Quality Assurance in Rural Hospitals

Implementation of an Inpatient Case Management Program in Rural Hospitals

“…Others have noted the need to be realistic about the time and effort required and that these are often underestimated (Hospital Case Management, 1993a, 1993bLumsdon & Hagland, 1993). Time constraints and workload may be accentuated in rural hospitals compared to larger urban hospitals (Bushy, 1991;Bushy & Tyler, 1989;Sowell & Fuszard, 1989), and they increase the tendency for individuals to respond with apathy, negative attitudes, or resistance (Bushy & Tyler, 1989). Workload can be reduced by replacing nursing care plans with CareMaps and charting-by-exception (writing lengthy notations only for variances).…”

“…For example, education was needed for issues such as uncertainty about what to do (for example, when more than one CareMap was applicable), misunderstandings about issues such as staff responsibilities, and changes in CareMaps that arose during implementation. Inadequate education is a commonly repeated concern in implementing quality assurance in rural hospitals (Bushy, 1991). It is not unusual for hospital staff to experience difficulty incorporating managed care and case management concepts into actual practice (Marr & Reid, 1992).…”

“…It is important to evaluate managed care and case management programs in rural hospitals because these hospitals differ from urban institutions in ways that affect their ability to implement successful programs (Bushy, 1991;Bushy & Tyler, 1989;Sowell & Fuszard, 1989). With lower reimbursement levels and fewer financial resources rural hospitals have less latitude to tolerate new activities that could increase costs.…”