2.50
Hdl Handle:
http://hdl.handle.net/10755/158290
Type:
Presentation
Title:
Quality of Care Assessment in Rural Hospitals: Realities and Challenges
Abstract:
Quality of Care Assessment in Rural Hospitals: Realities and Challenges
Conference Sponsor:Western Institute of Nursing
Conference Year:2003
Author:Shreffler, M., PhD
P.I. Institution Name:Montana State University-Bozeman
Title:Assistant Professor
Contact Address:College of Nursing, Missoula Campus, Bozeman, MT, 59717, USA
Contact Telephone:4069940211
Co-Authors:Shreffler-Grant, M. Jean
Need: The purpose of this study was to develop a method to assess the quality of care for patients with chronic health problems provided in Critical Access Hospitals (CAH). The CAH is a national limited-service hospital model that provides low-intensity acute care in remote rural areas, areas where residents with chronic conditions are more likely to be dependant on local health care facilities. Despite the growth of the CAH model, very little is known empirically about the quality of care provided for patients with chronic or acute health care problems. Specific aims were to: (a) develop selected clinical performance indicators that focus on care for patients with acute exacerbations of chronic health problems for use in assessment of care provided by CAHs; (b) conduct an initial test of the clinical performance indicators that focus on care for patients with acute exacerbations of chronic health problems, and © conduct an initial exploration of the patterns of use of CAH emergency rooms by rural residents with chronic health problems. Conceptual Foundation: The conceptual framework guiding this study was Donabedian’s triad of structure, process, and outcomes or the interconnected components of health care that reveal information about quality of care. Description of Sample: A convenience sample of two CAHs was recruited for the pilot. Thirty eligible patients were identified from each facility emergency room log. Patients were then invited to participate; the sample consisted of all those who consented. Methods: Using a national clinical guideline database and published literature, performance indicators were developed to assess quality of care for four selected clinical problems of patients with acute exacerbations of chronic health problems and piloted at two CAHs. Performance indicators included structure, process, and outcome elements adapted as necessary for the rural practice environment. The clinical problems were somewhat “generic,” i.e. experienced by patients with multiple health problems and thus did not require large numbers of any particular diagnosis. To evaluate the clinical indicators, data were obtained from chart audits and patient interviews. Field notes documented adequacy, feasibility, and ease of use of the indicators. Analysis was accomplished by quantitative comparisons of actual care with recommended care (per performance indicators), qualitative analysis of patient comments, and review of field notes. Research Findings/Results: Although sufficient numbers of eligible patients were found at each facility, a limited number of patient participants were actually recruited into the study due to impeding factors. These factors included: cumbersome and time consuming patient recruitment procedures, heightened sensitivity about patient privacy, and the nursing shortage. Data from charts and patient interviews from the limited number of participants were used to conduct the initial evaluation of the performance indicators. The clinical performance indicators were then revised as indicated. The presenter will also discuss modifications required due to the Health Insurance Portability and Accountability Act and other impeding factors. Conclusions: The results of this study indicate that the clinical performance indicator method has merit for quality of care evaluation in small rural hospitals although modifications to the approach are required. Ultimately, the results of this study and subsequent work may contribute to an improved understanding of quality of care in rural facilities which can be used for planning and improving approaches to care delivery for rural residents.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleQuality of Care Assessment in Rural Hospitals: Realities and Challengesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158290-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Quality of Care Assessment in Rural Hospitals: Realities and Challenges </td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Shreffler, M., PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Montana State University-Bozeman</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">College of Nursing, Missoula Campus, Bozeman, MT, 59717, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">4069940211</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value"> </td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Shreffler-Grant, M. Jean </td></tr><tr><td colspan="2" class="item-abstract">Need: The purpose of this study was to develop a method to assess the quality of care for patients with chronic health problems provided in Critical Access Hospitals (CAH). The CAH is a national limited-service hospital model that provides low-intensity acute care in remote rural areas, areas where residents with chronic conditions are more likely to be dependant on local health care facilities. Despite the growth of the CAH model, very little is known empirically about the quality of care provided for patients with chronic or acute health care problems. Specific aims were to: (a) develop selected clinical performance indicators that focus on care for patients with acute exacerbations of chronic health problems for use in assessment of care provided by CAHs; (b) conduct an initial test of the clinical performance indicators that focus on care for patients with acute exacerbations of chronic health problems, and &copy; conduct an initial exploration of the patterns of use of CAH emergency rooms by rural residents with chronic health problems. Conceptual Foundation: The conceptual framework guiding this study was Donabedian&rsquo;s triad of structure, process, and outcomes or the interconnected components of health care that reveal information about quality of care. Description of Sample: A convenience sample of two CAHs was recruited for the pilot. Thirty eligible patients were identified from each facility emergency room log. Patients were then invited to participate; the sample consisted of all those who consented. Methods: Using a national clinical guideline database and published literature, performance indicators were developed to assess quality of care for four selected clinical problems of patients with acute exacerbations of chronic health problems and piloted at two CAHs. Performance indicators included structure, process, and outcome elements adapted as necessary for the rural practice environment. The clinical problems were somewhat &ldquo;generic,&rdquo; i.e. experienced by patients with multiple health problems and thus did not require large numbers of any particular diagnosis. To evaluate the clinical indicators, data were obtained from chart audits and patient interviews. Field notes documented adequacy, feasibility, and ease of use of the indicators. Analysis was accomplished by quantitative comparisons of actual care with recommended care (per performance indicators), qualitative analysis of patient comments, and review of field notes. Research Findings/Results: Although sufficient numbers of eligible patients were found at each facility, a limited number of patient participants were actually recruited into the study due to impeding factors. These factors included: cumbersome and time consuming patient recruitment procedures, heightened sensitivity about patient privacy, and the nursing shortage. Data from charts and patient interviews from the limited number of participants were used to conduct the initial evaluation of the performance indicators. The clinical performance indicators were then revised as indicated. The presenter will also discuss modifications required due to the Health Insurance Portability and Accountability Act and other impeding factors. Conclusions: The results of this study indicate that the clinical performance indicator method has merit for quality of care evaluation in small rural hospitals although modifications to the approach are required. Ultimately, the results of this study and subsequent work may contribute to an improved understanding of quality of care in rural facilities which can be used for planning and improving approaches to care delivery for rural residents. </td></tr></table>en_GB
dc.date.available2011-10-26T20:41:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:41:54Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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