title: Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia.
abstract: BACKGROUND
  This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.
  
  
  METHODS
  Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.
  
  
  RESULTS
  Centers for Medicare and Medicaid Services "Hospital Compare" data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01) and Union General Hospital (P = 0.01). This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02). When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (-3.44 versus -6.07, respectively, P = 0.54).
  
  
  CONCLUSIONS
  The range of process of care scores submitted by acute care hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services "Hospital Compare" information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area.
authors.affiliation: Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA ; Graduate School of Life Sciences, University of Westminster, London, UK.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.forename: Liubomir
authors.initials: L
authors.lastname: Chiriac
authors.forename: Denis
authors.initials: D
authors.lastname: Vaughan
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jones
authors.forename: Shala A
authors.initials: SA
authors.lastname: Salem
keywords: North Carolina; hospital quality; process of care; rural