Evaluation of the Use of Critical Access Hospital [CAH] Cohorts for Quality Improvement Activities

Document Type

Policy Brief

Publication Date



MRHRC, rural, hospitals, cohorts, quality improvement


This policy brief reports on a qualitative evaluation on the use of cohorts of Critical Access Hospitals (CAHs) to support quality improvements initiatives implemented by State Flex Programs (SFPs). The brief examines how SFPs use CAH cohorts in their QI initiatives, the benefits and challenges of using cohorts, and opportunities to enhance the use of cohorts in Flex Program initiatives. In the brief, the Flex Monitoring Team (FMT) lays out a conceptual framework to assess the cohort projects proposed by SFPs and the extent to which they are likely to contribute to improved QI performance by the participants.

Some SFPs may implement individual elements of the FMT’s framework to support their QI interventions by comparing and grouping CAHs and targeting meetings or webinars to meet their needs. A more advanced use of cohorts incorporates all elements of the framework to actively engage groups of CAHs in collaborative QI initiatives that result in shared learning through the implementation of a common QI project. Successful SFP cohort initiatives actively engage CAHs in implementing a shared QI project, provide opportunities for shared learning, and establish a clear data reporting process.

FMI: John Gale, john.gale@maine.edu


Rural Hospitals, Quality Improvement,


This study was conducted by the Flex Monitoring Team with funding from the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), under PHS Grant No. U27RH01080. The information, conclusions, and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

HRA-Federal Office of Rural Health Policy

Grant Number