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A Hospital-Randomized Controlled Trial of an Educational Quality Improvement Intervention in Rural and Small Community Hospitals in Texas Following Implementation of Information Technology

Institute for Health Care Research and Improvement, Baylor Health Care System, and at the Department of Statistical Science, Southern Methodist University, Dallas, Texas

David Nicewander, MS

Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas

Cody Hamilton, PhD

Baylor Health Care System Institute for Health Care Research and Improvement, Dallas, Texas

Jeph Herrin, PhD

Edwards LifeSciences Inc, Irvine, California

Percy Galimbretti, MD, PhD

Flying Buttress Associates, Charlottesville, Virginia

Mari Tietze, PhD, RN

Rural and Community Health Institute, Texas A&M University Health Science Center, College Station

Susan McBride, PhD, RN

Dallas-Fort Worth Hospitals Council, Dallas, Texas

Julie Gunderson, RN, BSN, MM, CPHQ

Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas

Ziad Haydar, MD

Health Texas Provider Network, Baylor Health Care System, Dallas, Texas

Josie Williams, MD, MMM

Rural and Community Health Institute, Texas A&M University Health Science Center, College Station

David J. Ballard, MD, MSPH, PhD

Baylor Health Care System, Executive Director and BHCS Endowed Chair, Institute for Health Care Research and Improvement, Dallas, Texas, dj.ballard{at}baylorhealth.edu

Rural and small community hospitals typically have few resources and little experience with quality improvement (QI) and, on average, demonstrate poorer quality of care than larger facilities. Formalized QI education shows promise in improving quality, but little is known about its effect in rural and small community hospitals. The authors describe a randomized controlled trial assigning 47 rural and small community Texas hospitals to such a program (n = 23) or to the control group (n = 24), following provision of a Web-based quality benchmarking and case review tool. Centers for Medicare and Medicaid Services Core Measures composite scores for congestive heart failure (CHF) and community-acquired pneumonia (CAP), using Texas Medical Foundation data collected via the QualityNet Exchange system, are compared for the groups, for 2 years postintervention. Given the estimated baseline rates for the CHF (68%) and CAP (66%) composites, the cohort enables the detection of 14% and 11% differences ( = .05; power = 0.8), respectively. (Am J Med Qual 2007;22:418-427)

Key Words: quality of care • rural hospitals • education • rapid-cycle quality improvement

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