Rural Health Quality Leadership Summit 2003

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Rural Health Quality Leadership Summit 2003

• Shepherdstown
• West Virginia

Terry Hill Executive Director Rural Health
Resource Center
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Summit Objectives

• Initiate a dialogue between rural health
  national quality leaders on rural quality
  improvement
• 2. Examine quality improvement opportunities
  obstacles in rural communities
• Enhance rural participation in the national
  quality movement and create laboratories for
  quality demonstration projects
• 4. Create strategies to integrate and enhance
  rural and national quality initiatives

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Quality Organization Participants

• AHRQ
• IHI
• NQF
• Leapfrog
• NCQA

• CMS
• IOM
• JCAHO
• AHA
• AHQA

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Agency for Healthcare Research and Quality
(AHRQ)

• Support, conduct, and disseminate research
  designed to improve access to care and the
  outcomes, quality, cost, and utilization of
  health care services
• Patient Safety Hospital Information Technology
  Initiative
• Rural Hospitals

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Institute for Healthcare Improvement

• Mission Improving health worldwide No more
  suffering
• Core principles Health care quality is not as
  good as should be Our patients deserve better
  Find, cultivate, and invent great improvement
  ideas Bring people and organizations together
  around these ideas and to learn from experts and
  each other All teach, all learn
• Offerings QualityHealthCare.org, Calls to
  Action, Forums, Summits, Collaboratives, IMPACT
• Why rural health? A great number of people
  worldwide receive their health care in rural
  settings

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National Quality Forum

• Established 1999 fully operational fall 2000
• Nonprofit open membership organization created to
  achieve national multi-stakeholder consensus on
  standardized healthcare quality measures and
  promote measurement, reporting, and quality
  improvement. Federal agencies can be members.
• Unique structure aimed at balancing interests
  (government and private sector consumers,
  providers/plans, purchasers, research/quality
  improvement organizations)
• Consensus project topics to date include patient
  safety, hospital care, long-term care,
  condition-specific care (diabetes, cancer)
• Issues of applicability/feasibility of measures
  in small institutions and rural areas frequently
  arise

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View from the Lily Pad
Founded By The Business Roundtable With Support
From RWJF
Rural Health Quality Leadership Summit
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Mission and Strategic Priorities

• Trigger a giant leap forward in the quality,
  customer service and affordability of health care
  for all Americans
• Leaps and purchasing principles
• Three inpatient leaps for urban hospitals
• Ambulatory and additional inpatient leaps
• Rural strategy
• Regional rollout strategy with activated
  purchasers
• Why is rural quality important to Leapfrog?
• Current leaps applied in MSAs only
• Members have significant interest in rural
  markets
• Credibility and influence

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NCQA

• National health care quality evaluation and
  reporting organization
• Measures and reports on health care quality at
  multiple levels of the system
• Oversight by independent board with broad
  representation from multiple sectors (nearly half
  physicians)
• Accreditation, certification and recognition
  programs along with HEDIS measure development and
  reporting

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Centers for Medicare Medicaids Rural Health
Efforts

• Initiatives
• Inclusion of rural as an underserved population
  in the QIOs 7th Scope of Work ,
• Assist providers in receiving reimbursement from
  Medicare,
• Improve quality of care in small rural and
  frontier hospitals,
• Assist hospitals with HIPAA compliance,
• Improve access to care,
• Enhance provider communications through open door
  meetings, and
• Reduce burdensome regulations.

• Programs
• Medicare
• Medicaid
• State Childrens Health Insurance
• Quality Improvement
• Health Insurance Portability and Accountability
  Act
• Clinical Laboratory Improvement Amendments

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Institute of Medicine

• IOM Advisor to the Nation for Health
• Crossing the Quality Chasm
• The health system is in need of fundamental
  reform
• Fostering Rapid Advances in Health Care
• Start by creating model 21st century community
  health systems
• New Project Building a 21st Century Community
  Health System in Rural America

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JOINT COMMISSION ON THE ACCREDITATION OF HEALTH
CARE ORGANIZATIONS

• Private, not for profit accrediting body since
  1951
• Mission To continuously improve the safety and
  quality of care provided to the public through
  the provision of health care accreditation and
  related services that support performance
  improvement in health care organizations.

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The Quality Initiative
A Public Resource on Hospital Performance 2003
The 10 Selected Performance Measures
Acute Myocardial Infarction (heart attack)1.
Aspirin prescribed at arrival2. Aspirin
prescribed at discharge3. Beta-blocker
prescribed at arrival4. Beta-blocker
prescribed at discharge5. ACE Inhibitor
prescribed for left ventricular systolic
dysfunction Heart Failure6. Left ventricular
function assessment performed 7. ACE
inhibitor prescribed for left ventricular
systolic dysfunctionPneumonia8. Timing of
initial antibiotic administration 9.
Administration of Pneumococcal vaccine10.
Oxygenation assessment
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QIOs Doing Broad Range of Work in Current
Contracts (2002-2005)

• Quality improvement hospitals, physician
  offices, nursing home, home health agencies, MC
  organizations (specific required focus on
  underserved populations which includes rural).
• New focus on promotion and explanation of CMSs
  publicly reported quality measures.
• Medical record review beneficiary complaints,
  hospital payment monitoring, discharge reviews,
  EMTALA reviews.

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Summit Recommendations

• Rural should lead the American Quality Movement
• Quality measures should be rural appropriate
• relevant
• - Rural needs to be at the table
• Recognize rural-urban differences
• Rural quality research should identify models
  and
• collect rural quality data

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• Rural IT capacity should be enhanced to enable
  evidence-based practice electronic records
• Equipment/Software
• Skills
• IT System Integration
• Additional QI technical assistance education
  should be available to rural providers
• QIO 7th and 8th Scope of Work
• Flex Program

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• Regulatory models should be developed that focus
  on processes systems in a rural context
• Rural quality networks should be developed and
  supported
• There should be a central point of access for
  rural quality information, models and expertise

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• Rural quality strategies should engage and inform
  the community to overcome negative stereotypes
  out-migration for care
• A comprehensive rural demonstration project
  should be developed to create a community based
  21st century health system

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Even if youre on the right track, youll get run
over if you just sit there WILL ROGERS