257430 Quality indicators at Florida's statutory rural hospitals

Wednesday, October 31, 2012 : 11:15 AM - 11:30 AM

Ronald Wiewora, MD, MPH , Health Care District of Palm Beach County, Palm Springs, FL
Daniel Kairys, MD , Lakeside Medical Center, Belle Glade, FL
STATEMENT OF PROBLEM: Florida law affords special protections for rural hospitals that meet certain statutory criteria. These are outlined in FS 395.602-395.6061. These provisions include financial incentives under the Medical Education Tuition Reimbursement Program, exceptions to certificate of need process for replacement facilities, extending Medicaid reimbursements, providing rural hospital capital improvement grants and encouraging state level provision of rural health services. In spite of state protections, rural hospitals must meet all the same accreditation and licensing standards as urban facilities. Meeting these standards can be challenging due to a lack of resources in the rural setting.

METHODOLOGY: All hospitals licensed in the state of Florida report quality indicators to the Agency for Health Care Administrations. This data is posted for public review. Twenty-seven statutory rural hospitals are included in the listing. Utilizing this public data, comparisons were made between the statutory rural hospitals and other Florida hospitals. Two indicators were chosen for review: Central Venous Catheter Related Bloodstream Infections and Decubitus Ulcers. RESULTS: The 27 statutory rural hospitals represent a variety of ownership types. Seven (7) are government-owned hospitals, nine (9) are for-profit or investor owned facilities and eleven (11) are not-for-profit entities. The average case mix was 1.0303 with a range from 0.725 to 1.386. The statutory rural hospitals generally had expected rates for the two indicators studied. Many of the rural hospitals had small volumes, which might affect the validity of the rate. The rates are similar when compared to urban hospitals in the same geographic area. Teaching hospitals in some areas had higher rates. These hospitals had a higher case mix, reflecting a more acutely ill and complex population.

CONCLUSIONS: Statutory rural hospitals have expected rates of two commonly reported quality indicators: Central Venous Catheter Related Bloodstream Infections and Decubitus Ulcers. The rates compare favorably to urban and teaching hospitals.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
At the end of the session the participant will be able to: 1. Define a Florida statutory rural hospital 2. Describe the difficulties rural hospitals have in achieving quality markers 3. Compare quality markers for dectubitus ulcers and central line infections from statutory rural hospitals to other licensed hospitals

Keywords: Rural Health Care, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as the CEO of a health system that operates a statutory rural hospital in the state of Florida.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.