Forum on Quality Draws out Major Issues for Rural Areas

October 1997

The fourth Rural Health Roundtable forum held September 22, 1997, drew an audience of 90 to a panel discussion addressing the issue of assessing and measuring quality in rural America. Quality in health care has been a subject of increasing study and debate, and has received visibility through the President’s Commission on Consumer Protection and Quality in the Health Care Industry. These and other activities, made exploring whether or not being "rural" makes a difference in considering quality a timely topic.

Panel participants included Gary Hart, of WWAMI Rural Health Research Center; Dennis Hamilton, President, Freeport Health Network; Phil Campbell, JCAHO Workgroup on Accrediatation of Small and Rural Hospitals; George Smith a physician from Virginia; and Darin Johnson of the National Rural Health Association as moderator. Dr. Hart indicated that the key to studying rural health care is to clearly understand the provider’s scope of practice, the number of activities done, and how well they are done. Dr. Hart cautioned that regulations developed to promote and safeguard quality should pay heed to the following:

• Guidelines and standards should make "rural sense." In other words, regulators should be careful not to create standards for something that does not need fixing. For example, one study found rural women received less prenatal care than their urban counterparts and yet they had similar outcomes. Thus, it is not always true that "less is worse" and regulators should recognize that the process for achieving a positive outcome may be different in rural areas.
• Standards should be evidence-based and regulators and others should not pre-suppose that rural health care is bad.
• Whether standards involve a real net benefit to the rural community.

The discussion among the panelists repeatedly touched on the theme that the process in which care is delivered is critical and may be different in rural areas. Furthermore, panelists agreed that it is necessary to measure outcomes but that patient satisfaction is also another relevant component of quality though they did not achieve agreement about it’s relative importance.

In conclusion, Mr. Hamilton cautioned that the governmental entities, including legislators and regulators, be very careful in their crafting of standards and ascertain their impact in general and in rural areas specifically.