Quality: Rural Health Research Products & Journal Articles

2024

Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2024
This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics.

2022

Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
Journal Article
University of South Carolina Rural Health Research Center
Date: 11/2022
Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.
Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
Policy Brief
WWAMI Rural Health Research Center
Date: 05/2022
This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.
Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.

2021

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
Journal Article
Maine Rural Health Research Center
Date: 09/2021
This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
High-Functioning Rural Medicare ACOs – A Qualitative Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
This brief identifies common success factors among four high-performing rural Medicare Accountable Care Organizations.

2019

Primary Care Clinician Participation in the CMS Quality Payment
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2019
Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.

2018

Changes to the Merit-Based Incentive Payment System Pertinent to Small and Rural Practices, 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
This policy brief highlights key regulatory changes to the Merit-based Incentive Payment System that occurred in 2018. It discusses the implications of these changes with an emphasis on how these changes may affect small and rural practices.
The Rural Hospital and Health System Affiliation Landscape – A Brief Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
The shift from traditional fee-for-service to value-based payment requires major capital investment. In this paper, we examine rural hospital and health system motivations for affiliation and present a non-exhaustive list of common affiliation structures with representative examples.
Organizational Attributes Associated With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2018
Peer-reviewed paper evaluating associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance.
Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
Policy Brief
Maine Rural Health Research Center
Date: 07/2018
This brief discusses the Merit-Based Incentive Payment System (MIPS) within the context of past and current Rural Health Clinic (RHC) quality reporting initiatives and assesses options for encouraging RHCs to voluntarily participate in MIPS.
Organizational Attributes With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneﬁciary panels, and higher post-hospitalization follow-up rates had better performance.

2017

A Positive Association Between Hospice Profit Margin and the Rate at Which Patients Are Discharged Before Death
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2017
The links between the increasing live discharge rate from hospice and the quality of care is examined.
After Hospital Closure: Pursuing High Performance Rural Health Systems Without Inpatient Care
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 06/2017
A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 06/2017
The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.

2016

Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2016
Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2016
There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
Policy Brief
Maine Rural Health Research Center
Date: 02/2016
More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 02/2016
Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.

2015

Rural Medicare Beneficiaries Have Fewer Follow-Up Visits and Greater Emergency Department Use Post-Discharge
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2015
Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties.
Care Coordination in Rural Communities Supporting the High Performance Rural Health System
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 06/2015
This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
Policy Brief
Maine Rural Health Research Center
Date: 02/2015
This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
Surgical Services in Critical Access Hospitals, 2011
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
Policy Brief
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 02/2015
This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
This brief discusses Medicare Shared Savings Program eligibility, participation requirements, and quality measures relative to accountable care organization formation.

2012

Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures
Policy Brief
Upper Midwest Rural Health Research Center
Date: 07/2012
As a part of a larger project that examined alternative ways of identifying high quality rural hospitals, this report assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals.

2011

Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Policy Brief
Upper Midwest Rural Health Research Center
Date: 09/2011
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.
Care Transitions: "Time to Come Home"
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2011
This policy brief examines care coordination, with a focus on the transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
Care Transitions: "Time to Come Home" (Full Report)
Upper Midwest Rural Health Research Center
Date: 03/2011
This report looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.

2010

Nurse Staffing and Rural Hospital Performance
Policy Brief
Upper Midwest Rural Health Research Center
Date: 12/2010
This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 12/2010
The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2010
This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
Patient Assessments and Quality of Care in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2010
This policy brief analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2010
This report analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences. It assesses whether rural patients' perspectives of quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery
RUPRI Center for Rural Health Policy Analysis
Date: 06/2010
This paper provides a summary of legislative provisions contained in the Patient Protection and Affordability Act of 2010 (PPACA) that have particular meaning to rural residents and to the delivery of services in rural areas.
Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2010
Overall, there has been improvement in acute myocardial infarction quality measures and persistent rural-urban disparities in only a few. Particularly in small/remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2010
In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.

2009

Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2009
This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.

2008

Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
RUPRI Center for Rural Health Policy Analysis
Date: 04/2008
This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based, safe medication practices, including the use of voluntary medication error reporting, in the nation's smallest hospitals.

2007

Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Upper Midwest Rural Health Research Center
Date: 08/2007
The Tennessee Rural Hospital Patient Safety Demonstration project included the implementation of three patient-safety initiatives in eight rural Tennessee hospitals using a collaborative model and an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
Upper Midwest Rural Health Research Center
Date: 08/2007
This policy brief reports the results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2007
The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas.
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Upper Midwest Rural Health Research Center
Date: 05/2007
This policy brief discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
Hospital Size, Uncertainty and Pay-for-Performance
Upper Midwest Rural Health Research Center
Date: 02/2007
This report examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.

2006

Prioritizing Patient Safety Interventions in Small Rural Hospitals
Journal Article
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 12/2006
Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
Policy Brief
Upper Midwest Rural Health Research Center
Date: 11/2006
This paper provides an overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration project.
Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
Upper Midwest Rural Health Research Center
Date: 10/2006
This report analyzes critical access hospital inpatient hospitalizations and transfers and assesses the implications for national quality measurement and reporting.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
Upper Midwest Rural Health Research Center
Date: 09/2006
This report shares 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.
A Rural Healthcare Quality Agenda
Journal Article
Upper Midwest Rural Health Research Center
Date: 09/2006
An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health.
Quality and Performance Improvement Grant Activities Under the Flex Program
Maine Rural Health Research Center
Date: 08/2006
This paper describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program.
Chronic Disease Management Systems (Registries) in Rural Health Care
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2006
A Chronic Disease Management System (CDMS) is a tool that helps providers collect and analyze patient information to promote quality care. This study shows that CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology.
Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
Maine Rural Health Research Center
Date: 02/2006
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy and provides a context for legislation that affects rural health services and populations.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Policy Brief
Upper Midwest Rural Health Research Center
Date: 01/2006
This study's results indicate that many small rural hospitals have limited hours of onsite pharmacist coverage and many either don't have a pharmacy computer or don't use it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
Journal Article
Upper Midwest Rural Health Research Center
Date: 2006
Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.

2005

Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Upper Midwest Rural Health Research Center
Date: 12/2005
This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Comparing Patient Safety in Rural Hospitals by Bed Count
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.

2004

Access To Primary Care and Quality of Care in Rural America
NORC Walsh Center for Rural Health Analysis
Date: 06/2004
This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.
Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
Maine Rural Health Research Center
Date: 02/2004
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
Comparative Performance Data for Critical Access Hospitals
Journal Article
Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
Date: 2004
Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2004
Acute myocardial infarction (AMI) is a common and important cause of admission to rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. This study examines the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.

2003

2003 Index of Hospital Quality
NORC Walsh Center for Rural Health Analysis
Date: 2003
Published annually by U.S. News & World Report, this report describes a series of factors regarding ranking of measuring hospital quality.

2001

Improving the Quality of Outpatient Care for Older Patients With Diabetes: Lessons From a Comparison of Rural and Urban Communities
Journal Article
WWAMI Rural Health Research Center
Date: 08/2001
Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.