title: Implementation of emergency department transfer communication measures in Minnesota critical access hospitals.
abstract: OBJECTIVE
  Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013.
  
  
  METHODS
  Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures.
  
  
  RESULTS
  Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account.
  
  
  CONCLUSIONS
  Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale.
authors.affiliation: Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Labovitz School of Business and Economics, University of Minnesota Duluth, Duluth, Minnesota.
authors.forename: Jill
authors.initials: J
authors.lastname: Klingner
authors.forename: Ira
authors.initials: I
authors.lastname: Moscovice
authors.forename: Michelle
authors.initials: M
authors.lastname: Casey
authors.forename: Alex
authors.initials: A
authors.lastname: McEllistrem Evenson
mesh_terms: D003142:Communication; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D006278:Medicare; D008910:Minnesota; D010360:Patient Transfer / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D014481:United States
keywords: critical access hospitals; emergency department quality measurement; patient transfer communication measures; rural hospital quality