Improving the quality of care provided by Critical Access Hospitals (CAHs) is an important goal of the Medicare Rural Hospital Flexibility Program. This report describes current CAH quality improvement initiatives and participation in quality reporting and benchmarking initiatives.
Data for this report were collected through a national telephone survey of CAH administrators conducted between January and May 2007. A total of 381 CAHs responded to the survey, yielding a response rate of 85%. Survey respondents were asked about their most important quality improvement activities and their participation in quality reporting and benchmarking initiatives.
CAHs continue to be actively involved in a wide range of quality improvement initiatives, with patient safety and medication safety in particular as major areas of focus. Among CAHs that do not report to Hospital Compare, the most important reasons for not reporting are an insufficient volume of patients; the fact that the hospital is not required by CMS to report; and insufficient staff time for chart review/data extraction. Among non-reporting CAHs, 30% plan to submit data in the next year. Two-thirds of CAHs participate in a national, state or local quality reporting or benchmarking initiative other than Hospital Compare.
Over half of non-participant CAHs cite an insufficient volume of patients as a reason for not participating in Hospital Compare. This finding indicates the importance of continuing to explore alternative ways of presenting and analyzing quality data for low volume hospitals, e.g., using composite measures and/or summarizing data over longer time periods. The high rate of CAH participation in national, state and local reporting initiatives other than Hospital Compare suggests that these efforts can help support expanded national reporting of quality measures among CAHs.