The Role of State Flex Programs in Supporting Quality Improvement in CAHs (Policy Brief #16)

Document Type

Policy Brief

Publication Date



MRHRC, Flex, Medicare Rural Hospital Flexibility Program, Critical Access Hospitals, Quality Improvement


This study examined QI activities supported by the Flex Program in nine states, assessed the role of the State Flex Programs in developing and supporting QI activities, and explored the effect of these initiatives on CAH QI efforts.

Key Findings:

  • The Flex Program has been instrumental in funding and providing leadership for the development of CAH quality improvement initiatives.
  • Collaborative shared learning strategies have been central to the success of Flex Program QI programs.
  • Scaling QI program activities to the capacity and resources of CAHs is critical to success.
  • Administrative, clinical, and board leadership and buy-in are also critical to the success of CAH QI initiatives.
  • Despite widespread support for these QI initiatives, there is limited hard evidence on their impact.
  • Overlap between the quality measures in Hospital Compare and those used by state and multi-state QI reporting and benchmarking programs offers the opportunity for developing a common set of “rural relevant” hospital quality measures.

Funding Organization

This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rural Health Policy

Grant Number

PHS Grant No. U27RH01080

policybrief16-qi-flex-program-cahs.pdf (314 kB)
The Role of State Flex Programs in Supporting Quality Improvement in CAHs (Policy Brief #16)