A systems approach to improving core measure outcomes in a small rural facility.

In spring 2005, Fairview Hospital, a small rural critical access facility, began an initiative to develop an integrated system for performance measurement and improvement. The system involved an organization-level change in the process of data collection, analysis, and dissemination, coupled with an organization-level change in structure that used the performance data to bring about continuous improvement. The system entailed no new investment in technology. Within the integrated system framework, Fairview used a patient-level composite score methodology to achieve dramatic improvement in core measure outcomes. This article describes key elements of Fairview's integrated system, as well as the specific initiatives that led to performance improvement on core measures, with the primary purpose of providing a framework for organization-level improvement.