The purpose of this study is to describe the continuing evolution and maturation of CAH QI activities, and to document the best practices of two CAHs that have developed innovative QI programs. This study is part of the overall monitoring effort of the MRHFP funded by the federal Office of Rural Health Policy. This component included a phone survey of 72 CAHs about their QI activities and in-depth case studies of two CAH “QI best practices” that can serve as models for other CAHs.

The results of the survey and site visits demonstrate that many CAHs are successfully implementing QI strategies, despite the challenges they face. Since conversion, the surveyed CAHs have implemented a wide range of QI activities that have made a significant contribution to improving patient care. These activities include patient safety initiatives; improvements in overall QI processes and peer review processes; and implementation of QI projects focused on treatment of one or more specific diseases such as pneumonia, congestive heart failure, acute myocardial infarction, or stroke. The CAHs are involved with multiple external organizations in these QI activities. Over half of the CAH respondents are working with their support hospitals and with groups of CAHs on their QI activities.