title: Comparative performance data for critical access hospitals.
abstract: BACKGROUND
  Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals.
  
  
  OBJECTIVE
  To identify how comparative performance data for critical access hospitals (CPD-CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD-CAH.
  
  
  METHODS
  Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses.
  
  
  RESULTS
  CPD-CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD-CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD-CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results.
  
  
  CONCLUSIONS
  CPD-CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD-CAH should be carefully weighed against its potential cost.
authors.affiliation: Department of Health Policy and Administration, University of North Carolina at Chapel Hill 27599-7411, USA. gpink@email.unc.edu
authors.forename: George H
authors.initials: GH
authors.lastname: Pink
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Slifkin
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Coburn
authors.forename: John A
authors.initials: JA
authors.lastname: Gale
mesh_terms: D019985:Benchmarking; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012423:Rural Health / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires