Rural and Community Health Institute Outreach Highlights
In June 2003, the Texas A&M Health Science Center established the Rural and Community Health Institute, which strives to partner with rural and community health facilities, clinics, and physicians to provide a variety of educational programs that strengthen and assure quality and patient safety. The institute targets healthcare delivery services, establishes database management and analysis, and conducts policy research that may be difficult for small facilities to accomplish alone.
HSC-RCHI has grown from three programs and grants its first year to eight in 2005. It also had peer review programs with 18 hospitals in 2005, compared to two hospitals in 2003.
The HSC-RCHI peer review program offers an effective, economical and reliable option for rural medical staffs throughout Texas to objectively evaluate the quality and appropriateness of patient care. It provides objective and impartial reviews by a peer review committee consisting of members within the same specialty and not in economic competition or partnership with the professional under review; assists rural hospital staffs in meeting the increasing and dynamic requirements of care review and fulfilling their legal obligation to provide quality care to patients; and fosters overall improvement in care. Through the peer review program, HSC-RCHI charges a small subscription fee to participating hospitals based on their average daily patient load. The hospital becomes a partner in the internal peer review system, determining what cases most need to be reviewed. The hospital provides a reviewer for each specialty being peer reviewed. Specialties include general surgery, emergency medicine, family medicine, internal medicine, and obstetrics and gynecology.
Peer review also is part of KSTAR, representing “Knowledge,” “Skills,” “Training,” “Assessment” and “Research.” This new HSC-RCHI program assists in determining if problems are systematic or specific to a physician and provides the appropriate resolutions to benefit both doctor and healthcare institution.
KSTAR encourages and stimulates medical practice improvement in an environment that allows for individualized and tailored assessment, education and training to create higher performing physicians and improve the safety and quality of provided medical care. It provides support to the National Coalition for Physician Enhancement, whose own mission is to support and develop expertise in personalized assessment and education to enhance physician performance.
KSTAR utilizes the “Just Culture” approach in dealing with problems specific to an individual physician, balancing the need to learn from mistakes with the need to take disciplinary action. It also takes into account the impact of systems issues on performance and adverse events.
Instead of immediate suspension, education, retraining and ongoing mentoring are provided through KSTAR to keep the physician in practice or limit privileges for a period of time. It also benefits physicians seeking new responsibilities or wanting to perform new procedures.
Alongside these HSC-RCHI programs are numerous conferences and meetings, such as the March 2007 “National Conference on Small Numbers” covering the challenges and innovations in evaluating quality of care measures based on small counts.The conference addressed accurately assessing the health status of populations through the measurement of indicators of quality of care and patient safety in small community hospitals and rural facilities experiencing small cell size issues. Many facilities also do not collect data on some indicators recommended by Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research & Quality (AHRQ) to measure quality of care and patient safety. The goal is to promote and stimulate discussion of current and innovative ways to approach these problems and develop new strategies.
