The values of rural America mirror those of health care quality: people first. The challenge of delivering equitable, effective care is particularly acute in rural areas, where residents face unique barriers to accessing these services. Despite comprising 97% of the country's land area and 60 million people, most rural communities have fewer health-related resources than their urban counterparts. The limited availability of health care providers, transportation barriers and geographic isolation make it difficult for some individuals and families in rural communities to access the care they need, resulting in significant health disparities as well as overall challenges to clinical quality.

The American Hospital Association recognizes the unique challenges faced by rural communities in accessing high-quality health care and continues to provide support to address these challenges.

Redefining Quality Essentials

A roundtable discussion at the 36th annual AHA Rural Health Care Leadership Conference in San Antonio in February focused on “Redefining Quality Essentials.” This roundtable featured a cadre of health care quality experts examining the opportunities and challenges of improving health care quality in rural areas. Led by Marie Cleary-Fishman, AHA vice president of clinical quality, and Chris DeRienzo, M.D., AHA chief physician executive, the conversation covered a range of topics, including electronic health record management, patient fall protocols, training needs and the broader issues of public trust and misinformation campaigns.

The group identified several performance improvement strategies that rural health care providers are incorporating to enhance health care outcomes. Key takeaways include:

  • Telemedicine can improve access to specialty care in rural areas where there may be limited availability of specialists. It also can improve patient access to primary care services, which can help in preventing and managing chronic conditions. Telemedicine also enhances the work experience for health care professionals. “When [health care] workers are empowered with the right tools and resources, they can provide better patient care, leading to better patient outcomes,” noted Barb Petersen, chief quality officer at Great Plains Health in North Platte, Neb., and a roundtable participant. “The worker experience is directly related to the patient experience, and telemedicine has the potential to improve both.”
     
  • The patient-centered medical home is a model of primary care that focuses on providing collaborative, comprehensive care. By adopting this model, rural health care providers can improve care coordination and patient outcomes and reduce costs.
     
  • The health information exchange allows health care providers to securely share patient health information electronically. This can enhance care coordination and help prevent medical errors.
     
  • Rural health care providers can implement quality and performance improvement initiatives using the Plan-Do-Study-Act model to help identify areas for improvement and implement changes to advance patient outcomes. Wendy Ward, director of patient safety and risk management at Great Plains Health and a roundtable participant, emphasized the importance of giving nurses a seat at the table to lead initiatives that improve patient outcomes and satisfaction and elevate the standard of care. “Nurses bring a unique perspective and expertise to quality improvement initiatives, and their front-line experience makes them invaluable in identifying areas for improvement and effective solutions,” she said.
     
  • Improving patient engagement by involving patients in their own care can improve outcomes and reduce health care costs. Patient engagement strategies, such as shared decision-making and patient portals, also could reduce medical mistrust and more quickly counter misinformation.

These are just a few examples of quality and performance improvement strategies that help rural hospitals and health systems improve health care quality outcomes. Specific strategies that would be most effective depend on the needs of the community and the resources available to health care providers.

The Performance Improvement Journey

By facilitating this exchange of ideas and expertise, the AHA aims to identify future solutions for ensuring better health care quality and outcomes for residents of rural communities across the country.

In April, the AHA is launching a new performance improvement collaborative — a peer-to-peer learning hub to address quality concerns and solutions. This three-month, virtual collaborative will convene selected leaders in health care quality to co-design strategies that will support the current needs of the field and help map out the future of quality. More information will be announced soon by the AHA’s Living Learning Network team.

Quality improvements fundamentally increase the human value of care, creating a living, breathing network of providers and patients working together to achieve optimal outcomes for all communities. The AHA is committed to providing resources and advocacy for rural hospitals and health systems and their current and future performance improvement efforts.

Benjamin C. Wise is a senior program manager of communications strategy for AHA Funded Partnerships.

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