Measuring rural hospital quality.
BACKGROUND
Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities.


OBJECTIVE
This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context.


METHODS
We develop a conceptual model for measuring rural hospital quality, with a focus on the special issues posed by the rural hospital context for quality measurement. With the assistance of a panel of rural hospital and hospital quality measurement experts, we review hospital quality measures from national and rural organizations for their fit to rural hospitals.


RESULTS
Based on this analysis, we recommend an initial core set of quality measures relevant for rural hospitals with less than 50 beds. This core set of 20 measures includes 11 core measures from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) related to community acquired pneumonia, heart failure, and acute myocardial infarction; 1 measure related to infection control; 3 measures related to medication dispensing and teaching; 2 procedure-related measures; 1 financial measure; and 2 other measures related to the use of advance directives and emergency department monitoring of trauma vital signs.


CONCLUSIONS
Based on the special measurement needs posed by the rural hospital context, we suggest avenues for future quality measure development for core rural hospital functions (eg, triage, stabilization, and transfer, and emergency care) not considered in existing quality measurement sets.
Moscovice
Ira
I
Rural Health Research Center, Division of Health Services Research and Policy, University of Minnesota, Minneapolis, MN 55455, USA. mosco001@umn.edu
Wholey
Douglas R
DR
Klingner
Jill
J
Knott
Astrid
A
D017714:Community-Acquired Infections / Q000628:therapy; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000628:therapy; D006743:Hospital Bed Capacity, under 100 / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D016015:Logistic Models; D009203:Myocardial Infarction / Q000628:therapy; D011014:Pneumonia / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012423:Rural Health / Q000706:statistics & numerical data; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology