The purpose of this study is to extend the work begun in a prior study on development of a method for assessing quality health care provided by Medical Assistance Facilities. The Medical Assistance Facility (MAF) is a limited service hospital in Montana that provides low-intensity acute care services with provisions for flexibility in staffing and other licensur requirements. The MAF program was the prototype for the 1997 federal legislation creating a permanent MAF-like Critical Access Hospital that is currently being implemented in rural areas nationwide. Despite the growth of the MAF model, very little is known empirically about the quality of care provide.
Specific aims of this study are to: (a) develop selected clinic performance indicators that focus on care for patients with acute exacerbations of chronic health problems; (b) conduct an initial evaluation of the clinical performance indicators that focus on care for patients with acute exacerbations of chrome heal problems; and (c) conduct an initial exploration of the patterns of use of MAF emergency rooms by rural residents with chronic health problems. Using a national clinical guideline database and published literature, performance indicators will be developed to assess the quality of emergency room care for patients with acute exacerbations of selected chronic health problems and piloted at four MAFs. Data will be obtained from chart audits and patient interviews for encounters. Field notes will document adequacy, feasibility, and ease of use of the indicators Development of a method to assess quality of care in low-acuity low volume facilities such as MAFs is essential for a better understanding of quality care in rural areas. The ultimate goal is an improved understanding of quality care in small rural health care facilities that may contribute to development of interventions for maintaining and improving the quality of their services.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory Grants (P20)
Project #
Application #
Study Section
Special Emphasis Panel (ZNR1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Montana State University Bozeman
United States
Zip Code
Shreffler-Grant, Jean; Weinert, Clarann; Nichols, Elizabeth (2014) Instrument to measure health literacy about complementary and alternative medicine. J Nurs Meas 22:489-99
Kuntz, Sandra W; Ricco, Jason A; Hill, Wade G et al. (2010) Communicating methylmercury risks and fish consumption benefits to vulnerable childbearing populations. J Obstet Gynecol Neonatal Nurs 39:118-26
Kuntz, Sandra W; Hill, Wade G; Linkenbach, Jeff W et al. (2009) Methylmercury risk and awareness among American Indian women of childbearing age living on an inland northwest reservation. Environ Res 109:753-9
Stepans, Mary Beth Flanders; Wilhelm, Susan L; Rodehorst, T Kim et al. (2009) Testing protocols: care of biological samples in a rural setting. Clin Nurs Res 18:6-22
Holkup, Patricia A; Rodehorst, T Kim; Wilhelm, Susan L et al. (2009) Negotiating three worlds: academia, nursing science, and tribal communities. J Transcult Nurs 20:164-75
Running, Alice; Shreffler-Grant, Jean; Andrews, Wendy (2008) A Survey of Hospices Use of Complementary Therapy. J Hosp Palliat Nurs 10:304-312
Holkup, Patricia A; Salois, Emily Matt; Tripp-Reimer, Toni et al. (2007) Drawing on wisdom from the past: an elder abuse intervention with tribal communities. Gerontologist 47:248-54
Salois, Emily Matt; Holkup, Patricia A; Tripp-Reimer, Toni et al. (2006) Research as spiritual covenant. West J Nurs Res 28:505-24; discussion 561-3
Cumbie, Sharon; Weinert, Clarann; Luparell, Susan et al. (2005) Developing a scholarship community. J Nurs Scholarsh 37:289-93
Walton, Joni; Craig, Carol; Derwinski-Robinson, Barbara et al. (2004) I am not alone: spirituality of chronically ill rural dwellers. Rehabil Nurs 29:164-8

Showing the most recent 10 out of 11 publications