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Health care quality standards for rural areas should be practical, useful, and affordable

Although it is desirable to have a national standard for health care quality, "one size" may not necessarily fit all. The nature of rural health care is necessarily different from that provided in large cities. Rural health care providers struggle to provide basic ambulatory and inpatient services to the communities they serve, but they may lack the organizational depth or sophistication to meet the requirements of external accrediting bodies.

Because of these limitations, accrediting agencies, third-party insurers, and health insurance purchasers need to tailor their expectations and develop rural health care quality standards that are practical and attainable, according to Ira Moscovice, Ph.D., of the University of Minnesota Rural Health Research Center (RHRC), and Roger Rosenblatt, M.D., M.P.H., of the University of Washington RHRC. Their work was jointly supported by the Health Resources and Services Administration's Office of Rural Health Policy and the Agency for Healthcare Research and Quality.

The push to measure and monitor rural health care quality has been prompted by several policy initiatives, such as establishment of the Medicare+ Choice Program and the Medicare Rural Hospital Flexibility Program. The first program has attempted to expand enrollment of rural Medicare beneficiaries in managed care plans and requires participating providers to document the quality of care provided to Medicare patients. The hospital program allows States to designate rural facilities as critical access hospitals (CAHs) if they are at least a 35-mile drive from another hospital or facility, make available 24-hour emergency care, maintain no more than 15 acute care beds, and provide acute inpatient care not longer than an average of 96 hours. CAHs receive Medicare payment for services on a reasonable-cost basis.

To facilitate community acceptance and achieve fiscal stability, CAHs must be able to document the quality of care they provide. However, the capital, personnel, and expertise needed to develop and operate sophisticated quality assurance (QA) and improvement (QI) programs are not readily available in most rural areas. The expectations of QA and QI activities in CAHs must take into consideration their limited institutional resources and their communities' preferences, note the researchers. They call for rural quality of care standards that are practical, useful, and affordable.

See "Quality-of-care challenges for rural health," by Drs. Moscovice and Rosenblatt, in the Spring 2000 Journal of Rural Health 16(2), pp. 168-176.

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