New Projects
1. Strategies for Improving the Safety of Care Delivered by Critical Access Hospitals
Lead Center: University of Southern Maine
Principal Investigators: Andrew F. Coburn, Ph.D. 207-780-4435 or andyc@usm.maine.edu
Contact Person: John A. Gale, M.S. 207-228-8246 or
jgale@usm.maine.edu
This project will develop and disseminate a list of evidence-based patient safety tools and strategies appropriate for use by state Flex Programs and CAHs to improve patient safety in CAHs. Strategies and tools will focus on patient safety culture (including safety culture, teamwork, leadership, and the development of reliable processes of care), medication safety, and hospital falls. A recent Flex Monitoring Team quality improvement and benchmarking study showed that, for many CAHs and small hospitals, patient safety tools such as TeamSTEPPS and the AHRQ Patient Safety Culture Survey are challenging to implement due to time and resource requirements. This project will identify and assess the appropriateness of evidence-based patient safety interventions for CAHs and other small hospitals through a review and synthesis of the literature on patient safety tools, programs and initiatives. In addition, we will identify and select State Flex Programs that have implemented patient safety initiatives to support their CAHs for in-depth interviews and analysis of their patient safety activities.
2. EMS Systems of Care at the Community and Regional Level: State Flex Program Initiatives and Support
Lead Center: University of Southern Maine
Principal Investigators: Andrew F. Coburn, Ph.D. 207-780-4435 or andyc@usm.maine.edu
Contact Person: John A. Gale, M.S. 207-228-8246 or
jgale@usm.maine.edu
This project will identify and assess Flex Program initiatives to support the development of local and regional systems of emergency care. This project fits
continues the FMT’s focus on health system development, community engagement, and community impact activities by examining the ways in which State Flex
Program have undertaken efforts to support the development of community and regional systems of EMS care and to integrate these EMS systems into the
continuum of care in rural communities. Through a review of state Flex Program EMS activity along with a review of the literature, we will categorize Flex
Program initiatives by type of activities (e.g., support of community needs assessments, developing regional systems of care for conditions such as stroke or
STEMI, coordinating service delivery between EMS and CAHs, etc.).
3. Developing an Evaluation Framework to Support the Multi-State Quality Improvement Project
Lead Center: University of Southern Maine
Principal Investigators: Andrew F. Coburn, Ph.D. 207-780-4435 or andyc@usm.maine.edu
Contact Person: John A. Gale, M.S. 207-228-8246 or
jgale@usm.maine.edu
This project will develop and implement an evaluation framework to support the implementation and monitor the impact of the Multi-State Quality Improvement Project (MSQIP). The primary goal of MSQIP is to support Critical Access Hospitals (CAHs) in the implementation of quality improvement initiatives to improve their patient care and operations. Additionally, MSQIP will encourage CAHs to collect and publicly report quality performance using a specific set of core quality measures and engage in collaborative quality improvement projects to benefit patient care.
Staff from the University of Southern Maine will lead this project and work with the federal Office of Rural Health Policy (ORHP) and the state participants to develop the evaluation framework for MSQIP. We will work with ORHP and the grantees to help: 1) clarify project strategies; 2) describe the underlying logic of project activities; 3) articulate the project’s “theory of change”; 4) assess the appropriateness of the project design, strategies, resources, and implementation mechanisms; 5) identify appropriate short, medium, and long term outcome targets and measures; and 6) identify potential obstacles to implementation. In addition, we will seek consensus on a logic model for the MSQIP to connect the program’s resources, activities, and plans to intended outcomes.4. Rural Relevant Quality Measures and Small Volume Issues for Critical Access Hospitals
Lead Center: University of Minnesota Rural Health Research Center
Principal Investigators: Ira Moscovice, Ph.D., 612-624-8618 or mosco001@umn.edu
Contact Person: Ira Moscovice, Ph.D. 612-624-8618 or
mosco001@umn.edu
The purpose of this project is to conduct a meta-analysis that summarizes information about 1) rural relevant hospital quality measures and 2) alternative methods of dealing with small volume issues; and disseminate this information to State Flex Coordinators, CAHs and policy makers. First, we will prepare and disseminate an up-to-date set of rural relevant hospital quality measures, including Hospital Compare inpatient process of care, HCAHPS and outpatient hospital measures, as well as additional measures of potential relevance to the small rural hospital environment. The measure set will include a core set of measures that are applicable to all CAHs, as well as other measures that apply to CAHs that provide certain key services (e.g., inpatient surgery and obstetrics). Second, we will prepare a peer-reviewed journal article that discusses alternative methods of dealing with small volume issues in quality reporting and the implications for CAHs of using these alternative methods for quality reporting.
5. Evidence-Based Programs and Strategies for Improving the Quality of Care for Critical Access Hospital Patients
Lead Center: University of Minnesota Rural Health Research Center
Principal Investigators: Ira Moscovice, Ph.D., 612-624-8618 or mosco001@umn.edu
Contact Person: Michelle Casey, MS 612-623-8316 or
mcasey@umn.edu
The purpose of this project is 1) to identify successful evidence-based quality improvement (QI) programs and strategies related to acute myocardial infarction (AMI), pneumonia, heart failure and surgical infection prevention that could be replicated in Critical Access Hospitals (CAHs) and 2) to disseminate information about these programs and strategies to State Flex Programs. We will review and synthesize several types of literature on QI programs and strategies, including articles in peer-reviewed healthcare journals and reports from a variety of public and private organizations working on QI issues in hospitals. The focus of the literature review and synthesis will be on initiatives to improve care for AMI, pneumonia, heart failure and surgical infection prevention in CAHs. We will identify programs and strategies that have been successfully implemented in small rural hospitals, as well as other programs and strategies that hold promise for adoption in the small rural hospital environment. We will consult with members of the Flex Monitoring Team Expert Work Group and additional quality experts to help identify QI programs and strategies that have not been documented in the literature, but have been successfully implemented in small rural hospitals.
6. Improving Financial Performance and Condition -- Evidence from the Literature, Hospital Survey and A Sample Of High-Performing CAHs
Lead Center: University of North Carolina Rural Health Research & Policy Analysis Center
Principal Investigators: Mark Holmes, Ph.D., 919-966-9694 or holmes@schsr.unc.edu
Contact Person: Mark Holmes, Ph.D. 919-966-9694 or
holmes@schsr.unc.edu
There are many anecdotes about what works and doesn't work in CAH financial management. Chargemaster review, improved billing and coding, better Medicare cost reporting and other strategies have been cited as ways to improve financial performance and condition. However, there is almost no systematically acquired information about the relative effectiveness of these strategies. Understanding of effective strategies is important to CAH administrators because they want to be confident that investment of organizational time and scarce resources will actually improve financial performance and condition. This information is also important to State Flex Coordinators that want to use their grant funds to support strategies that help CAHs through this financially challenging era. This project will attempt to systematically assemble information about how to improve CAH financial performance and condition. The method will draw information from four sources: 1. Review of literature 2. On-line hospital survey of CEOs and CFOs. 3. Interviews with administrators of high-performing CAHs. 4. Interviews with other experts. We will analyze and synthesize the findings from the literature review, the on-line survey results, and the contents of the interviews to identify the most common, effective financial management strategies and practices.