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Rural Hospital Flexibility Program Tracking Project

Appendix 2
Sampling Plan

MEMO

To: CAH/Flex Evaluation Consortium 
From: George Wright
Re: Case Study CAH Selection
Date: January 25, 2000

We will select two case study CAHs from each of the 12 study states by regionally disaggregating recruitment by cooperating center, but coordinating as a group the final site selection. To ensure uniformity, this memorandum suggests a process all centers will follow.

1. Regional Disaggregation:

Hope: Identify sites for EMS focus
Maine: Minnesota, Oklahoma, North Carolina
Minnesota: Maine, Kansas, Wisconsin,
UNC Arkansas, Georgia, Texas 
WWAMI: Idaho, Missouri, Montana

2. Recruitment Process

Each Center talks to the Office of Rural Health or other agency responsible for the program and working with sites and with one other state-level respondent, (usually the Hospital Association) to discuss each of the converted CAHs. Include CAHs
Under the following criteria:

• Former MAFs or RPCHs are not to be included.

• If there is a choice, do not include CAHs that were under well underway to conversion under the MAF and EACH-RPCH programs.

• Include all CAHs that have been surveyed even if they are not yet being paid on a cost basis.

• In states with three or less surveyed CAHs, include hospitals that are scheduled for survey in February or March, extend this window if necessary, particularly in states that do not yet have two converted CAHs.

3. Information Collected

Each center will fill in the profile sheet developed by Maine for each CAH. To get started, each center can use the AHA guide and/or information from respondents to fill in missing statistical data for hospitals. These can be harmonized/updated later with consistent data from UNC's system. After all, the purpose of the information at this stage is to provide a rough guide to hospitals' comparative profiles. 

Add information on the practicality of site visits such as how enthusiastic a host the local administrator may be or how difficult it is to reach a particular hospital .

Conclude the conversation with an open question about recommendations for good study sites and why. It should be made clear that we will value the states' input and opinion but that we will make the final selection on a national basis in order to assure a sample representing the diversity of facilities. The importance of contacting two respondents lies in comparing these subjective judgments, or at least finding one source that knows the hospitals.

4. Site Selection Criteria

Not knowing the breadth of CAH characteristics, it is difficult to specify de novo the criteria we will use in selecting hospitals. Our principle will be to select a nationally representative set of case study facilities which may not include a state's stellar example or reflect the range of differences within the context of a single state. For example, we may decide that isolation is an important factor. Given geographic realities, isolated hospitals will tend to come from western states. Our goal, however, is to identify as few criteria as possible. Criteria we have already discussed include: 1) whether a hospital is the first conversion in a state, 2) the degree to which state-level personnel or private consultants were involved, and 3) the complexity of the CAH's planning process. 

Our first task as a group will thus be to define selection criteria on the basis of the characteristics of hospitals each center has gathered information on including salient concerns in respondents' minds and statistical profiles. Each center should suggest selection criteria shared by e-mail. Our first task as a group will be to decide on core selection criteria in the context of each center's recommendations for CAH case study sites. 

5. Final Site Selection

Each center will summarize the pros and cons of each hospital as a case study and make a recommendation of two CAHs. When possible, each center will also recommend a third CAH in case one of the hospitals should prove unwilling/unable to participate. Each Center will e-mail the site data grid and hospital-by-hospital comments to all evaluation consortium members. These messages should be treated as strictly confidential. 

We will proceed on a flow basis with a target of selecting two sites for initial testing of the protocols.

Once we have a list of candidates, each center will then call up candidate CAHs and see if they are willing to play along. 


6. EMS Case Study Sites

Project HOPE will be conducting site visits that are focused on local EMS issues and development. While in some cases these sites may not be one of the two CAHs selected in each state, in most cases the hospital will be the focus of the site visit but other local stake holders will be interviewed as well. Project HOPE will first select five EMS case study states, and contact state officials separately for information on EMS development. 

7. Lags in Site Visit Identification

Since some states that are moving slowly, we cannot assume site selection will be completed before we start scheduling and visiting facilities. We expect to have to identify two or three "potentials" in some sates and wait until April or May to make a final selection.

CAHs selected for site visits
Unofficial Version
(AR, GA, ID, KS, ME, MN, MO, MT, NC, OK, TX, WI)

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