Introduction
Forty-nine million people live in rural America. Comprising a variety of ethnic groups, varying degrees of remoteness and population densities, diverse economic backgrounds, and a multitude of social characteristics; one common bond is the need to receive quality health care. Concern about the quality of health care in both urban and rural United States has increased markedly since the release of two landmark reports by the Institute of Medicine - To Err is Human (1999) and Crossing the Quality Chasm (2001). Significant gaps exist across all health care settings and there is no guarantee that consumers will receive quality care, regardless of where that care is provided. To improve care quality requires a number of strategies including a major redesign in health systems, paying for services in ways that encourage the delivery of high quality care, and the development of quality improvement infrastructure that measures care on meaningful indicators to determine where improvement efforts need to be made.
Most of the research - designed to address these issues - is conducted in urban health care settings. While some of these research findings and quality indicators are highly relevant to rural health care settings, many are not. Recently, increased attention is being paid to quality efforts designed to address the distinctive features of rural health care systems and settings such as limited access to core health care services, shortages in qualified health professionals, and an aging population. In addition, advances in technology have presented new opportunities for delivering medical care in rural areas. Telemedicine, telepharmacy, electronic medical records, and computerized physician order entries have shown to increase quality as well as access to health care particularly with the underserved and vulnerable populations. Most importantly improving care quality requires the participation of a range of stakeholders. Federal and state governments, purchasers of care, insurance companies, as well as health care providers must work together to ensure quality health care for the millions in rural America.
Frequently Asked Questions
Tools
2007 State Snapshots
Web site
Provides State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement.
Access for All America: Expanding the Reach of Community Health Centers To Provide Care to Those without a Health Care Home
Web site
Working to reduce the ranks of America’s medically disenfranchised by preserving, strengthening and expanding health centers from a stable base to reach a total of 30 million patients by the year 2015.
Advances in Patient Safety: From Research to Implementation
Web site
A compendium of 140 articles in the 4-volume set cover a wide range of research paradigms, clinical settings, and patient populations.
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Web site
A public-private initiative to develop standardized surveys of patients' experiences with ambulatory and facility-level care.
ConsumerHealthRatings.com
Web site
Provides a listing of organizations that rate or report performance on specific hospitals, health plans, physicians, nursing homes, home health agencies and other health care providers in the United States. The ratings information is free.
HCUPnet
Database
Online query tool for accessing Healthcare Cost and Utilization Project data. Provides access to health statistics and information on hospital stays at the national, regional, and State level. Includes data on rural hospital diagnoses and procedures.
Health Care Excel (HCE)
Web site
Evaluates health-care quality, clinical appropriateness, and outcome assessments. Also designs customized management solutions and develops appropriate educational programs to significantly improve the delivery of health services.
Health Care Innovations Exchange
Web site
Designed to support health care professionals in sharing and adopting innovations that improve the delivery of care to patients.
Healthcare 411 Audio Series
Web site
Audio program featuring the latest health care research findings, news, and information from the Agency for Healthcare Research and Quality. Users can listen to individual programs or subscribe to the series.
Healthcare and Quality
Web site
A topic page from the Institute of Medicine (IOM) that contains links to current projects, events, and reports addressing health care services and the quality of care. Included are works from the Institute of Medicine's Health Care Quality Initiative, as well as work on the consequences of being uninsured.
Hospital Survey on Patient Safety Culture
Research instrument
Describes a survey tool which can be used to assess the safety culture of a hospital as a whole, or for specific units within hospitals, as well as to track changes in patient safety over time and evaluate the impact of patient safety interventions.
HRSA Health Disparities Collaborative
Web site
A centralized portal for communication as well as a forum for sharing the challenges, successes, tools, and lessons learned to improve access to high quality, culturally and linguistically competent primary and preventive healthcare for underserved, uninsured, and underinsured Americans.
IHI conferences and Seminars
Web site
Offers conferences and seminars that provide opportunities to learn the latest improvement ideas, connect with like-minded colleagues, and generate momentum for change in an organization.
IHI.org
Web site
A resource from the Institute of Healthcare Improvement. Website provides tools, literature, and practices that can be implemented and measured to help facilitate improvement of health care quality.
Improving Chronic Illness Care (ICIC)
Web site
Offers technical assistance with training and has an online archive of materials to help directors, coordinators and improvement experts in any effort aimed at improving care for the chronically ill.
Joint Commission Newsletters and Journals
Web site
A list of newsletters available from the Joint Commission website.
KaiserEDU
Web site
Detailed resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, the uninsured, quality of care, and more. Designed for health policy students and faculty.
Medicare Quality Monitoring System (MQMS)
Web site
Information on quality indicators of health care provided to Medicare beneficiaries, national and state-level outcomes, and brief reports on quality for clinical topics, such as heart failure and stroke.
MedlinePlus: Patient Rights
Web site
A collection of authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations on the topic of patient rights.
MedlinePlus: Patient Safety
Web site
A collection of authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations on the topic of patient safety.
My PHR: Personal Health Record
Web site
A guide to understanding and managing your personal health record. Provides step-by-step instructions for creating your own PHR.
National Guideline Clearinghouse
Database
Comprehensive database of evidence-based clinical practice guidelines, including patient safety guidelines. To limit search results to patient safety, use the detailed search and select Safety from the IOM Domain field.
National Healthcare Quality Report State Snapshots
Web site
Health care quality report for each state, based on the National Healthcare Quality Report and National Healthcare Disparities Report.
National Quality Measures Clearinghouse
Web site
A public repository and database for evidence-based quality measures and measure sets. Includes standardized abstracts containing information about measures and their development; a utility for comparing attributes of two or more quality measures; and links to full-text quality measures and/or ordering details for the full measure.
Patient Safety Toolbox for States
Web site
Provides background information and tools related to states' use of adverse event reporting systems to improve patient safety.
Patient Safety Tools: Improving Safety at the Point of Care
Web site
Tools designed to help health care institutions and clinicians provide - and consumers receive - safe, quality health care at various points in the health care process.
Performance Snapshots
Web site
An authoritative online resource about health system performance. Tracks health system performance and provides access to more than 180 charts and associated narratives.
Physician Quality Reporting Initiative
Web site
A voluntary physician quality reporting program established by CMS providing financial incentive for eligible professionals.
Provider's Guide to Quality and Culture
Web site
Designed to assist healthcare organizations throughout the United States in providing high quality, culturally competent services to multi-ethnic populations.
PSNet: Patient Safety Network
Web site
A continuously updated, annotated, and selected collection of patient safety news, literature, tools, and resources.
Quality Initiatives
Web site
Contains resources of quality improvement efforts developed by CMS. Provides fact sheets and other documents, data, and a listing of organizations. Topics include home health, hospital, nursing home, and physician focused quality initiatives.
Quality Through Collaboration: Models that Work
Web site
Examples of collaboration in communities with the goal of improving the quality of health care provided in a community and addressing the needs of population health.
Quality Through Collaboration: The NRHA Quality Initiative
Web site
NRHA initiative to promote access to coordinated, high-quality care in every rural community. Includes information on ways NRHA and the rural health community can achieve the recommendations of the Institute of Medicine's report, "Quality Through Collaboration: The Future of Rural Health."
QualityTools
Web site
QualityTool, sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, is a Web-based clearinghouse providing practical tools for assessing, measuring, promoting, and improving the quality of Americans' health care. Site includes sections for health care providers, health plans, policymakers, purchasers, patients and consumers.
Rural Health Clinics Technical Assistance Conference Call Series
Web site
An ongoing series of technical assistance conference calls for Rural Health Clinics. Includes transcripts from past calls and related resources and tools.
Rural Health Research: Quality
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of health care quality, produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Hospital Education Gateway
Web site
A one-stop shop for rural hospitals to access distance and web-based educational resources on topics including community engagement, hospital finance, management and leadership, performance improvement, workforce and quality.
State Scorecard
Web site
An interactive U.S. Map that displays state-specific rankings and results comparing benchmark levels of performance from the Commonwealth Fund Commission's report, "Aiming Higher: Results from a State Scorecard on Health System Performance."
TalkingQuality
Web site
Designed for people and organizations trying to educate consumers about health care quality. It is intended to help those who are providing consumers with information on the performance of health plans and providers.
TASC Quality & Performance Improvement Tools
Web site
A list of tools and resources to aid CAHs and state FLEX programs to improve the quality of patient care.
Trauma System Self-Assessment Supplemental Tool: Benchmarks, Indicators, and Scoring
Web site
A tool to accompany HRSA's Model Trauma System Planning and Evaluation document, a guide to modern statewide trauma system development. This tool focuses on state and regional trauma system self-assessment.
Value-Driven Health Care
Web site
Provides health care consumers with the information necessary to choose health care providers based on value.
Your Guide to Choosing Quality Health Care
Web site
A website to help consumers choose the best healthcare provider for them.
Regulations, Forms & Other Useful Documents
2006 CAHPS Health Plan Survey Chartbook: What Consumers Say About the Quality of Their Health Plans and Medical Care
Sponsoring organization: Agency for Healthcare Research and Quality
This chartbook presents summary-level results for the CAHPS Health Plan Survey 3.0 for the years 2005 and 2006. It also presents selected historical data for the six year period from 2001 through 2006. The data presented include 2005 and 2006 results for the following populations:
• Commercial Adult
• Medicaid Adult
• Medicaid Child
• State Children's Health Insurance Program (SCHIP) (2006 only)
• Medicare Managed Care
Date: 09 / 2006
2006 Update on Consumers' Views of Patient Safety and Quality Information
Sponsoring organization: Kaiser Family Foundation
Charts highlight data from the updated Kaiser Family Foundation and U.S. Agency for Healthcare Research and Quality survey conducted in August 2006. The survey captures the public's views and knowledge of medical errors and their experiences with improving the quality of their care.
Date: 09 / 2006
2007 Guide to State Adverse Event Reporting Systems
Author(s): Jill Rosenthal, Mary Takach
Sponsoring organization: National Academy for State Health Policy
A snap shot of the current scope and operations of state adverse event reporting systems and compares current information with information from previous NASHP work.
Date: 12 / 2007
A Roadmap to Health Insurance for All: Principles for Reform
Author(s): Sara R. Collins, Cathy Schoen, Karen Davis, Anne K. Gauthier, Stephen C. Schoenbaum
Sponsoring organization: Commonwealth Fund
Explores the different health insurance coverage options and how they improve quality and efficiency as well as gain control over spiraling health care costs.
Date: 10 / 2007
Addressing the New Health Care Crisis: Reforming the Medical Litigation System to Improve the Quality of Health Care
Sponsoring organization: U.S. Department of Health and Human Services
Discusses the medical litigation system as it relates to health care access. Includes statistics on malpractice insurance rates. Proposes limits on non-economic damages and protection from litigation for reporting safety problems.
Date: 03 / 2003
Advances in Patient Safety: From Research to Implementation
Sponsoring organization: Agency for Healthcare Research and Quality
Describes what federally funded programs have accomplished in understanding medical errors and implementing programs to improve patient safety over the last five years. This compendium is sponsored jointly by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD)-Health Affairs. The 140 articles in the 4-volume set cover a wide range of research paradigms, clinical settings, and patient populations.
Date: 06 / 2005
Aiming Higher: Results from a State Scorecard on Health System Performance
Author(s): Joel C. Cantor, Dina Belloff, Cathy Schoen, Sabrina K. H. How, Douglas McCarthy
Sponsoring organization: Commonwealth Fund
Assesses health system performance on 32 measures of access and quality, avoidable hospital use and costs, equity and healthy lives. Intended to assist states in identifying opportunities to better meet their residents current and future health needs and enable them to live long and healthy lives.
Date: 06 / 2007
At A Tipping Point: Transforming Medicine with Health Information Technology: A Guide for Consumers
Sponsoring organization: Verizon Foundation
This report written for healthcare stakeholders illustrates how health information technology is a powerful tool for quality improvement, provided it is part of a larger strategy to improve quality and make healthcare
more affordable and accessible.
Date: 04 / 2005
Bringing Patients to the Center of Hospital Care
Author(s): Sarah Klein
Sponsoring organization: Commonwealth Fund
Discusses how patient-reported, hospital experience data collected by the Centers for Medicare and Medicaid may increase interest in collaborative approaches to improving the quality of inpatient care.
Date: 03 / 2007
Charting the Legal Environment of Health Information
Author(s): Sara Rosenbaum, Phyllis C. Borzi, Lee Repasch, Taylor Burke, John F. Benevelli
Sponsoring organization: Robert Wood Johnson Foundation
Overview of the legal environment of health information systems. Examines issues related to new information technology that enables the sharing of health information among many users.
Date: 05 / 2005
Checkup on Health Care Markets
Author(s): Patricia E. Powers, Michael W. Painter
Sponsoring organization: Robert Wood Johnson Foundation
Findings of a study of 14 selected communities that provides a roadmap for community-level improvements in the quality of health care for people with chronic illnesses.
Date: 2007
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 7—Care Coordination
Sponsoring organization: Agency for Healthcare Research and Quality
Defines and discusses care coordination as a key strategy for improving the effectiveness and efficiency of the health care system in mostly urban but also in rural settings.
Date: 06 / 2007
Committed to Safety: Ten Case Studies on Reducing Harm to Patients
Author(s): Douglas McCarthy, David Blumenthal
Sponsoring organization: Commonwealth Fund
This report presents 10 case studies of health care organizations, clinical teams, and
learning collaborations that have designed innovations in five areas for improving patient safety nationally: promoting an organizational culture of safety, improving teamwork and communication, enhancing rapid response to prevent heart attacks and other crises in the hospital, preventing health care - associated infections in the intensive care unit, and preventing adverse drug events throughout the hospital. Participating organizations ranged from large integrated delivery systems to small community hospitals.
Date: 04 / 2006
Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Briefing Paper)
Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. A policy brief is also available.
Date: 04 / 2007
Evidence-Informed Case Rates: A New Health Care Payment Model
Author(s): François de Brantes, Joseph A. Camillus
Sponsoring organization: Commonwealth Fund
Reports on a new payment model, based on evidence-informed case rates (ECRs) as a way to address the flaws of traditional health care payment methods, and to improve health care quality and support a patient-centered, consumer-driven environment.
Date: 04 / 2007
Geographic Variation in Health Care Spending
Sponsoring organization: Congressional Budget Office
Examines the amount of and trends in geographic variation in health care spending, mostly in the Medicare program, and the causes of that variation. Also examines the relationship between spending and quality of care.
Date: 02 / 2008
Guide to Clinical Preventive Services, 2007: Recommendations of the U.S. Preventive Services Task Force
Sponsoring organization: Agency for Healthcare Research and Quality
Provides recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. Recommendations are organized for quick reference and easy searching.
Date: 09 / 2007
Guide To Health Care Quality: How To Know It When You See It
Sponsoring organization: Agency for Healthcare Research and Quality
The purpose of this booklet is to help individuals get quality health care. Includes tips to help an individual be active in
making decisions about their health care.
Date: 09 / 2005
Health Care 20 Years From Now: Taking Steps Today to Meet Tomorrow's Challenges
Sponsoring organization: Government Accountability Office
Summarizes the ideas and themes that emerged at a health care forum convened by the Government Accountability Office. The discussion sessions focused on three topics: cost and personal responsibility; coverage of the uninsured; and quality, standards, and outcomes.
Date: 09 / 2007
Health Care in America 2006 Survey
Sponsoring organization: Kaiser Family Foundation
Highlights data from the 2006 survey on Health Care in America conducted jointly by ABC News, the Kaiser Family Foundation and USA Today between Sept. 7 and 12, 2006. The survey examines Americans' views and experiences related to health care costs and quality, as well as their attitudes toward possible policy solutions.
Date: 10 / 2006
Health Literacy: Program Brief
Sponsoring organization: Agency for Healthcare Research and Quality
Summarizes the research supported by the Agency for Healthcare Research and Quality (AHRQ) to improve health literacy as it pertains to prevention, healthy living, chronic disease management, patient-centered health care, cultural competence, and health disparities.
Hospital Performance Improvement: Trends in Quality and Efficiency--A Quantitative Analysis of Performance Improvement in U.S. Hospitals
Author(s): E. Kroch, M. Duan, S. Silow-Carroll et al.
Sponsoring organization: Commonwealth Fund
Presents results of a quantitative examination of the dynamics of hospital performance: the degree to which hospitals are improving (or deteriorating) in quality and efficiency over time.
Date: 04 / 2007
Hospital Quality Improvement: Strategies and Lessons From U.S. Hospitals
Author(s): S. Silow-Carroll, T. Alteras, J. A. Meyer
Sponsoring organization: Commonwealth Fund
Focuses on the dynamics of hospital performance: how hospitals achieve and sustain improvements over time.
Date: 04 / 2007
Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project
Author(s): Walter Gregg, Ira Moscovice, Denise Remus
Sponsoring organization: Upper Midwest Rural Health Research Center
Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
Date: 09 / 2006
Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller
Sponsoring organization: Upper Midwest Rural Health Research Center
Executive summary of a report describing a project to improve patient safety in eight rural hospitals by strengthening their capacity to implement priority patient safety initiatives. Full report available by contacting raasc001@umn.edu.
Date: 08 / 2007
Improving Quality and Achieving Equity: The Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care
Author(s): Joseph R. Betancourt
Sponsoring organization: Commonwealth Fund
Reviews key principles of quality (as it relates to the overall quality of the health care system and individual approaches to quality improvement); reviews evidence of the existence and root causes of racial and ethnic health disparities and recommendations to address them; and discusses strategies by which the quality and cultural competence movements could be linked.
Date: 10 / 2006
Improving Quality of Health Care Relies on Effective Language Services
Sponsoring organization: Robert Wood Johnson Foundation
Highlights how data are helping hospitals improve the way they provide language services to America's increasingly diverse patient populations.
Date: 09 / 2007
Improving the Quality of Healthcare through Health Information Exchange: Selected Findings from Ehealth Initiative's Third Annual Survey of Health Information Exchange Activities at the State, Regional and Local Levels
Sponsoring organization: eHealth Initiative
Highlights trends across the United States in health information exchange activities. Overview of federal and state policies related to the use of health information technology (HIT) to improve the quality and efficiency of healthcare.
Date: 09 / 2006
Institute of Medicine Rural Health Report: Next Steps in Legislation and Programs
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
Recommends federal policies that will improve patient safety and health care quality in rural America. The Panel's recommendations include innovative resource redirection and program coordination that will increase the value of federal quality improvement programs and ultimately improve the health of rural people and communities.
Date: 02 / 2006
Knowing What Works in Health Care: A Roadmap for the Nation
Sponsoring organization: Institute of Medicine
Results of the Robert Wood Johnson Foundation request that the Institute of Medicine convene a committee to recommend methods to better identify the most effective health care services. This report provides a blueprint for a national clinical effective assessment program.
Date: 2008
Market for Medical Care: Why You Don’t Know the Price; Why You Don’t Know about Quality; And What Can Be Done about It.
Author(s): Devon M. Herrick, John C. Goodman
Discusses the issues regarding the differences in the way health care is marketed and ranked for quality, and discusses the solutions that are challenging these traditional practices.
Date: 02 / 2007
Measuring Hospital Performance: The Importance of Process Measures
Author(s): Anthony Shih, Stephen C. Schoenbaum
Sponsoring organization: Commonwealth Fund
Discusses measures that can have an impact on quality and health outcomes and identifies activities hospitals can do to improve performance.
Date: 07 / 2007
Medicare "Pay-for-Performance (P4P)" Initiatives
Sponsoring organization: Centers for Medicare & Medicaid Services
Identifies various CMS initiatives to encourage improved quality of care in all health care settings where Medicare beneficiaries receive their health care services, including physicians' offices and ambulatory care facilities, hospitals, nursing homes, home health care agencies and dialysis facilities.
Date: 01 / 2005
Medicare Physician Group Practices: Innovations in Quality and Efficiency
Author(s): Michael Trisolini, Gregory Pope, John Kautter, Jyoti Aggarwal
Sponsoring organization: Commonwealth Fund
Centers for Medicare and Medicaid Services initiated the Physician Group Practice Demonstration to provide participating practices the opportunity to earn performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries. This report discusses the experiences of the participating practices.
Date: 12 / 2006
Medication Safety: Patients' Concerns About Medical Errors During Hospitalization
Author(s): Burroughs, Thomas; Waterman, Amy; Gallager, Thomas
Sponsoring organization: Joint Commission
Results of a study which discusses patients' understanding and perceived risk of medical errors in 2002 with 1,656 inpatients from 12 Midwestern hospitals.
Journal citation: Joint Commission Journal on Quality and Patient Safety Volume 33 Issue 1 Pages: 5-14
Date: 01 / 2007
Moving from Research to Practice: Evaluation Report II
Author(s): Donna O. Farley, Sally C. Morton, Cheryl L. Damberg, M. Susan Ridgely, Allen Fremont, Michael D. Greenberg, Melony E. Sorbero, Stephanie S. Teleki, Peter Mendel
Sponsoring organization: Agency for Healthcare Research and Quality
The second report in a four part series of evaluation report. Documents activities, progress, and issues involved in conducting the AHRQ-funded patient safety projects; building the infrastructure to support improved patient safety practices; and disseminating research results and products.
Date: 2007
Multicultural Health Care: A Quality Improvement Guide
Sponsoring organization: National Committee for Quality Assurance
Provides a quality improvement framework for health care organizations seeking to promote culturally appropriate care, provide equitable access for individuals with limited English proficiency and reduce health care disparities.
Date: 2008
Multinational Comparisons of Health Systems Data, 2006
Author(s): Jonathan Cylus, Gerard F. Anderson
Sponsoring organization: Coalition for Health Services Research
A chartbook of data collected by the Organization for Economic Cooperation and Development (OECD) to compare the health care systems and performance in nine industrialized countries—Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, the United Kingdom, and the United States.
Date: 05 / 2007
National Health Plan Collaborative, Phase One Summary Report: Reducing Racial and Ethnic Disparities & Improving Quality of Health Care
Sponsoring organization: Robert Wood Johnson Foundation
Summarizes and shares what those companies know about disparities in health care delivery. The authors propose key steps to build on that knowledge - collecting additional data, enhancing access for non-English speakers, supporting investment in disparities reduction, and disseminating what member plans have learned.
Date: 11 / 2006
National Healthcare Disparities Report, 2006
Sponsoring organization: Agency for Healthcare Research and Quality
Comprehensive national overview of disparities in health care. Covers health care quality and health care access issues. Includes a section on health disparities experienced in rural areas.
Date: 12 / 2006
National Healthcare Disparities Report, 2007
Sponsoring organization: Agency for Healthcare Research and Quality
Comprehensive national overview of disparities in health care. Describes the quality of and access to care for multiple subgroups across the United States, and also represents a source of information for tracking the Nation's progress over time.
Date: 02 / 2008
National Healthcare Quality Report, 2006
Sponsoring organization: Agency for Healthcare Research and Quality
A comprehensive national overview of the quality of
health care in the United States. Includes measures of effectiveness, patient
safety, timeliness, and patient centeredness.
Date: 12 / 2006
National Healthcare Quality Report, 2007
Sponsoring organization: Agency for Healthcare Research and Quality
A comprehensive national overview of the quality of health care in the United States. Includes measures of effectiveness, patient safety, timeliness, and patient centeredness.
Date: 02 / 2008
Pay for Performance: Are Hospitals Ready and Willing?
Author(s): Suzanne Felt-Lisk, Mary Laschober
Sponsoring organization: Mathematica Policy Research, Inc.
Examines hospital public reporting of healthcare quality information, conducted for the Centers for Medicare & Medicaid Services (CMS). A nationally representative survey of acute care hospitals were asked about hospital participation in pay-for-performance (P4P) programs.
Date: 11 / 2006
Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs
Author(s): K. Kuhmerker, T. Hartman
Sponsoring organization: Commonwealth Fund
Examines the current and planned P4P activities of state Medicaid programs, based on a survey and follow-up interviews with state Medicaid directors and their staffs as well as review of related documents.
Date: 04 / 2007
Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives
Sponsoring organization: Robert Wood Johnson Foundation
Addresses five questions which are What explains the current widespread interest in physician P4P?; How are current incentive programs structured and how prevalent are they?; What performance measurement issues does physician P4P raise?; How do physicians perceive quality incentive programs?; and What is the research evidence on the impact of P4P?
Date: 12 / 2007
Physician Pay-for-Performance in Medicaid: A Guide for States
Author(s): Karen LLanos, Joanie Rothstein, Mary Beth Dyer, Michael Bailit
Sponsoring organization: Center for Health Care Strategies
Offers actionable steps to help states design and implement physician-level P4P strategies.
Date: 03 / 2007
Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
Author(s): Gary Cochran, Katherine Jones, Liyan Xu, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Describes the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in small rural hospitals.
Date: 04 / 2008
Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
Sponsoring organization: Flex Monitoring Team
Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs).
Date: 09 / 2004
Quality Improvement Strategies and Best Practices in Critical Access Hospitals
Author(s): Michelle Casey, Ira Moscovice
Sponsoring organization: University of Minnesota Rural Health Research Center
Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
Date: 01 / 2004
Quality Initiative: A Public Resource on Hospital Performance
Sponsoring organization: American Hospital Association
Describes a project to collect data about hospital performance on 10 measures across three disease areas: acute myocardial infarction, heart failure and pneumonia.
Date: 2003
Quality Through Collaboration: The Future of Rural Health Care (Executive Summary)
Sponsoring organization: Institute of Medicine
Summary of an Institute of Medicine (IOM) report that examines the quality of health care in rural America. Includes key findings on rural health care quality and patient safety, as well as recommendations.
Date: 11 / 2004
Quality Through Collaboration: The Future of Rural Health Care (Full Report)
Sponsoring organization: Institute of Medicine
Examines the quality of health care in rural America. Includes recommendations to improve health care quality and safety in rural communities. Addresses workforce, information technology, finance and other factors that impact rural health care quality.
Date: 11 / 2004
Race, Ethnicity, and Language of Patients: Hospital Practices Regarding Collection of Information to Address Disparities in Health Care
Author(s): Marsha Regenstein, Donna Sickler
Sponsoring organization: Robert Wood Johnson Foundation
Addresses the ability of health care organizations to describe their populations and assess the size and
scope of health care disparities in-house. Provides information on the state of data collection in the U.S. hospital industry and also describes data collection practices at more than 60 safety net hospital systems across the country.
Date: 01 / 2006
Racial and Ethnic Disparities in Access to and Quality of Health Care
Author(s): José J. Escarce,
Sponsoring organization: Robert Wood Johnson Foundation
Takes a critical look at the research evidence on racial and ethnic disparities in health care.
Date: 09 / 2007
Realizing the Transformative Potential of Personal Health Records
Sponsoring organization: Kaiser Permanente
Explores the potential of Personal Health Records
(PHRs) to transform the way care is delivered and received. Examines how consumer-centric health records and related technologies can improve the quality, efficiency, and effectiveness of health care. Also defines PHRs and the variety of existing technologies
Date: 04 / 2007
Reducing Racial and Ethnic Disparities & Improving Quality of Health Care
Sponsoring organization: Robert Wood Johnson Foundation
A report by the nation's major health plans that summarizes what they know about disparities in health care delivery. Key steps are proposed to build on that knowledge - collecting additional data, enhancing access for non-English speakers, supporting investment in disparities reduction, and disseminating what member plans have learned.
Date: 11 / 2006
Resource Guide for Implementing the JCAHO 2007 Patient Safety Goals on Suicide
Author(s): Douglas Jacobs
Sponsoring organization: Screening for Mental Health
A resource guide for implementing the Joint Commission on Accreditation of Healthcare Organizations 2007 National Patient Safety Goals on suicide.
Date: 2007
Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality
Author(s): Mary Catherine Beach, Somnath Saha, Lisa A. Cooper
Sponsoring organization: Commonwealth Fund
Explores the historical evolution of patient-centeredness and cultural competence in health care quality, and how each approach holds promise for improving the quality of health care for individual patients, communities, and populations.
Date: 10 / 2006
Small Rural Hospital Improvement Grant (SHIP): Annual Report for FY 2005
Sponsoring organization: Office of Rural Health Policy
A summary of the use of SHIP grant funds by 1,591 participating hospitals as reported by the 46 participating State Offices of Rural Health and Puerto Rico. Provides an overview of unmet needs and current activities in small rural hospitals (under 50 beds) throughout the nation.
Date: 05 / 2006
State of Health Care Quality, 2007
Sponsoring organization: National Committee for Quality Assurance
Produced annually by NCQA to monitor and report on performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement.
Date: 2007
States' Roles in Shaping High Performance Health Systems
Author(s): Catherine Hess
Sponsoring organization: Commonwealth Fund
Presents findings from the State Health Policies Aimed at Promoting Excellent Systems project, undertaken by the National Academy for State Health Policy, with support from The Commonwealth Fund.
Date: 04 / 2008
Testimony--Health and Wealth: Measuring Health System Performance
Sponsoring organization: Commonwealth Fund
Discusses how establishing national goals for the U.S. health system, setting priorities for improvement, and making an annual report to Congress on health system performance can ensure access to and accountability of healthcare that is essential to the well-being of all Americans.
Date: 03 / 2008
To Err is Human: Building a Safer Health System (Full Report)
Sponsoring organization: Institute of Medicine
A report on a specific quality concern - patient safety. Discusses types of errors that occur in hospitals and strategies for improving patient safety.
Date: 2000
Transforming Hospitals: Designing for Safety and Quality
Sponsoring organization: Agency for Healthcare Research and Quality
Reviews the case for evidence-based hospital design and how it increases patient and staff satisfaction and safety, quality of care, and employee retention, and results in a positive return on investment.
Date: 09 / 2007
Transforming U.S. Health Care: Policy Challenges Affecting the Integration and Improvement of Care
Author(s): James J. Morgan, Robert E. Mechanic, Thomas H. Lee
Sponsoring organization: Brookings Institution
Discusses the need to improve safety, quality, reliability, effectiveness, and efficiency of health care and how this change depends on the transformation of the processes, organization, and infrastructure of the delivery system.
Date: 12 / 2006
Trauma Performance Improvement: A Reference Manual
Sponsoring organization: American College of Surgeons
Designed to provide an online handbook of definitions, models, practical suggestions and examples of performance improvement applications for trauma. Complements the ACS publication,
Resources for Optimal Care of the Injured Patient.
Date: 01 / 2002
Using Evidence-Based Performance Improvement in The Community
Author(s): Janice McCoy, Jacqueline Fowler Byers
Sponsoring organization: National Association for Healthcare Quality
Explores one community hospital's success in bringing a research focus into its performance improvement initiatives.
Date: 12 / 2006
Who Pays for Medical Errors?: An Analysis of Adverse Even Costs, the Medical Liability System, and Incentives for Patient Safety Improvement
Author(s): Michelle M. Mello, David M. Studdert, Eric J. Thomas, Catherine S. Yoon, Troyen A. Brennan
Sponsoring organization: Commonwealth Fund
Study shows that hospitals may lack the financial incentives needed to improve safety.
Date: 12 / 2007
Women's Health Care in the United States: Selected Findings from the 2004 National Healthcare Quality and Disparities Reports. Fact Sheet
Sponsoring organization: Agency for Healthcare Research and Quality
Examines: (1) Disparities in care among women by race, ethnicity, and socioeconomic status. (2) Disparities in health care for women compared with men. and (3) Trends and state variation in women's health care over time.
Date: 05 / 2005
Journals
Health Affairs
Peer-reviewed publication focusing on U.S. health policy and health care. Content is available free online after three years.
Hot Topics in Rural Health Care
Discusses relevant rural health topics important to health care providers, rural community leaders, and others.
Joint Commission Journal on Quality and Patient Safety
A peer-reviewed journal, available through subscription, which serves as a forum for practical approaches to improving quality and safety in health care. Articles provide in-depth case studies that help readers to adopt or adapt methods, programs, and strategies to their own settings. Abstracts are available online and articles are available online for purchase.
Joint Commission Online
Monthly news brief from the Joint Commission, an independent, not-for-profit entity that sets standards and accredits health care organizations.
Journal for Healthcare Quality
The official journal of the National Association for Healthcare Quality.
Research Activities
Includes announcements of the Agency for Healthcare Research and Quality, their products and projects, and summarizes research findings from studies supported by the Agency.
Organizations
Agency for Healthcare Research and Quality (AHRQ)
Federal government
Sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers - patients and clinicians, health system leaders, purchasers, and policymakers - make more informed decisions and improve the quality of health care services.
American Health Quality Association
National organization
A charitable, educational, not-for-profit national membership association dedicated to health care quality through community-based, independent quality evaluation and improvement programs.
American Hospital Association (AHA)
National organization
Represents and serves all types of hospitals, health care networks, patients and communities.
Association for Professionals in Infection Control and Epidemiology (APIC)
National organization
An association that influences, supports, and improves the quality of healthcare through the practice and management of infection control and the application of epidemiology in all health settings.
Association of Clinicians for the Underserved (ACU)
National organization
A nonprofit, transdisciplinary organization of clinicians, advocates, and health care organizations united in a common mission to improve the health of America's underserved populations and to enhance the development and support of the health care clinicians serving these populations.
Center for Medicare Advocacy
National organization
A national non-partisan education and advocacy organization that identifies and promotes policy and advocacy solutions to ensure that elders and people with disabilities have access to Medicare and quality health care.
Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.
Delta Rural Hospital Performance Improvement Project (RHPI)
Federal government
Brings technical expertise, information and business tools to small rural hospitals in the Mississippi Delta.
Flex Monitoring Team
National organization
Performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program) conducted by the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine.
Institute for Healthcare Improvement (IHI)
Nonprofit/Foundation
Drives the improvement of health by advancing the quality and value of health care. Provides conferences, seminars, and practices that can be implemented and measured to help facilitate improvement of health care quality.
Institute for Safe Medication Practices (ISMP)
National organization
Mission is to understand the causes of medication errors and provide time-critical error-reduction strategies to the healthcare community, policy makers, and the public.
Institute of Medicine (IOM)
National organization
Works to advance and disseminate scientific knowledge to improve human health. Part of the National Academy of Sciences.
Joint Commission
National organization
Works to improve safety and quality of care provided to the public through health care accreditation and related services that support performance improvement in health care organizations. Evaluates and accredits nearly 17,000 health care organizations and programs in the United States.
Joint Commission International Center for Patient Safety
International organization
The mission of the center is to continuously improve patient safety in all health care settings. An extension of the Joint Commission on Accreditation of Healthcare Organizations and Joint Commission Resources (JCR) acting as a focal point for additional research and related efforts to develop and provide patient safety-related solutions.
Leapfrog Group
Nonprofit/Foundation
Composed of more than 150 public and private organizations that provide health care benefits. Works with medical experts throughout the U.S. to identify problems and propose solutions that will improve hospital systems that could break down and harm patients. Representing more than 34 million health care consumers in all 50 states, Leapfrog provides information and solutions for consumers and health care providers.
Medicare Quality Improvement Community (MedQIC)
Nonprofit/Foundation
Supports state Quality Improvement Organizations (QIOs) and providers of services to Medicare beneficiaries in finding, using and sharing quality improvement resources thereby advancing the quality improvement community. Provides a list of contacts for state QIOs.
National Area Health Education Center Organization (NAO)
National organization
Supports and advances the AHEC network in improving the health of individuals and communities by transforming health care through education.
National Association for Healthcare Quality (NAHQ)
National organization
An organization that promotes the continuous improvement of quality in healthcare by providing educational and development opportunities for professionals at all management levels and within all healthcare settings.
National Committee for Quality Assurance (NCQA)
Nonprofit/Foundation
NCQA is an independent, 501(c)(3) non-profit organization whose mission is to improve health care quality everywhere.
National Initiative for Children's Healthcare Quality (NICHQ)
National organization
An education and research organization dedicated solely to improving the quality of health care provided to children.
National Patient Safety Foundation (NPSF)
Nonprofit/Foundation
A resource and a central voice for individuals and organizations committed to improving the safety of patients.
National Quality Forum (NQF)
National organization
Works to develop and implement a national strategy for health care quality measurement and reporting.
National Rural Health Association (NRHA)
National organization
Promotes leadership, ideas, information, communication, education, research, advocacy, and methods to improve rural health. Composed of individual and organizational members who share a common interest in rural health.
Office of Rural Health Policy (ORHP)
Federal government
Promotes better health care service in rural America. Part of the Health Resources and Services Administration, U.S. Department of Health and Human Services. Focuses on matters affecting rural hospitals and health care, coordinating activities within the department that relate to rural health care, and maintaining a national information clearinghouse.
Qualis Health
State/regional organization
Serves as the Quality Improvement Organization (QIO) for Idaho and Washington. Also provides service to Alaska.
Quality Health Foundation (QHF)
Nonprofit/Foundation
Works to improve the health of individuals and communities. Provides grants to organizations that wish to undertake improvement projects.
Risk Management and Patient Safety Institute (RMPSI)
National organization
Developed to meet the risk, quality, claims management and patient safety needs of the health care industry with a primary focus on clinical risk reduction, quality patient outcomes, education and claims management.
Rural Health Resource Center (RHRC)
National organization
Provides technical support for the State Offices of Rural Health and their flex coordinators for the Rural Hospital Flexibility Program, focuses on rural practice opportunities for healthcare providers in Minnesota and the surrounding region, does performance improvement with hospitals across the country, and develops the Rural Health Resource Directory of rural consultants and speakers found throughout the United States.
Stratis Health
Nonprofit/Foundation
A non-profit independent quality improvement organization that collaborates with providers and consumers to improve health care.
Surgical Care Improvement Project (SCIP)
National organization
A national partnership of organizations committed to improving the safety of surgical care through the reduction of post-operative complications.
Terms & Acronyms
Accreditation Process that gives public recognition to institutions that meet certain standards. It is a promise that an institution will provide the quality of services it claims to offer.
Balanced Scorecard (BSC) An integrated framework for describing and translating strategy through the use of linked performance measures in four balanced perspectives: Customer, Internal Processes, Learning and Growth, and Financial. The Balanced Scorecard acts as a measurement system, strategic management system, and communication tool.
Clinical Performance The degree of accomplishment of desired health objectives by a clinician or health care organization.
Clinical Performance Measure A subtype of quality measure that is a mechanism for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in the optimal time period.
Computerized Provider Order Entry (CPOE) A system that includes both inpatient orders and the electronic ordering of outpatient prescriptions often referred to as e-prescribing. The CPOE allows physicians and other caregivers to input orders directly into a computer, thereby eliminating problems with handwriting legibility and order transcription.
Electronic Medical Record (EMR) A generic term used to describe a computer-based patient medical record that includes patient information regarding diagnoses, test/procedure results and other relevant medical information such as medical appointments and correspondence.
Health Information Technology (HIT) A significant infrastructure that involves the application of computer technology to generate, validate, secure and integrate healthcare data so it can be effectively utilized to support the decision-making activities of clinical and administrative professionals. HIT can provide immediate access to patient information, care guidelines for clinicians, or health services that transcend geographic distances.
Measure A mechanism to assign a quantity to an attribute by comparison to a criterion.
Medical Homes Also referred to as Patient-Centered Model Homes. This is a model of care, originally used in reference to the care of children with special needs, and now expanded to include the care of all patients. The principles are: each patient receives care from a personal physician; the personal physician leads a team of providers who are responsible for a patient's ongoing care;
the personal physician is responsible for the "whole person"; a patient's care is coordinated across the health system and community; quality and safety are hallmarks of the practice; enhanced access to care is offered through open scheduling, expanded hours, and new care options such as group visits; and
the payment structure recognizes the enhanced value provided to patients.
Medicare Conditions of Participation (CoP) CMS conditions that health care organizations must meet to participate in the Medicare and Medicaid programs. Used to improve quality and protect the health and safety of beneficiaries.
Medicare Rural Hospital Flexibility Program (Flex Program) Federal initiative created by the Balanced Budget Act of 1997 that provides funding to State Governments to strengthen rural health. Requires the development of state rural health plan. Provides funding to States network development, quality improvement, designation of Critical Access Hospitals (CAHs), and improvement of rural EMS.
Pay-For-Performance A reimbursement concept whereby a provider's pay is based upon quality of care provided.
Personal Health Record (PHR) A collection of important information about a person's health or the health of someone a person is caring for, such as a parent or child. The PHR is actively maintained and updated by both the healthcare provider, the care giver, and the person for whom it belongs.
Quality Improvement Organization (QIO) QIOs review Medicare services. They work with consumers, physicians, hospitals, and other caregivers to make sure patients get the right care at the right time, particularly among underserved populations.
Quality Measure A mechanism to assign a quantity to quality of care by comparison to a criterion. The definition of a quality measure relies on the definition of, "Clinical performance," "Clinical performance measure," "Measure," and "Quality of care."
Quality of Care The degree to which health care services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge.
Rationale for the Measure A brief statement describing the patients and the specific aspect of health care to which the measure applies. The rationale may also include the evidence basis for the measure, and an explanation of how to interpret results.
Regional Health Information Organization (RHIO) A cooperative organization which can enable the regional constituents to securely and reliably exchange patient healthcare information. Their purpose is to improve patient health services and care through information sharing, advocacy, collaboration, technical innovations, and community affiliations.
Regionalization The identification of available resources within a geographic area, and the coordination of services to meet the needs of a specific group of patients.
TASC (Technical Assistance and Services Center) The technical assistance center for the Medicare Rural Hospital Flexibility Program (Flex Program). Provides information, tools and resources on all aspects of the Flex Program, including CAH, networking, EMS, and quality improvement. TASC is run by the Rural Health Resource Center in Duluth, MN.
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