Are the CMS hospital outpatient quality measures relevant for rural hospitals?
To increase sample sizes for smaller rural hospitals, CMS could combine data for similar inpatient and outpatient measures, use composite measures by condition, or use a longer time period to calculate measures. A menu of outpatient measures would allow smaller rural hospitals to choose relevant measures depending on the outpatient services they provide. Global measures and care coordination measures would be useful for quality improvement and have sufficient sample size to allow reliable measurement in smaller rural hospitals.
In this experience, most cases of systolic anterior motion resolved with conservative measures including beta-blockade, vasoconstriction, and fluid administration. Persistent systolic anterior motion with left ventricular outflow tract obstruction was documented in 2.3% of patients who had early systolic anterior motion, but late reoperation was not required. Furthermore, the clinical outcomes of patients with systolic anterior motion are comparable to the current norms for mitral valve repair. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV.