Hospitals and healthcare providers in rural areas are faced with a number of challenges when it comes to measuring quality performance and optimizing quality improvement efforts, according to a report published by the National Quality Forum.
The rural health committee that authored the NQF report identified four interrelated key issues and challenges that have the potential to negatively influence quality measures and improvement activities for critical access hospitals, rural health clinics, community health centers, small rural non-critical access hospitals and other small rural clinical practices. The four biggest issues are highlighted below.
1. Geographic isolation. Many, though not all, rural health providers are geographically isolated, which can limit patients' access to healthcare providers and specialists. Isolation is also frequently associated with patient transportation issues and limited broadband, hindering information technology capabilities.
2. Small practice size. Small rural hospitals and clinician practices often have limited time, staff and finances available to dedicate to quality improvement efforts. Additionally, the staff in rural areas frequently lack the specialized technological skills required to measure, calculate and drive quality improvements.
3. Heterogeneous setting and patient population. Rural areas tend to have disproportionately vulnerable residents who are socioeconomically disadvantaged and in poor health. This heterogeneity affects healthcare performance measurement and may mean quality measures have to be adjusted for patient characteristics.
4. Low case volume. Some rural providers do not have enough patients to achieve reliable and valid measurement results, a challenge which can be particularly relevant for certain condition-specific measures and for providers in more isolated rural areas.
According to the authoring committee, "urban and suburban areas experience some of the same challenges as rural areas, but [we] believe that these challenges are more likely to impede quality measurement and improvement in rural areas."
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