title: A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.
abstract: OBJECTIVE
  To investigate the effectiveness of a quality improvement educational program in rural hospitals.
  
  
  METHODS
  Hospital-randomized controlled trial.
  
  
  METHODS
  
  
  
  METHODS
  A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool.
  
  
  METHODS
  The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves.
  
  
  METHODS
  Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program.
  
  
  RESULTS
  No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group.
  
  
  CONCLUSIONS
  While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.
authors.affiliation: Institute for Health Care Research and Improvement, 8080 N. Central Expressway, Suite 500, Dallas, TX 75206, USA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.forename: David
authors.initials: D
authors.lastname: Nicewander
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Janine
authors.initials: J
authors.lastname: Edwards
authors.forename: Percy
authors.initials: P
authors.lastname: Galimbertti
authors.forename: Mari
authors.initials: M
authors.lastname: Tietze
authors.forename: Susan
authors.initials: S
authors.lastname: McBride
authors.forename: Julie
authors.initials: J
authors.lastname: Gunderson
authors.forename: Ashley
authors.initials: A
authors.lastname: Collinsworth
authors.forename: Ziad
authors.initials: Z
authors.lastname: Haydar
authors.forename: Josie
authors.initials: J
authors.lastname: Williams
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D019985:Benchmarking; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000517:prevention & control; D006333:Heart Failure / Q000628:therapy; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013781:Texas