title: Quality improvement strategies and best practices in critical access hospitals.
abstract: BACKGROUND
  Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs.
  
  
  OBJECTIVE
  This article describes key quality improvement initiatives for a national sample of CAHs that are actively involved in implementing quality-related initiatives in collaboration with support hospitals and statewide organizations.
  
  
  METHODS
  Researchers conducted a national telephone survey of 72 CAHs and 2 in-depth case studies of CAHs.
  
  
  RESULTS
  The survey and case studies demonstrate that many CAHs are successfully implementing QI activities, including patient safety initiatives, improvements in overall QI processes and peer review processes, and implementation of QI projects focused on treatment of 1 or more specific diseases. The CAHs are involved with multiple external organizations in these activities. The administrators of the 2 case study CAHs have made QI a priority for their hospitals; ensured that resources are available for QI activities; and worked with their support hospitals, statewide organizations, and other CAHs to develop and implement rural-relevant QI initiatives.
  
  
  CONCLUSIONS
  Cost-based Medicare reimbursement has been a key factor in the ability of CAHs to fund additional staff, staff training, and equipment to improve patient care. The commitment of hospital leaders and key staff is a crucial factor in moving QI initiatives forward in CAHs.
authors.affiliation: Rural Health Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, Minn 55414, USA. mcasey@umn.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Casey
authors.forename: Ira
authors.initials: I
authors.lastname: Moscovice
mesh_terms: D019985:Benchmarking; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D017721:Hospital Costs; D006780:Hospitals, Rural / Q000191:economics / Q000592:standards*; D006801:Humans; D006278:Medicare / Q000592:standards; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000592:standards; D010561:Personnel Staffing and Scheduling / Q000592:standards; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D012423:Rural Health / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States