Rural hospital patient safety systems implementation in two States.
OBJECTIVE
With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals.


METHODS
Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times.


RESULTS
On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis."


CONCLUSIONS
Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems.
Longo
Daniel R
DR
Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA. drlongo@vcu.edu
Hewett
John E
JE
Ge
Bin
B
Schubert
Shari
S
D004059:Diffusion of Innovation; D005163:Factor Analysis, Statistical; D017144:Focus Groups; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000458:organization & administration* / Q000592:standards; D006786:Hospitals, Urban / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D008923:Missouri; D015397:Program Evaluation; D017751:Safety Management; D011795:Surveys and Questionnaires; D013997:Time Factors; D014589:Utah