Small Rural Hospitals Have a Harder Time Achieving Success in Continuous Quality Improvement: An Example From a Stroke Care Network

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University of Kentucky HealthCare established a Stroke Care Network (SCN) in 2008 to address the challenges of rural stroke care and improve care quality.


The SCN collects quality data from each affiliate that include volumes, mortality, length of stay, turnaround times, rt-PA door-to-needle time, 8 stroke core measures, and dysphagia screen measure. Characteristics of affiliate hospital studies include number of beds, Stroke Disease-Specific Care (DSC) certification by The Joint Commission, Appalachian designated county or not, time dedicated to stroke coordinator, submission of quality data for the calendar year, success of data, and utilization of American Heart Association's Get With the Guidelines.


Seventeen of 23 (74%) affiliate hospitals submitted data. Highest scoring quality measures were antithrombotic by discharge (96%), antithrombotic by end of day 2 (93%), and assessed for rehabilitation (92%). Hospitals with DSC certification were more likely to succeed in stroke quality than those without (P = .0357). Hospitals in Appalachian counties were less likely to succeed in quality measures than those in non-Appalachian designated counties (P = .02).


Our results demonstrate successful collection of quality data among hospitals bound only by an affiliation agreement. Areas to improve quality identified are door to computed tomographic interpretation, thrombolytic therapy, and dysphagia screening. We suspect that DSC certification is driving quality success in our network hospitals. That Appalachian affiliate hospitals are less likely to succeed could be due to a number of reasons such as the fewer resources available in Appalachian counties and may reflect the financial plight of rural hospitals more generally.

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