Quality improvement in rural america

Chronic diseases are a leading cause of morbidity and mortality in the world. According to the World Health Statistics Report 2012, one in three adults has hypertension, while one in ten adults has diabetes. In the United States, the prevalence of diabetes has increased dramatically by 82% between 1990 and 2010. In rural areas, this is exacerbated by high rates of poverty, older populations, and less access to care. High quality care is needed in the primary care setting to effectively manage chronic diseases. To respond to this need, the Small Health Care Provider Quality Improvement Program was developed by the Office of Rural Health Policy in the Health Resources and Services Administration. The purpose of the program is to assist primary care providers in rural areas with implementation of quality improvement strategies, with the goal of development of an evidence-based culture and delivery of coordinated care. Major activities of the program include: implementation of the Chronic Care Model to identify areas of improvement for the organization; performing plan-do-study-act cycles to test changes in the delivery of health care; the use of a registry or other clinical information system to track and report health indicators; and analysis of data to drive quality improvement. Participation in this program will help prepare organizations to participate in for pay-for-performance and other incentive programs, such as Accountable Care Organizations, Meaningful Use, and Patient-Centered Medical Home. Organizations funded under this program are required to report data on clinical measures related to diabetes and cardiovascular disease. Data from this program will be shared, showing improvement in blood pressure control, as well as higher rates of glycemic control when compared with Medicaid data from the National Committee on Quality Assurance. Additional information will be provided on successes, challenges, and lessons learned from this program.