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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
Giovanni Filardo, PhD, MPH
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
References
- Sussman G., DeNino L., Steinfeldt L. Considerations of hospital viability in rural Texas. QRB Qual Rev Bull. 1986; 12:136-140.[Medline]
[Order article via Infotrieve]
- Kohn L., Corrigan JM, Donaldson MS To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
- Corrigan JM, Donaldson MS, Kohn LT, Maguire SK, Pike KC Crossing the Quality Chasm. A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
- Health care consumers say they want to know more objective measures about quality. Qual Lett Healthc Lead. 2001; 13(4):12-13.[Medline]
[Order article via Infotrieve]
- McGlynn EA, Asch SM, Adams J., et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-2645.[Abstract/Free Full Text]
- Endsley S., Kirkegaard M., Baker G., Murcko AC Getting rewards for your results: pay-for-performance programs. Fam Pract Manag. 2004;11(3):45-50.[Medline]
[Order article via Infotrieve]
- Keeler EB, Rubenstein LV, Kahn KL, et al. Hospital characteristics and quality of care. JAMA. 1992;268:1709-1714.[Abstract/Free Full Text]
- Rosenblatt RA Quality of care in the rural context: a proposed research agenda. J Rural Health. 2002;18(suppl):176-185.[Web of Science][Medline]
[Order article via Infotrieve]
- Sheikh K., Bullock C. Urban-rural differences in the quality of care for Medicare patients with acute myocardial infarction. Arch Intern Med. 2001;161:737-743.[Abstract/Free Full Text]
- Corrigan JM, Aspden P, Snyder LP, Wolcott J, Wunderlich G, Russell B, ed. Quality Through Collaboration: The Future of Rural Health. Washington, DC: National Academies Press; 2004.
- Calico FW, Dillard CD, Moscovice I., Wakefield MK A framework and action agenda for quality improvement in rural health care. J Rural Health. 2003;19:226-232.
- National Advisory Committee on Rural Health and Human Services. Health Care Quality: The Rural Context. Rockville, MD: US Department of Health and Human Services; 2003.
- Hibbard JH, Stockard J., Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood). 2003;22(2):84-94.[Abstract/Free Full Text]
- Kiefe CI, Allison JJ, Williams OD, Person SD, Weaver MT, Weissman NW Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001;285:2871-2879.[Abstract/Free Full Text]
- Pai CW, Finnegan GK, Satwicz MJ The combined effect of public profiling and quality improvement efforts on heart failure management. Jt Comm J Qual Improv. 2002;28:614-624.[Medline]
[Order article via Infotrieve]
- Casey MM, Moscovice I. Quality improvement strategies and best practices in critical access hospitals. J Rural Health. 2004;20:327-334.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Westfall JM, Fernald DH, Staton EW, VanVorst R., West D., Pace WD Applied strategies for improving patient safety: a comprehensive process to improve care in rural and frontier communities. J Rural Health. 2004;20:355-362.
- Thompson DN, Wolf GA, Spear SJ Driving improvement in patient care: lessons from Toyota. J Nurs Adm. 2003;33:585-595.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Wilf-Miron R., Lewenhoff I., Benyamini Z., Aviram A. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care. Qual Saf Health Care. 2003;12:35-39.
- Berwick DM Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53-56.[Web of Science][Medline]
[Order article via Infotrieve]
- Ferguson TB Jr, Peterson ED, Coombs LP, et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA. 2003;290:49-56.[Abstract/Free Full Text]
- Lappe JM, Muhlestein JB, Lappe DL, et al. Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program. Ann Intern Med. 2004;141:446-453.[Abstract/Free Full Text]
- Chu LA, Bratzler DW, Lewis RJ, et al. Improving the quality of care for patients with pneumonia in very small hospitals. Arch Intern Med. 2003;163:326-332.[Abstract/Free Full Text]
- Sehgal AR Impact of quality improvement efforts on race and sex disparities in hemodialysis. JAMA. 2003;289:996-1000.[Abstract/Free Full Text]
- The Academic Medical Center Working Group of the Institute for Healthcare Improvement. The imperative for quality: a call for action to medical schools and teaching hospitals. Acad Med. 2003;78:1085-1089.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Djuricich AM, Ciccarelli M., Swigonski NL A continuous quality improvement curriculum for residents: addressing core competency, improving systems. Acad Med. 2004;79(10 suppl):S65-S67.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Intermountain Health Care. Mini-Advanced Training Program in Health Care Delivery Improvement. Available at: http://intermountainhealthcare.org/xp/public/institute/courses/miniatp/. Accessed August 29, 2007.
- Cognos Inc. The Strategic Importance of OLAP Analysis: A Cognos White Paper. Available at: http://www.cognos.com/pdfs/whitepapers/wp_strategic_importance_of_olap_analysis.pdf. Accessed August 29, 2007.
- Dalton K., Slifkin R., Poley S., Fruhbeis M. Choosing to convert to Critical Access Hospital status. Health Care Financ Rev. 2003;25(1):115-132.[Medline]
[Order article via Infotrieve]
- Donner A., Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. London, UK: Arnold; 2000.
- Murray DM Design and Analysis of Group Randomized Trials. New York, NY: Oxford University Press; 1998.
- Joint Commission on Accreditation of Healthcare Organizations. Change in ACEI for LVSD measures (HF-3, AMI-3): Incorporation of ARBs. Available at: http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalSummaryOfMeeting1.pdf. Accessed August 29, 2007.
- Epstein AM Rolling down the runway: the challenges ahead for quality report cards. JAMA. 1998;279:1691-1696.[Abstract/Free Full Text]
- Lied TR, Malsbary R., Eisenberg C., Ranck J. Combining HEDIS indicators: a new approach to measuring plan performance. Health Care Financ Rev. 2002;23(4):117-129.[Medline]
[Order article via Infotrieve]
- Centers for Medicare and Medicaid Services. CMS HQI Demonstration Project Composite Quality Score Methodology Overview. Available at: http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalCompositeQualityScoreMethodology-Overview.pdf. Accessed August 29, 2007.
- Landrum MB, Bronskill SE, Normand ST Analytic methods for constructing cross-sectional profiles of health care providers. Health Serv Outcomes Res Methodol. 2000;1:23-47.[CrossRef]
- Texas Medical Foundation. The Appropriate Care Measure. Available at: http://www.tmf.org/hospitalqi/8sowpreview/AppropriateCareMeasure.htm. Accessed June 30, 2005.
- Zaslavsky AM, Shaul JA, Zaborski LB, Cioffi MJ, Cleary PD Combining health plan performance indicators into simpler composite measures. Health Care Financ Rev. 2002;23(4): 101-115.[Medline]
[Order article via Infotrieve]
American Journal of Medical Quality, Vol. 22, No. 6,
418-427 (2007)
DOI: 10.1177/1062860607307995
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