Quality-of-care challenges for rural health

The purpose of this article is to examine the issue of quality of care in r ural America and to help others examine this issue in a way that is consist ent with the very real challenges faced by rural communities in ensuring th e availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Rural ru ral providers can document that the quality of local health care meets obje ctive external standards third-party payers might refuse to contract with r ural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve measurement of heal th care quality in a rural setting, a number of issues specific to the rura l environment must be addressed, including small sample sizes (volume and o utcome issues), limited data availability, the ability to define rural heal th service areas, rural population preferences and the lower priority of fo rmal quality-of-cure assessment in shortage areas. Several current health p olicy initiatives have substantial implications for monitoring and measurin g the quality of rural health services health services. For example, to rec eive community acceptance and fiscal stability, critical access hospitals ( CAHs) must be able to document that the care they provide is at least compa rable to that of their predecessor institutions. The expectations for quali ty assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban ar eas, there will be an inevitable collision between the ability to provide c are and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not ail attainable go al. The spectrum and content of rural health care are different from the sp ectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable.