentive Payment System Pertinent to Small and Rural Practices, 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
This policy brief highlights key regulatory changes to the Merit-based Incentive Payment System that occurred in 2018. It discusses the implications of these changes with an emphasis on how these changes may affect small and rural practices.
The Rural Hospital and Health System Affiliation Landscape – A Brief Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
The shift from traditional fee-for-service to value-based payment requires major capital investment. In this paper, we examine rural hospital and health system motivations for affiliation and present a non-exhaustive list of common affiliation structures with representative examples.
Organizational Attributes Associated With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2018
Peer-reviewed paper evaluating associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance.
Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
Policy Brief
Maine Rural Health Research Center
Date: 07/2018
This brief discusses the Merit-Based Incentive Payment System (MIPS) within the context of past and current Rural Health Clinic (RHC) quality reporting initiatives and assesses options for encouraging RHCs to voluntarily participate in MIPS.
Organizational Attributes With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneﬁciary panels, and higher post-hospitalization follow-up rates had better performance.
Critical Access Hospital Swing-Bed Quality Measures: Findings From Key Informant Interviews
Policy Brief
University of Minnesota Rural Health Research Center
Date: 04/2018
This study examines how Critical Access Hospitals (CAHs) are currently assessing the quality of care provided to their swing-bed patients.
Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2018
While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2018
The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.

2017

Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2017
This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.
Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2017
Patient sociodemographic characteristics, such as age, race, gender, income, and education, can affect health outcomes and healthcare providers' performance on quality measures. The discussion about how to tackle these issues around quality measurement haven't included rurality, but this study examines it.
A Positive Association Between Hospice Profit Margin and the Rate at Which Patients Are Discharged Before Death
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2017
The links between the increasing live discharge rate from hospice and the quality of care is examined.
After Hospital Closure: Pursuing High Performance Rural Health Systems Without Inpatient Care
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 06/2017
A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 06/2017
The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2017
Analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.
Resources to Reduce Adverse Drug Events in Rural Hospitals
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2017
This policy brief provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals.

2016

Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2016
Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2016
There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
Ensuring Access to High-Quality Maternity Care in Rural America
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2016
Examines the access to high-quality for rural women care during pregnancy and childbirth. Policy interventions at the local, state, and federal levels could help to address maternity care workforce shortages and improve quality of care available to the one-half million rural U.S. women who give birth each year.
Quality Measures and Sociodemographic Risk Factors: The Rural Context
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2016
This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures
Journal Article
University of Minnesota Rural Health Research Center
Date: 04/2016
In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births. This study used the publicly available Join Commission Quality Check data from April 2014 to March 2015.
Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
Policy Brief
Maine Rural Health Research Center
Date: 02/2016
More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 02/2016
Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.

2015

Rural Hospital and Physician Participation in Private Sector Quality Initiatives
Policy Brief
University of Minnesota Rural Health Research Center
Date: 10/2015
This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
Policy Brief
University of Minnesota Rural Health Research Center
Date: 10/2015
The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
Rural Medicare Beneficiaries Have Fewer Follow-Up Visits and Greater Emergency Department Use Post-Discharge
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2015
Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties.
Care Coordination in Rural Communities Supporting the High Performance Rural Health System
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 06/2015
This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
Poorer Quality Outcomes of Medicare-Certified Home Health Care in Areas With High Levels of Native American/Alaska Native Residents
Journal Article
Rural and Minority Health Research Center
Date: 04/2015
Examines CMS quality indicators in home healthcare to determine disparities in rural areas with high population of Native American or Alaska Natives.
Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
Policy Brief
Maine Rural Health Research Center
Date: 02/2015
This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
Surgical Services in Critical Access Hospitals, 2011
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
Policy Brief
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 02/2015
This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
This brief discusses Medicare Shared Savings Program eligibility, participation requirements, and quality measures relative to accountable care organization formation.
Birth Volume and the Quality of Care in Rural Hospitals
Journal Article
University of Minnesota Rural Health Research Center
Date: 2014
Evaluates obstetric care quality in low-, medium-, and high-volume areas by using hospital discharge data.

2012

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.

2011

Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Policy Brief
Upper Midwest Rural Health Research Center
Date: 09/2011
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.
Care Transitions: "Time to Come Home"
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2011
This policy brief examines care coordination, with a focus on the transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
Care Transitions: "Time to Come Home" (Full Report)
Upper Midwest Rural Health Research Center
Date: 03/2011
This report looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.

2010

Nurse Staffing and Rural Hospital Performance
Policy Brief
Upper Midwest Rural Health Research Center
Date: 12/2010
This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 12/2010
The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2010
This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
Patient Assessments and Quality of Care in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2010
This policy brief analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2010
This report analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences. It assesses whether rural patients' perspectives of quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery
RUPRI Center for Rural Health Policy Analysis
Date: 06/2010
This paper provides a summary of legislative provisions contained in the Patient Protection and Affordability Act of 2010 (PPACA) that have particular meaning to rural residents and to the delivery of services in rural areas.
Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2010
Overall, there has been improvement in acute myocardial infarction quality measures and persistent rural-urban disparities in only a few. Particularly in small/remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2010
In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.

2009

Implementing Patient Safety Initiatives in Rural Hospitals
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2009
This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.
Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2009
This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.

2008

Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
RUPRI Center for Rural Health Policy Analysis
Date: 04/2008
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 nation's smallest hospitals.

2007

Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Upper Midwest Rural Health Research Center
Date: 08/2007
The Tennessee Rural Hospital Patient Safety Demonstration project included the implementation of three patient-safety initiatives in eight rural Tennessee hospitals using a collaborative model and an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
Upper Midwest Rural Health Research Center
Date: 08/2007
This policy brief reports the 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.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2007
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.
Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2007
This policy brief examines the second-year participation and quality measure results for critical access hospitals in the Centers for Medicare and Medicaid Services Hospital Compare public reporting database.
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Upper Midwest Rural Health Research Center
Date: 05/2007
This policy brief discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results: Briefing Paper
University of Minnesota Rural Health Research Center
Date: 04/2007
This brief examines the second-year participation and quality measure results for critical access hospitals in the Centers for Medicare and Medicaid Services Hospital Compare public reporting database for hospital quality measures.
Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
University of Minnesota Rural Health Research Center
Date: 03/2007
This report shares findings from a project testing emergency department (ED) quality measures in critical access hospitals in Washington state. The quality measures focused on patients presenting to the ED with chest pain/acute myocardial infarction or trauma and patients seen in the ED who were transferred to another hospital for care.
Hospital Size, Uncertainty and Pay-for-Performance
Upper Midwest Rural Health Research Center
Date: 02/2007
This report examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.

2006

Prioritizing Patient Safety Interventions in Small Rural Hospitals
Journal Article
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 12/2006
Determines 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. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
Policy Brief
Upper Midwest Rural Health Research Center
Date: 11/2006
This paper provides an 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 project.
Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
Upper Midwest Rural Health Research Center
Date: 10/2006
This report analyzes critical access hospital inpatient hospitalizations and transfers and assesses the implications for national quality measurement and reporting.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
Upper Midwest Rural Health Research Center
Date: 09/2006
This report shares 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.
A Rural Healthcare Quality Agenda
Journal Article
Upper Midwest Rural Health Research Center
Date: 09/2006
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.
Quality and Performance Improvement Grant Activities Under the Flex Program
Maine Rural Health Research Center
Date: 08/2006
This paper describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program.
Chronic Disease Management Systems (Registries) in Rural Health Care
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2006
A Chronic Disease Management System (CDMS) is a tool that helps providers collect and analyze patient information to promote quality care. This study shows 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
University of Minnesota Rural Health Research Center
Date: 02/2006
This paper 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 results for CAHs and comparisons with other hospital groups on quality measures for various conditions.
Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
Maine Rural Health Research Center
Date: 02/2006
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy and provides a context for legislation that affects rural health services and populations.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Policy Brief
Upper Midwest Rural Health Research Center
Date: 01/2006
This study's results indicate that many small rural hospitals have limited hours of onsite pharmacist coverage and many either don't have a pharmacy computer or don't use it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
Journal Article
Upper Midwest Rural Health Research Center
Date: 2006
Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.

2005

Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Upper Midwest Rural Health Research Center
Date: 12/2005
This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one 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
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.

2004

Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
University of Minnesota Rural Health Research Center
Date: 09/2004
This paper describes the patient safety results from a 2004 survey of critical access hospital administrators.
Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
University of Minnesota Rural Health Research Center
Date: 09/2004
This paper describes quality improvement efforts in critical access hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. It includes data on the use of clinical guidelines and quality measures in CAHs and the role of Medicare Quality Improvement Organizations.
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.
Nursing Homes in Rural And Urban Areas, 2001
Southwest Rural Health Research Center
Date: 06/2004
This chartbook provides descriptive data on the entire population of longer-stay nursing home residents in the country in 2001 and categorizes them according to the rurality of the nursing homes in which they receive care in an effort to address questions related to residents' characteristics and quality of care.are.
Measuring Rural Hospital Quality
University of Minnesota Rural Health Research Center
Date: 04/2004
This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and are sensitive to the rural hospital context.
Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
Maine Rural Health Research Center
Date: 02/2004
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
Quality Improvement Strategies and Best Practices in Critical Access Hospitals
University of Minnesota Rural Health Research Center
Date: 01/2004
This paper describes critical access hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. It includes lists of changes made to staffing, training, equipment, and other issues related to QI.
Comparative Performance Data for Critical Access Hospitals
Journal Article
Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
Date: 2004
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.
Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2004
Acute myocardial infarction (AMI) is a common and important cause of admission to rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. This study examines the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.

2003

Environmental Context of Patient Safety and Medical Errors
University of Minnesota Rural Health Research Center
Date: 03/2003
This paper explores the environmental context of patient safety/medical errors with specific interest in rural areas. It reviews patient safety/medical error literature, identifies features of rural healthcare organizations and their environment relating to patient safety issues/medical errors, and discusses error reduction/prevention strategies.
2003 Index of Hospital Quality
NORC Walsh Center for Rural Health Analysis
Date: 2003
Published annually by U.S. News & World Report, this 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
University of Minnesota Rural Health Research Center
Date: 08/2002
This paper assesses the potential of a diverse set of rural health clinics (RHCs) 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.

2001

Improving the Quality of Outpatient Care for Older Patients With Diabetes: Lessons From a Comparison of Rural and Urban Communities
Journal Article
WWAMI Rural Health Research Center
Date: 08/2001
Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. 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.