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Flex Monitoring Team Projects

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The Flex Monitoring Team (FMT) is a consortium of the Rural Health Research Centers at the Universities of Minnesota, Southern Maine, and North Carolina. The FMT is funded by the Office of Rural Health Policy, Grant No. U27RH1080 to evaluate the impact of the Medicare Rural Hospital Flexibility Grant Program in three areas:

  • improving access to and the quality of health care services;
  • improving the financial performance of CAHs;
  • and engaging rural communities in health care system development.

The University of Minnesota’s FMT projects focus on quality performance measures and reporting systems and quality improvement activities in Critical Access Hospitals. For additional information, visit

Past Projects:

Rural Relevant Quality Measures and Small Volume Issues for Critical Access Hospitals

The purpose of this project was to conduct a meta-analysis that summarized information about:

  1. rural relevant hospital quality measures; and
  2. alternative methods of dealing with small volume issues; and disseminate this information to State Flex Coordinators, CAHs and policy makers.

First, an up-to-date set of rural relevant hospital quality measures was prepared and disseminated, including Hospital Compare inpatient process of care, HCAHPS and outpatient hospital measures, as well as additional measures of potential relevance to the small rural hospital environment. The measure set includes a core set of measures that are applicable to all CAHs, as well as other measures that apply to CAHs that provide certain key services (e.g., inpatient surgery and obstetrics). Second, we prepared a peer-reviewed journal article that discusses alternative methods of dealing with small volume issues in quality reporting and the implications for CAHs of using these alternative methods for quality reporting.