Defining Sustainability of Care Delivery in Rural Hospitals: A TCAB Pilot Project

Saturday, 16 November 2013: 3:15 PM

Roseanne Fairchild, PhD, RN, CNE, NE-BC
Department of Advanced Practice Nursing, Indiana State University, Terre Haute, IN
Shiaw-Fen Ferng, Ph.D.
Randi Zwerner, MSN, RN
Advanced Practice Nursing, Indiana State University, Terre Haute, IN

Learning Objective 1: To understand and apply "Transforming Care at the Bedside" (TCAB) quality improvement model emphasizing patient-centered care to the unique context of rural hospital settings.

Learning Objective 2: To extend TCAB model by delineating practical plans and highlight barriers and facilitators to tailor the model's key variable outcomes to rural care delivery settings.

Robert Wood Johnson’s Transforming Care at Bedside (TCAB) quality improvement (QI) model addresses patient-centered care, value-added productivity, patient safety, employee vitality. Application of the model has been demonstrated to increase quality of care in urban hospitals, but no study has been completed to tailor TCAB and its variable measures to rural hospitals. Based on promising results in urban settings, TCAB needs to be adapted to the unique context of rural hospital settings, including working, managing and measuring on a smaller scale and constrained financial and technological resources.

The purpose of this six-month pilot study was to measure levels of employee vitality and engagement, assess patient health outcome indicators, and highlight unique issues facing rural hospitals to determine revisions needed to TCAB outcome variables for rural hospitals.

Method: Ten qualitative focus groups were conducted with employees (n=37) to gather thematic data regarding unique issues and QI opportunities in rural hospitals. Kriskal-Wallis ANOVA and Mann-Whitney U tests were used to identify differences in employees’ vitality and engagement (n=139/193;72% response rate). Hospital Compare data in the CMS core measures were assessed for below-average scores. The significance level was set at 0.05.

Results: There were statistically significant differences in vitality among administrative, clinical and ancillary staff (p<.030). There were below-average scores in CMS hospital readmissions. Focus group participants revealed multiple innovative ideas to promote QIs in patient education, patient satisfaction, transformational leadership, staff recognition. Recycling was observed to be lacking, but indoor air quality (IAQ), ventilation rate, relative humility, carbon dioxide levels were within-normal-limits.

Conclusions: Revisions to selected TCAB outcome variables are needed to tailor TCAB to rural hospitals. This pilot study should allow development of a set of evidence-based QI strategies and outcomes that are relevant to rural hospitals and can be implemented and tested in a larger group of rural U.S. CAHs.