MAP Rural Health Final Recommendations Report - 2020 

Low case-volume, due to low population density and limited access to care, poses a challenge for many rural healthcare providers. Low case-volume contributes to reduced reliability and validity of quality measure scores, which in turn disrupts efforts to measure performance over time or compare performance to other providers. In 2018, the National Quality Forum (NQF) convened a Technical Expert Panel (TEP) to discuss measurement science related to case-volume; the TEP made recommendations for statistical approaches that can potentially be used to address the low case-volume challenge, including “borrowing strength,” and recommended that these statistical approaches be tested in the future. In 2019, NQF continued the TEP’s work by convening the multistakeholder Measure Applications Partnership (MAP) Rural Health Workgroup for input on measures that can be used to test borrowing strength and other statistical approaches. This final recommendations report includes a list of rural-relevant measures that should be prioritized for future testing of statistical approaches to address low case-volume and discusses reporting challenges, gaps, and future considerations for rural health measurement.