Quality indicators at Florida's statutory rural hospitals

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.