Rural Hospital Collaborative for Excellence Using IT

For rural and small community hospitals, the ability to implement advanced information technologies (IT) may be a matter of life and death - both to themselves and their patients. Perhaps more than other health care facilities, these providers, which often serve widely dispersed populations, need access to real-time patient data. When patient information is fragmented and difficult to lay hands on at the crucial moment, patient care can be compromised.

But IT implementation requires significant financial and human resources, which are in short supply at rural hospitals. That poses a serious problem:  Simply put, if rural facilities can't implement IT and care standards to meet government and payer reporting requirements for patient safety and quality of care, they could be driven out of business. That would leave millions of people without access to acute care.

In Texas, a rural hospital initiative supported by a three-year, $1.4 million AHRQ grant is exploring ways to solve that problem. By October 2007, the initiative will have implemented advanced IT in more than 60 rural and community hospitals, and will have evaluated the effectiveness of providing IT training to those facilities on how to use and interpret the data. An online tool kit providing help and guidance to other rural hospitals will also be produced.

"By and large, small and rural facilities lack the money to purchase IT tools. There are very talented and skilled people who work in rural facilities and provide good care to the patients they serve, but they need to have the data to prove it. They just need a little help," says Josie R. Williams, MD, director of the Rural and Community Health Institute (RCHI) at the Texas A&M University System Health Science Center.

According to Williams, the AHRQ grant is providing that help. 

"We could not do this project without AHRQ's support," says Williams, who co-directs the project with David Ballard, MD, senior vice president and chief quality officer for the Baylor Health Care System (BHCS). Patricia Dorris, CEO of Palo Pinto General Hospital, is the project's principal investigator. The network's additional partners include the Dallas/Fort Worth Hospital Council Data Initiative, RCHI, BHCS, and the Texas Medical Foundation.

"Our goal is to get 60 to 65 of the small rural and community hospitals in Texas into a single standardized database, so that they can report quarterly and also get real-time and live access to their data and compare it to other facilities in the state of Texas benchmarking and improving their care," Williams explains.

The data are to be translated into the same format used by the Dallas/Fort Worth Hospital Council Data Initiative's database, which contains more than 2.7 million patient records and processes over 600,000 records per year. The Data Initiative's web-portal reporting capability allows member hospitals to interact with its public-use data file and with the AHRQ Quality Indicator Reports for Patient Safety Indicators and Inpatient Quality Indicators.

So far, 64 facilities have signed onto the project, and researchers have collected and formatted data from more than 48 rural hospitals. Formatting, which involves accessing, organizing, and putting hospital data into the proper format, has been labor-intensive, and required earning the trust of opinion leaders and physicians.

"It's not like we can go in and say that we want to talk to the quality director," Williams says. "With few resources, leaders at small and rural hospitals wear many hats. At one hospital, an individual was the director of utilization review, quality improvement, health information management, and housekeeping." Understanding the culture of such facilities - Williams has worked in rural facilities for 30 years - has helped the project team gain such trust.

Some hospitals don't even have computers, so project researchers have taken hand-written patient records and entered the information into computers. In one facility, the sole computer had crashed, and there was no money to replace it. Using funds from a $50,000 grant provided by the Texas Medical Foundation, Williams' team donated computers to five hospitals so that they could participate in the project.

The project's second phase, which starts in April 2006, involves randomizing the participating facilities into two groups. One will receive technology and education support to see if such training improves patient quality data; the other will receive technology but not education training. Training for the intervention group will take place in six sessions over a four-month period. If the study's results show that training is beneficial, Dr. Williams and her team will make sure that all of the facilities in the study eventually receive training.

"This is an extremely innovative project. Small rural hospitals are a vital part of the health care system, and we believe that with a bit of support these facilities will be able to provide top-quality health care services or people in rural communities and sustain reporting of the services they provide," says Williams. With help from the AHRQ grant, the project may be able to provide such support.