Continuous quality improvement in rural health clinics.

Abstract

Continuous quality improvement has been shown to work in urban and suburban clinics. The objective of this project is to test whether continuous quality improvement would improve the quality of care for patients with diabetes mellitus and/or hypertension in a rural health clinic. Rural health clinic with 3 providers and two and half full-time registered nurses. Patients were mostly older adults with Medicare health insurance. Health care providers and nursing staff agreed on the quality improvement project. The intervention included providing quarterly feedback to health care providers, empowering the nurses to remind patients of diabetes care, and flagging the charts to remind providers. The proportions of diabetic patients who had ophthalmologic exam, pneumococcal vaccine and lipid screening significantly improved over 12-month period. The proportions of patients with hypertension who had blood pressure less than 140/90 and patients who were taking aspirin also significantly improved over 12-month period. The quality of care for patients with diabetes and patients with hypertension could be improved in rural health clinics using repetitive cycles of measurements, implementation of interventions and evaluation of outcomes. This process could be used as the backbone for translation of evidence into practice and improving quality of care.