Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals
Purpose: Critical Access Hospitals (CAHs) have served their rural communities since they were created in the 1990s. CAHs have been exempt from the multiple organizational performance-based approaches that use financial incentives and thus quality indicators targeting CAHs specifically do not exist....
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Rural Nurse Organization; Binghamton University
2023-05-01
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| Series: | Online Journal of Rural Nursing and Health Care |
| Online Access: | https://rnojournal.binghamton.edu/index.php/RNO/article/view/733 |
| _version_ | 1797633329539842048 |
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| author | Marianne Baernholdt Nancy Dunton Elizabeth M. Grandfield Emily Cramer |
| author_facet | Marianne Baernholdt Nancy Dunton Elizabeth M. Grandfield Emily Cramer |
| author_sort | Marianne Baernholdt |
| collection | DOAJ |
| description | Purpose: Critical Access Hospitals (CAHs) have served their rural communities since they were created in the 1990s. CAHs have been exempt from the multiple organizational performance-based approaches that use financial incentives and thus quality indicators targeting CAHs specifically do not exist. Reports have suggested indicators that are appropriate for rural hospitals and CAHs but none have included all types of quality indicators - structures, work processes, outcomes, and quality improvement (QI) activities. Using a subset of the National Database of Nursing Quality Indicators® (NDNQI®) we assessed whether existing indicators for the work environment (structure), patient - and nurse outcomes are appropriate for CAHs.
Methods: Using 2017 NDNQI® data on 16 structure and outcome indicators (8 work environment, 6 patient- and 2 nurse outcomes) were extracted. Employing bootstrapped confidence intervals CAHs were compared to other small (less than 50 beds) rural and urban hospitals.
Findings: 103 CAHs, 63 small rural hospitals and 91 small urban hospitals had data on at least one indicator (range 87-239 for each indicator). There were no differences between CAHs and other small rural and urban hospitals for 15 of the 16 quality indicators. CAHs had fewer bachelor prepared nurses compared to urban hospitals.
Conclusion: Our results suggest that quality indicators for structure and outcomes currently used in approximately 2000 hospitals are also applicable for CAHs. Whether they apply to all 1350 CAHs and can be used to guide benchmarking and QI in CAHs needs further study.
Keywords: Critical Access Hospitals, Quality Indicators, National Database of Nursing Quality Indicators®
DOI: https://doi.org/10.14574/ojrnhc.v23i1.733 |
| first_indexed | 2024-03-11T11:52:35Z |
| format | Article |
| id | doaj.art-1f3d202cb01f443daa561c31dc8dce0e |
| institution | Directory Open Access Journal |
| issn | 1539-3399 |
| language | English |
| last_indexed | 2024-03-11T11:52:35Z |
| publishDate | 2023-05-01 |
| publisher | Rural Nurse Organization; Binghamton University |
| record_format | Article |
| series | Online Journal of Rural Nursing and Health Care |
| spelling | doaj.art-1f3d202cb01f443daa561c31dc8dce0e2023-11-08T20:29:22ZengRural Nurse Organization; Binghamton UniversityOnline Journal of Rural Nursing and Health Care1539-33992023-05-01231150172644Quality Indicators in Critical Access Hospitals, Small Rural, and Urban HospitalsMarianne Baernholdt0https://orcid.org/0000-0001-5499-7457Nancy Dunton1https://orcid.org/0000-0001-7776-7814Elizabeth M. Grandfield2Emily Cramer3https://orcid.org/0000-0001-7969-7522University of VirginiaUniversity of Kansas Medical CenterUniversity of Kansas Medical CenterUniversity of Kansas Medical CenterPurpose: Critical Access Hospitals (CAHs) have served their rural communities since they were created in the 1990s. CAHs have been exempt from the multiple organizational performance-based approaches that use financial incentives and thus quality indicators targeting CAHs specifically do not exist. Reports have suggested indicators that are appropriate for rural hospitals and CAHs but none have included all types of quality indicators - structures, work processes, outcomes, and quality improvement (QI) activities. Using a subset of the National Database of Nursing Quality Indicators® (NDNQI®) we assessed whether existing indicators for the work environment (structure), patient - and nurse outcomes are appropriate for CAHs. Methods: Using 2017 NDNQI® data on 16 structure and outcome indicators (8 work environment, 6 patient- and 2 nurse outcomes) were extracted. Employing bootstrapped confidence intervals CAHs were compared to other small (less than 50 beds) rural and urban hospitals. Findings: 103 CAHs, 63 small rural hospitals and 91 small urban hospitals had data on at least one indicator (range 87-239 for each indicator). There were no differences between CAHs and other small rural and urban hospitals for 15 of the 16 quality indicators. CAHs had fewer bachelor prepared nurses compared to urban hospitals. Conclusion: Our results suggest that quality indicators for structure and outcomes currently used in approximately 2000 hospitals are also applicable for CAHs. Whether they apply to all 1350 CAHs and can be used to guide benchmarking and QI in CAHs needs further study. Keywords: Critical Access Hospitals, Quality Indicators, National Database of Nursing Quality Indicators® DOI: https://doi.org/10.14574/ojrnhc.v23i1.733https://rnojournal.binghamton.edu/index.php/RNO/article/view/733 |
| spellingShingle | Marianne Baernholdt Nancy Dunton Elizabeth M. Grandfield Emily Cramer Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals Online Journal of Rural Nursing and Health Care |
| title | Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals |
| title_full | Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals |
| title_fullStr | Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals |
| title_full_unstemmed | Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals |
| title_short | Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals |
| title_sort | quality indicators in critical access hospitals small rural and urban hospitals |
| url | https://rnojournal.binghamton.edu/index.php/RNO/article/view/733 |
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