. . . . zyxw Rural Crossroads . . . . . Quality Improvement in Critical Access Hospitals: Addressing Immunizations Prior to Discharge Edward F. Ellerbeck, MD, MPH; Bonnie Totten, MN; Samuel Markello, PhD; Kelly Patterson, BSN; Thomas R. Sipe, MHSA; and Chris Tilden, PhD ABSTRACT zyxwvutsrqpon Context: zyxwvutsrqp Many zyxwvutsrq patients hospitdized in immuniuztions. ike conventional hospitals, critical access hospitals (CAHs) need to addiress issues related to quality assurance arid quality performance. Yet these hospitals face unique L barriers in the conduct of quality improve- ment projects.' With the small number of discharges in these hospitals, it is difficult for them to accumulate adequate numbers of patients with specific disease conditions to support data-driven quality improvement activities. In addition, these hospitals seldom have personnel dedicated to quality improvement. The staff at CAHs who are responsible for quality improvement activities often have multiple responsibilities, and quality improvement/quality assurance is just a small part of their responsibilities. Hospital-based immunization has several features that make it of particular interest to small rural hospitals initiating quality improvement activities. First, since the majority of patients admitted to these hospitals may be The analyses upon which this publication is based were performed through a contract with the Kansas Rural Health Options Project (a partnershipof the Kansas Department of Health and Environment, the Kansas Hospital Association, the Kansas Board of Emergency Medical Services, and the Kansas Medical Society) that administers the Medicare Rural Hospital Flexibility (FLEX) Program in Kansas and under Contract 500-99-KS01titled "Utilization and Quality Control Peer Review Organization for the State of Kansas," sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The authors assume full responsibilityfor the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcome. For further information, contact Edward F. Ellerbeck, MD, MPH, Department of Preventive Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7313; e-mail eellerbeQkumc.edu. zy Ellerbeck et a1 433 Fall 2003