Experience with and expertise in QI implementation play an important role in LHDs' decision to seek accreditation, and their accreditation-seeking efforts may benefit from prior implementation of systematic QI strategies.

Small LHDs and rural LHDs have QI maturity levels that are comparable to larger, less rural LHDs, but their AR is much lower. As accreditation has been found to have positive benefits, it is important that all LHDs have the capacity and resources to meet the performance standards required of accredited LHDs. Small, rural LHDs may need additional resources and support in order to improve their ability to be accredited and/or certain accreditation requirements may need modification to make accreditation more accessible to small LHDs.

A B S T R A C TIntroduction: Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics. Methods: The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACOparticipating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach. Results: The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, © J Kim, L Young, S Bekmuratova, DJ Schober, H Wang, S Roy, SS Bhuyan, A Schumaker, L-W Chen, 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas.Conclusions: This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.Key words: accountable care organizations, colorectal cancer screening, delivery system innovation, primary care, rural health services, USA. IntroductionColorectal cancer (CRC) is the second-leading cause of death in the USA 1. The US Preventive Services Task Force recommends that adults aged between 50 and 75 years have a CRC screening, including fecal occult blood testing annually, sigmoidoscopy every 5 years, or colonoscopy every 10 years 2 . Despite the significant health benefits of routine CRC screening [2][3][4][5][6][7] , previous studies well documented the disparities between urban and rural communities in CRC screenings [8][9][10][11] . Primary care providers (PCPs) in rural clinics can play a critical role i...

While patient-reported outcomes measures (PROMs) are used in many practice settings as a standardized system of outcome measures, various factors may impact the meaningful use of PROMs by clinicians operating in various settings. Very limited research exists that focused on examining the use of FOTO® in outpatient rehabilitation settings. This study aimed to explore the barriers and facilitators in achieving FOTO® treatment completion rates and patient functional outcomes among physical therapists. Additionally, the study aimed to explore the internal acceptance of FOTO as a useful tool in rehabilitation from the perspectives of physical therapists. Qualitative data were collected through four focus group interviews with physical therapists at outpatient rehabilitation clinics. The interviews were audio-recorded and transcribed, and transcribed, and qualitative content analysis was applied for data analysis. Four major themes emerged from qualitative data analyses including (a) use of FOTO® in clinical practice, (b) reasons why the FOTO® process may not be followed, (c), therapists’ perceptions of FOTO®, and (d) perceived barriers and enablers related to FOTO®. The study concluded that multi-level determinants impact the successful use of FOTO® by therapists in outpatient rehabilitation settings. The findings have important implications for clinical practice, organizational leaders, and PROM developers.