Editorial


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Editorial 
 

LETTER FROM THE EDITOR: QUALITY HEALTH 
CARE FOR RURAL RESIDENTS 

 
Jeri Dunkin, PhD, RN 

 Editor 
 
 

What is quality in health care?  In 1990 the Institute of Medicine (IOM) defined 
quality of care as the degree to which health services for individuals and populations 
increase the likelihood of desired health outcomes and are consistent with current 
professional knowledge (Institute of Medicine, 2005, p.4) 

The Institute of Medicine (IOM) was established in the United States, in 1970 by 
the National Academy of Sciences to secure the services of eminent members of 
appropriate professions in the examination of policy matters pertaining to the health of 
the public.  The Institute acts under the responsibility given to the National Academy of 
Sciences by its congressional charter to be an adviser to the federal government and, 
upon its own initiative, to identify issues of medical care, research, and education.  The 
Institute has had a long-standing focus on quality of care.  In the first phase of the IOM 
quality initiative, the National Roundtable on Health Care Quality highlighted serious 
problems with the overall quality of care delivered in the United States.  In the second 
phase, two reports, To ERR is Human:  Building a safer Health System and Crossing the 
Quality Chasm: A New Health System for the 21st Century, were released.  Both reports 
called for a fundamental redesign of the health care delivery system (Institute of 
Medicine, 2005). 

In the third and current phase, the IOM has sought to elaborate and to realize the 
vision of a future health systems s set forth in the Quality Chasm report.  The Quality 
Chasm report identified six aims for the delivery of health care: care should be safe, 
effective, patient-centered, timely, efficient, and equitable.  Among the profound changes 
needed to achieve these aims are that information technology must play a central role in 
support of the delivery of acre; that provider payment systems must reward the provision 
of quality care; and that the education and training of health professionals must 
encompass evidence-based skills and working in interdisciplinary teams (Institute of 
Medicine, 2005). 

The issue of quality in health care is not unique to the United States.  Indeed, this 
issue has been discussed for the past several decades in almost every country in the 
world.  Most of these discussions have focused on large systems of care in the large cities 
with the focus on procedures, encounters and financial implications. That has certainly 
been true in the United States.  Indeed, rural providers had largely been left out of the 
quality discussion.  Much of what had been developed and published was irrelevant to 
rural providers and in reality resources had been shifted from the rural areas to support 
this new initiative. 

Recently the National Academy Press published another report in its Quality 
series.  This one is on Rural Health Care.  It is titled Quality Through Collaboration: The 
Future of Rural Health. With the release of this report rural health care providers had a 

Online Journal of Rural Nursing and Health Care, vol. 5, no. 2, Fall 2005 



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unique opportunity to lead the quality movement to new levels of effectiveness.  We must 
engage!! 

The report provides us with a rural quality conceptual framework that includes: 
Collaboration, Continuity, Communication, Community, and the IOM six aims of health 
care: safe, timely, patient-centered effective, efficient, and equitable. Using this 
framework the report summarizes almost all the rural health care issues of the past two 
decades and introduces new insights and recommendations on workforce issues, quality 
improvement infrastructure, finance, and health information and communication 
technology. 

The report advocates development of rural systems of care designed for high 
quality and realizing the goals of health care.  It demonstrates how the rural sector can 
exert quality leadership and advance the national quality improvement movement.  It 
opens the door to rural engagement of the national “quality establishment” that has not 
been in the past. And maybe most important, it creates new opportunities for resources 
for quality health care in rural America.  It is a report that every rural health professional 
should be familiar with and use to support quality health care initiatives.  The report can 
be accessed at http://www.iom.edu/report.asp?id=23359. 
 

REFERENCE 
 
Institute of Medicine. (2005). Quality through collaboration: The future of rural health. 

Washington, DC: National Academy Press. Retrieved January 25, 2005, from 
http://www.iom.edu/report.asp?id=23359

Online Journal of Rural Nursing and Health Care, vol. 5, no. 2, Fall 2005 

http://www.iom.edu/report.asp?id=23359
http://www.iom.edu/report.asp?id=23359