Promising Practice: Community Cafes in Alaska Give People a Say in Their Health Care

i Apr 1st No Comments by

Often the best ideas on community healthcare come from community members themselves—especially when they are engaging in active discussions with healthcare providers and others.

That’s the idea behind community cafes, sponsored by the Alaska State Office of Rural Health (AK-SORH), which are being held in small towns in the state.

“Last spring we told all our Critical Access Hospitals (CAHs) that we can come to their communities to facilitate a conversation on whatever topics they want,” said Heidi Hedberg, AK-SORH Director.

The community cafes are set up to last an hour, with the first 25 minutes devoted to a presentation on a chosen topic. Attendees then break into smaller groups for discussion. “We have a facilitator in each small group and a scribe,” Hedberg said. “This is where we are looking for the community to provide feedback on the topic they were just educated on.”

Petersburg Medical Center (PMC) in Petersburg, a small town on an island in southeastern Alaska, was the first to sponsor a community cafe last November at the Petersburg Public Library. Jeannie Monk, Vice President of the Alaska State Hospital and Nursing Home Association, spoke on the changing landscape of healthcare in rural communities and how communities must pivot to accept these changes. Phil Hofstetter, PMC CEO, added his perspective following Monk’s presentation, Hedberg said.

“When we broke into small groups after their presentation, one of the questions we asked was, ‘As a community member, what healthcare services will keep you in your community?’” Hedberg said. “It was fascinating to hear what they want and what they perceive, and their thoughts on healthcare.”

AK-SORH held community cafes twice that day at PMC on the same topic. The morning cafe had 50 to 60 people, and the afternoon cafe had around 30 people participating, Hedberg said.  “It’s important that the cafes have a limited number of participants, because in a smaller group, it’s easier to draw out the quiet voices,” she explained. “You could have a town hall meeting, but it would be harder to have one-on-one conversations. In rural communities, the smaller the group, the more information you can draw out of them.”

Hedberg called the first community cafes “a fantastic start,” especially since they included a wide swath of community members. “It enabled us to see where their knowledge base was so that we can target our education and further that conversation,” she said.

PMC, which is Petersburg’s only hospital, is a CAH built in 1917 that was last remodeled 30 years ago, Hedberg said. “One thing we all realized is if Petersburg wants a new hospital it needs to be community-driven,” she said. “And we need to know what services they want so we can build it into that plan.”

The first cafes were such a success that AK-SORH was invited back to PMC in February to do another, this time on the promise of new telehealth offerings. The group experienced a tele-psychiatry visit through a camera, Hedberg said, then broke into smaller groups to answer questions including “what types of services are you looking for?” and “how much would you be willing to pay for these services?” Since then, PMC has launched tele-psychiatry services.

PMC helped advertise the cafes by making posters and putting them in local venues and promoted them on their weekly radio session and their website, which helped lead to their success, Hedberg said.

The idea for AK-SORH’s community cafes sprang from those sponsored by the state’s Office of Substance Misuse and Addiction Prevention (OSMAP), which visited more than 20 Alaskan communities “to educate them on opioids and to hold conversations on how to resolve the issue,” Hedberg said. “From that, a lot of communities formed their own coalitions and OSMAP created a statewide strategy plan drawn out of the responses from those communities.”

“This is not a new idea—it’s just how you organize it,” Hedberg added. “Consensus meetings, listening sessions, community cafes— there’s all different types of them, but for small rural communities, the cafes are a great way to have a structured format to both educate and receive feedback on any topic.” AK-SORH funds its community cafe work through Flex money for travel, and SORH money for staffing time, she said.

Since the cafes that were held in Petersburg, other communities have expressed interest in them, she said.

“It’s exciting when you bring a community together and through that relationship comes feedback, and out of that comes these new service delivery models,” Hedberg concluded. “We’ll continue to do these as long as communities ask us to facilitate these conversations on healthcare topics that are impacting the community—we hope to do these forever!”

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Promising Practice: Pennsylvania Office of Rural Health Puts Focus on Rural Human Trafficking

i Mar 4th No Comments by

By Beth Blevins

Human trafficking doesn’t just happen in big cities in the United States—it happens in rural areas as well. Lisa Davis, Director of the Pennsylvania Office of Rural Health (PORH), is working to bring more attention to this issue.

Davis said her interest in human trafficking came unexpectedly, at a presentation given at a Pennsylvania Critical Access Hospital Consortium meeting in November 2017. It was unclear if the topic resonated with the hospital leadership in the audience, she said. “But hospital CEOs came up to me after the meeting and told me they never knew that human trafficking was an issue in rural Pennsylvania or was something they should think about.”

Davis added, “It was clear that their facilities needed to be prepared to identify potential victims and to have systems in place to refer them for the services they would need.”

The administrators then asked if PORH could develop training programs for them. “PORH staff made a deliberate choice to train rural providers on the threat of human trafficking,” Davis said. “We know that we can be a resource for rural hospitals and other providers.”

Since the beginning of 2018, PORH has worked to address the issue in rural Pennsylvania. As a first step, a statewide committee of government, academic, community, and hospital representatives was organized. In November 2018, the group launched the Rural Human Trafficking Initiative with an introductory webinar targeting small rural hospitals, community-based organizations, and others interested in serving potential victims.

Since then, Davis said, “We continue to keep the hospitals informed—we’ve gotten a lot of interest from them.”

Davis also is reaching beyond Pennsylvania to raise awareness of rural human trafficking in other states. She gave a presentation in October 2018 at the Annual Meeting of the National Organization of State Offices of Rural Health (NOSORH) in Cheyenne, Wyoming. “It was the first time anyone had talked about that topic at NOSORH,” Davis said.

“I wanted to have NOSORH begin to think about how State Offices of Rural Health (SORHs) could address human trafficking with the Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Clinics with which they work,” she said.

This summer, PORH and its partners will host a summit on rural human trafficking (June 26-27) in State College, Pennsylvania. “We are beginning to put in place some of the training programs that the hospitals can implement to identify point persons in their facilities, and the programs and connections that they need to address human trafficking,” Davis said.

Davis observed, “Human trafficking is often thought of as sexual exploitation but it’s also labor exploitation, which can occur essentially anywhere: in restaurants, domestic service, agricultural production, and more.”

Human trafficking is of special concern in Pennsylvania, Davis said, “because we are a state with two main cities and a number of interstate systems that traverse rural areas. With lots of travel routes into, out of, and through the state, it’s much easier to transport victims from one place to another.” According to the National Human Trafficking Hotline, there were 127 cases of human trafficking in Pennsylvania in 2018, with the majority of those cases sex trafficking.

As PORH staff became more informed about human trafficking, Davis said, they found a large network of individuals and organizations that have been focusing on the issue for a long time.

“We’ve made excellent contacts,” she said. “We’ve connected with Villanova University’s Commercial Sexual Exploitation Institute. We’ve been learning about coordinated efforts between the FBI and other law enforcement agencies to address human trafficking. And we’re working with the Region III offices of HHS and HRSA, which have an intergovernmental task force focused on human trafficking.”

However, she noted, “PORH is still very early in the learning stage and is committed to becoming a trusted resource for rural health care providers.”

Davis concluded, “Every story is heartbreaking and if we can make a difference in even one life, this effort will be well worth it.”

If you see someone who you think might be a human trafficking victim, contact the National Human Trafficking Hotline at 1-888-373-7888 (text to: 233733).

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Promising Practice: NC Office of Rural Health Helps Rural Providers Get Connected to HIT

i Feb 4th No Comments by

By Beth Blevins

Behavioral and other healthcare providers in rural North Carolina are getting connected to the statewide health information exchange thanks to the state’s Office of Rural Health Information Technology (ORH HIT) program.

The ORH HIT program evolved from the North Carolina 2015 Health Information Exchange Act (HIE Act), which mandates that healthcare providers that bill for Medicaid or receive state funds for services must connect to NC HealthConnex, the statewide HIE, by June 1, 2019, to continue to receive payments.

“The ORH already saw a need for more HIT support, but the HIE Act made a compelling case for a team to help smaller, rural providers with HIT needs,” said Lakeisha Moore, HIT Program Manager at the NC ORH since August 2017. “We work closely with the NC HealthConnex team to support all healthcare providers, especially rural/safety net providers.”

While the NC HealthConnex team can pay for providers to get connected to the HIE, it lacks specific funding for healthcare providers to purchase an Electronic Health Record system (EHR), Moore said.  “So, our team worked with the NC HealthConnex team and other stakeholders to design a complementary program to assist certain providers with funds to procure an EHR to get them connected.”

NC ORH HIT Program Details

Last year, the HIT program offered the Behavioral Health EHR Funding Program, and 243 providers applied to get financial as well technical assistance to purchase an EHR and get connected to the state’s HIE, according to Allison Owen, NC ORH Deputy Director.

The grant offered three tiers of funding, from small to large providers, Moore said. Of the 243 behavioral health providers that applied, 178 were awarded. “The majority of this funding was awarded to organizations with 11 or fewer providers, which was encouraging for us, because it showed that we were helping a lot of those smaller provider practices that might not be able to invest in EHR technology.”

In the future, the HIT program hopes to offer grants to providers that were excluded from Meaningful Use funds such as Long Term Post-Acute Care Providers and Home Health Care Providers, Moore said. “We still find providers whose patient records are still on paper and we have to meet them where they are.” Other providers have implemented an EHR but need additional help in making the switch from fee-for-service to a (CMS) value-based care model, she said.

Grantee Map

Moore attributes the HIT program’s success to the many partnerships it has forged. For example, her office reaches out to rural physicians through partnerships including the state’s Primary Care Advisory Committee, Medicaid listservs, Medical Society, and Area Health Education Centers (AHECs), as well as via social media channels and marketing tools. The Rural HIT Team meets regularly with members of the HIE Authority, along with the state’s AHEC staff, to share information and update one another on the status of key joint initiatives, Moore said.

“We have a really good relationship with the NC AHEC and their technical team,” Owen added. “We look at how we complement each another with our strengths and our skill sets. We come together to talk about challenges and successes, and we’ve had many brainstorming sessions. I would recommend that other states look to AHECs because often they are really strong for technical expertise.”

NC ORH HIT receives 90/10 funding—90% CMS dollars with a 10% state match, distributed through the state’s Medicaid HIT plan, Moore said. The program is in its second two-year funding cycle and will work with the Medicaid HIT team managers to update performance measures in July, the middle of the current cycle, Moore said.

“I’m excited that our Medicaid HIT team reached out to ORH and thought this was a program worth investing in,” Moore said. “I feel that other states may want to collaborate with their Medicaid team because that’s exactly how we received our funding and continue to receive our funding.”

Moore concluded, “Our program has been primed for more opportunities to support rural healthcare providers with Health IT, with a lot of the changes in our state and nationally. Providers need to utilize EHRs and HIT to help better take care of their patients and for population health management.”

Owen agreed, saying that telehealth will become more and more important, especially in rural areas. “Our state didn’t expand Medicaid, but we have transitioned to a managed care framework—we’re right in the heart of that,” Owen said. “One thing managed care organizations (MCOs) have to do is demonstrate that they can provide a broader range of care for their Medicaid population. Telehealth, we think, will be key in helping MCOs demonstrate that they can provide that access. Great opportunities abound!”

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Promising Practice: Loan Repayment Programs in Nebraska Yielding Huge Payoffs

i Dec 6th No Comments by

By Beth Blevins

Loan repayment programs in rural Nebraska are showing huge payoffs: family medicine providers who participate in them are significantly less likely to leave small towns and rural areas than those who don’t.

“We’re trying to maximize the impact and the opportunities for loan repayment in rural and urban underserved areas in the state,” said Thomas Rauner, Program Manager at the Nebraska Office of Rural Health (NORH). “So we are assessing how effective the programs are, and how are they working.”

Towards that end, NORH issued a report in July that examined the impact of incentive programs on retention of family practice providers—the most frequent specialty participating in loan repayment programs and serving in rural areas, Rauner said. The findings showed that these programs are especially effective in rural areas of the state—for example, participating small town and rural area providers are more likely to remain in their positions than non-obligated providers by 23% and 42%, respectively. They remain significantly longer by 2.3 years (small town) and 4.3 years (rural) than non-obligated providers.

A sample visual from the “Analyzing the Impact of Incentive Programs on Retention of Family Practice Providers in Rural Nebraska” report.

One thing that makes the report interesting, Rauner said, is that it offers visual representations of the data. “We’ve been working in the last few years to come up with more visualization components,” he said. “You can look at number, but a picture makes it easier to understand and share with a much broader group.” In the future, he said, they will share data by a place-based and legislative format.

Though the report was issued earlier this year, it has been in the making for nearly two decades with resources from the State Office of Rural Health and Primary Care Office grant programs, Rauner said. “The data on family medicine providers was analyzed by a graduate student intern in our office, using information from the University of Nebraska Medical Center (UNMC) Health Professions Tracking Service (HPTS), which they collaborated with our office to develop over 20 years ago,” he said.

HPTS tracks providers enrolled in all state and federal loan repayment programs during and after their obligation, Rauner said. “Using HPTS, we’re able to track all the healthcare providers in our state,” he said. “The system also allows them not only to track whether physicians who served their obligation out there stay longer in practice than those who did not have obligations, but also gives them the capacity to look at that data over time.”

HPTS data can also be used for economic analysis, Rauner said. “Some of the more interesting findings from the report was that analysis based on years worked shows there is a significant economic benefit associated with rural healthcare providers—a total of $3.6 billion,” he said. “This benefit far outweighs the financial investment in incentive programs.”

HPTS tracks physicians as well as dentists, physician assistants, nurses, graduate-level mental health providers, and allied health providers—those who qualify for loan repayment in the state. Its data also has been used by UNMC authors for reports on primary care nurse practitioners, on physician assistants, and on the status of healthcare workforce in the state.

In addition to HPTS, Rauner said, NORH uses the Practice Sights Retention Management System “to solicit feedback from the providers while serving their obligation, determining if they would like and need to continue receiving loan repayment assistance, and their anticipated and actual retention.”

The data from the two systems benefit both providers and communities, Rauner said. “There are many variables when it comes to assessing workforce needs,” he said. “Each community desires the right care, right time, right place, and the right cost. NORH is continuing to work with communities to develop such a system of care, while working to improve the process and utility of loan repayment programs.”

With the proven success of the loan repayment programs in Nebraska, NORH also has been working to get more healthcare students enrolled in them. “We’ve been trying to simplify it as much as possible,” Rauner said. “We recently combined and changed our loan repayment applications to be a single online application. This will allow NORH to track and process applications for loan repayment and determine the best fit for the provider and the site.”

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Promising Practice: Arizona Center for Rural Health SHAREs Health Insurance Information, Gets People Enrolled

i Oct 31st No Comments by

by Beth Blevins

People in Arizona communities are becoming more aware of their health insurance options through Project SHARE (Students Helping Arizona Register Everyone).

Project SHARE, run by the Arizona Center for Rural Health (AzCRH), trains University of Arizona health sciences students as Certified Application Counselors (CACs) that provide information on enrollment through the Affordable Care Act (ACA) marketplace. Alyssa Padilla, who supervises the SHARE program for the Arizona State Office of Rural Health (AzSORH) under the AzCRH, said that the program helps not just the patients but also the students, who become more rural and health insurance literate.

Second-year UA College of Medicine – Phoenix student and SHARE leader, Jaymus Ryan Lee

“SHARE gives the students a better understanding of social support services and how to connect individuals with those services,” Padilla said. Through SHARE, the students earn volunteer credits that allow them to graduate with distinction. But, more importantly, Padilla said, graduates of the program “are better equipped to answer patients’ questions about coverage on the spot.” To become a SHARE participant, students take five to 10 hours of online federal training in addition to in-person session training, Padilla said.

When surveyed afterwards, participants have said the program has given them a better understanding of the ACA, health insurance premiums and deductibles, and the value of expanding Medicaid in Arizona, Padilla said.

Lauren Dominick said she has already benefited from the program. Dominick, an MD candidate and Project SHARE leader for the UA-College of Medicine–Phoenix, joined last year hoping to develop the skills that will help her better serve current and future patients. “I have gained so much knowledge of how the marketplace works and how to navigate it,” Dominick said. “I’ve helped patients complete their ACA applications and seen the empowerment they experience as they take better control of their health care. The program opens up their opportunities to seek preventative health care rather than just when they have an acute, major issue.”

Unfortunately, Dominick said, as a medical student she has seen many patients with very advanced diseases who were unable to access care earlier. “This is heartbreaking, especially when their condition could have been prevented or effectively managed if they had had access to health care.” Dominick added, “Helping sign people up for insurance makes me feel like I am making a difference and hopefully having a positive impact on their health even before I see them in the clinic or the hospital.”

Kendra Marr, SHARE leader, presents on the SHARE project

Kendra Marr, an MD/PhD student at the UA College of Medicine-Tucson and Tucson SHARE leader, said that another benefit she has found with SHARE is the “wealth of opportunities for collaboration with other clubs and services within the College of Medicine,” including the Commitment to Underserved People (CUP) health clinics. Marr has been working with the free, student-run CUP clinics to form a partnership so that SHARE can refer patients to them and vice versa, and has been holding her SHARE enrollment office hours at the clinics.

Project SHARE has benefited the university as well. “The University of Arizona is a White House Healthy Campus because of Project SHARE and UA Campus Health’s efforts to improve access to health insurance coverage,” Padilla said.

Right now, Project SHARE offers in-person, outreach, education, and one-on-one enrollment services in Pima County and in-person outreach services in Maricopa County, Padilla said. The CACs also can volunteer to staff the Cover Arizona phone number, where they answer insurance questions and schedule appointments for patients across the state.

Typically, 15 to 25 students work for SHARE each year, Padilla said. So far, 90 students from the UA Colleges of Medicine, Nursing, Public Health, and Pharmacy have gone through the SHARE program since its inception in 2015.

In her role with the AzSORH, Padilla oversees the licensing, recruitment, training, and mentoring of the SHARE participants. Most of the funding for the program comes from SORH grants, Padilla said, with small additional amounts of funding from UA College of Medicine CUP, which pays for things like food for the students during their trainings.

Padilla said she hopes other SORHs will consider replicating Project SHARE. The AzSORH has created templates on the processes involved and how-to directions, which Padilla will provide to any interested SORHs. Meanwhile, Padilla said that AzCRH is planning to extend the reach of SHARE to remote areas of her state through partnerships with Critical Access Hospitals and rural faith-based communities.

Since the ACA has been in effect, Padilla said, the uninsured rate in Arizona has been cut in half (to 10 to 11 percent), similar to the national average. “It’s important to note that we have a conservative Republican governor, and we have expanded Medicaid,” she said. “Our hospitals are no longer in the red because we have patients that are now insured due to Medicaid expansion and the ACA.”

“Medicaid expansion has really helped our bottom line,” Padilla concluded. “State Offices of Rural Health support that effort and that message ‑ it can do wonders for our rural and underserved communities.”

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Promising Practice: Team Effort in Idaho Achieves New Funding for Physician Repayment Program

i Sep 28th No Comments by

by Beth Blevins

Remarkably, less than a year after the Idaho State Office of Rural Health (ID SORH) set a goal to find new funding for a physician loan repayment program, the state legislature appropriated $640,000 annually for it.

“It’s something we’re thrilled about,” said Mary Sheridan, ID SORH Director. “I think it points to the reasons we take advantage of new opportunities, even though we may be unsure of the ultimate outcome.”

Mary Sheridan (third from left) with the Idaho team that attended the NCSL meeting last June.

That opportunity was a three-day meeting in June 2017, convened by the National Conference of State Legislatures (NCSL), on “Challenges and Innovations in Rural Health Policy.”  Sheridan attended the meeting along with three Idaho state legislators, the Primary Care Office Program Manager, and deputy administrators from the Division of Public Health and Division of Medicaid.

The NCSL event, funded through a cooperative agreement with the Health Resources and Services Administration, included presentations from rural health policy experts and state-specific team meetings for developing collaborative action plans to improve rural health. Idaho was one of eight states attending.

“Our team there identified three goals: securing reimbursement and funding for community paramedic programs, securing funding for loan repayment, and expanding telehealth,” Sheridan said. “Afterward, the team typically met monthly to share updates and progress on all project goals. The on-going support from NCSL post-meeting was truly helpful in moving the loan repayment legislation forward.” Members of the team are currently working on the other two goals, Sheridan said.

It was a team effort that got the loan repayment legislation to the floor in the next (January 2018) legislative session. “One strategy was for me to provide a presentation on loan repayment and physician shortages to the Idaho legislature’s Health and Welfare committees,” Sheridan said. “Team members made it happen. They worked with legislative leadership to schedule it on the calendar and NCSL actually came to that presentation and lent their support. The Idaho Medical Association worked actively with legislators on the issue and it went from there.” A legislator who was on the team introduced House Bill (HB 472) to fund the loan repayment program.

“It’s remarkable how fast it went, especially when you realize this is the first time we’ve ever had state funding for loan repayment,” she said.

HB 472 provides state funding for the Rural Physician Incentive Program (RPIP), a program that already existed but which had been paid for with student fees‑Idaho students attending out-of-state medical schools in Washington and Utah at in-state tuition rates had been assessed $1,600 per year, which went into the RPIP fund. In order to qualify for loan repayment, physicians must work in a Health Professional Shortage Area (HPSA) in Idaho and receive up to $25,000 per year for four years.

According to the Idaho Physician Workforce Profile, Idaho has a significant shortage of primary care physicians, ranking 49 out of 50 states for physician workforce. “Approximately 98% of the state is designated as a HPSA for primary care and dental, and 100% for mental health,” Sheridan said. “So loan repayment is hugely important for us, and is certainly a tool for recruitment and retention of physicians in rural and underserved communities.” NCSL estimates that the $640,000 loan appropriation will fund about six more physicians per year, more than double the current number.

Sheridan said that she is pleased that so much has resulted from the NCSL meeting, especially since she initially had few expectations going into the meeting. “In fact, when I first got the invitation I thought, ‘if we’re going to just take Idaho there, why can’t we just meet in Idaho and do this very same thing?’” she said. “But I think it was that structure of being away and focused on an issue, of us learning together and having facilitated discussions to create this plan that provided an opportunity to really focus on rural health in Idaho in a very coordinated and collaborative fashion.”

Sheridan added, “The NCSL event provided a unique opportunity to identify Idaho-specific rural health issues. We’re extremely pleased to have participated. It truly provided leverage and new collaborative opportunities to advance rural health in Idaho.”

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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.

Promising Practice: Texas SORH’s Handheld Ultrasound Project – An Innovative Approach to Providing Training & Technology to Small Rural Hospitals

i Sep 4th No Comments by

by Beth Blevins

At a rural hospital in Texas last year, a woman’s life was saved when doctors, using a handheld ultrasound device, determined that her abdominal pain was due to a ruptured ectopic pregnancy and were able to act quickly to address it.

The hospital had the handheld unit on-loan as part of an innovative pilot project run jointly by the Texas State Office of Rural Health (TX SORH) and the Texas Tech University Health Sciences Center (TTUHSC). The devices, as well as accompanying training, were offered to Small Hospital Improvement Project (SHIP) hospitals in the state.

TX SORH had received approval from the Federal Office of Rural Health Policy to use $95,000 in unencumbered funds from their 2015-2016 SHIP grant for the project, according to Shari Wyatt, Rural Health Specialist at TX SORH. “We had asked ourselves: ‘what can we use this funding for that will help hospitals?’” Wyatt said.  “The GE Vscan Extend handheld unit had just come out. It’s an innovative piece of equipment that a lot of hospitals hadn’t used or even knew about.”

A Texas hospital participates in a training session.

“I love new technology,” Wyatt continued, “but if you don’t get it into the hands of the rural providers and clinicians, they never know about it. Some of the big vendors don’t bother with small rural hospitals—when you’re rural, you’re the little dog. They’re not really going to pay attention to you. That’s another reason I wanted to do it, so rural hospitals actually got to try out new technology to determine its usefulness in their facilities.”

TX SORH contracted with TTUHSC on the two-year project to help provide training on the devices. “Our state is big so we divided it into four regions,” Wyatt explained. “Texas Tech and I went to those four regions along with a sonographer from GE who did basic training on using the handheld unit.” Providers who could not attend in person were invited to participate in webinar training on the device, she said.

With TX SORH funding, eight Vscan Extend devices were purchased by Texas Tech to deploy to the hospitals that had been trained, for a one-month trial period each. A total of 67 hospitals signed up.

Hospital staff participate in a training session.

“They could use it anyway they wanted to for four weeks—any department, any doctor, nurse, or health care professional,” Wyatt said. “We only asked them to complete a brief evaluation sheet and send it back when they returned the device.”

The project was completed in July 2018, and TX SORH recently received the project completion report. The report reveals that more than 90% of the hospitals found the unit to be extremely helpful, and that the device was used mostly for abdominal scans and OB concerns. In addition, users found that the device was helpful for easier IV placement, for quickly scanning a patient for vascular effusion, and for checking an accident victim for fluid in the abdomen, helping avoid more costly, time-consuming imaging studies.

TX SORH negotiated with a vendor and obtained bulk discounted pricing for those hospitals that wanted to purchase the devices after the trial period. “This gave them the ability to purchase handheld ultrasounds at a price they could afford,” Wyatt said. As a result, several hospitals bought the units, with others planning to purchase the device with future SHIP funding.

“Through the negotiation we also were able to provide one year of online ultrasound training with SonoSim for all employees at the hospitals that purchased the devices,” Wyatt said. “I think online training will make a difference. A lot of the doctors really liked the device, but they wanted additional training for it.”

This is not just a one-time project, Wyatt added. The units purchased for the initial training project will be used in future training initiatives as well, she said.

“Many small, rural hospitals are financially hurting and don’t have the means to purchase innovative equipment, or get the opportunity to try out new products,” Wyatt said. “The handheld unit project gave the hospitals’ providers the ability to use the technology and determine its usefulness within their facilities. I feel that these are the types of projects that truly benefit rural hospitals.”

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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.

Promising Practice: Alabama SORH Collaborates with VA to Provide Telehealth Care for Vets

i Jun 4th No Comments by

A chance encounter at a local store sparked a telehealth partnership between the Alabama Office of Rural Health (AL SORH) and Alabama Veterans Affairs (VA).

“A couple of years ago, I was out shopping on a Sunday night and ran into Dr. Randall Weaver, whom I hadn’t seen in awhile,” said Chuck Lail, AL SORH Director. Lail, a military veteran, already knew Weaver from the VA hospital where Lail has gone for his annual physicals. “I said to him, ‘We really need to get something going with the VA—I think there are good opportunities for telehealth.’ And he said, ‘Why don’t you call me and we’ll explore it.’ ”

“Our office has always been a strong advocate of telehealth,” Lail continued. “The state health department was starting to install telehealth carts in our county health departments, so I thought there might be an opportunity to marry the needs of the VA with the county telehealth program.”

The Alabama SORH has the advantage of being located within the Alabama Department of Public Health (ADPH), explained Rob Boyles, PCO Program Manager at the AL SORH. “We have access to other divisions and bureaus, including the Distance Learning and Telehealth Division.”

With the aim of creating a partnership between ADPH and the VA, the two groups began having regularly scheduled telephone conferences, Boyles said. “We worked together to assess which rural county would be the best site to pilot the project, in terms of rurality, the number of Veterans, and the distance they travel for healthcare services.”

Through those discussions, Lail said, they determined that mental health services would be a good place to start. “It seemed to be one of the greatest needs of the VA,” Lail explained. “And telemental health and delivery of telepsychiatry have been proven to be deliverable seamlessly over telehealth media.” The long-term objective of the program, he said, is to expand beyond mental health to many types of services for VA telehealth delivery.

Cullman County Health Department was the site of the first VA telehealth pilot, which began in spring 2017. The VA provided the services, Lail said, while ADPH facilitated the telehealth encounter. “Veterans there can visit their local county health department and have a virtual visit with their mental health care team from the Birmingham VA,” he said.

An initial evaluation by participants at the pilot site was done via an informal survey, Lail said. “The veterans stated that they were pleased with their telehealth consults, and that they liked being able to receive services from the VA at their local county health department,” he said.

Michael Smith, (ADPHTP) Director, said the county telehealth program has benefited from having funding from a variety of sources. “In Alabama, we’ve had telehealth with small networks,” Smith said. “You wrote a grant, the grant ended and the funding went away, and then the technology got pushed into a corner. But ADPHTP has been aggressive in terms of expanding our sites at county health departments and collaborating with health care providers.”

Smith said the expansion of the county telehealth program has been possible through several infrastructure grants from organizations including: the , the Centers for Disease Control (), and the USDA (); and from AL-ORH, using federal Health Resources Services Administration funding (SORH and Primary Care Office grants). Each grant award, Smith said, has funded a number of telehealth carts given to county health departments. “We’ll have a total of 60 county health departments with telehealth carts by this summer,” he said. Alabama has 67 counties.

“We’re looking at health departments to be single point of entry for a variety of services for all patients, such as counseling prior to a procedure, mental health services, genetic counseling, maternal fetal medicine, and pediatric neurology,” Smith said. “Patients shouldn’t have to travel a long distance for a routine appointment that can be just as successfully achieved via telehealth technology.

Lail reflected on the chance meeting that started it all. “It can be a small world,” he said. “Dr. Weaver and I had been acquaintances for some time. It was from that rapport that the rest of this story sprang.”

Promising Practice: Summits Tackle Opioid Misuse and Treatment in Rural Illinois

i May 1st No Comments by

by Beth Blevins

Illinois is tackling the opioid crisis in its rural communities through a series of opioid summits sponsored by the Illinois Center for Rural Health (ICRH).

“We realized there were no coalitions or groups working on opioid misuse in rural Illinois,” said Julie Casper, ICRH Director. “Community Health Needs Assessments have consistently listed drug use and addiction as problems in their communities, so making opioid misuse a priority was a natural conclusion.”

The first “Opioid Crisis Next Door” summit was held June 2016 with the stated purpose of building local coalitions to increase awareness of opioid and heroin use in rural communities and to identify ways for communities to respond to the crisis. At the end of the summit, attendees took a pledge to work together to combat opioid misuse in rural Illinois, Casper said.

Local coalitions, healthcare providers, and other rural community stakeholders attended the “Opioid Crisis Next Door: Identifying, Organizing and Activating Local Resources” summit in October 2017.

Each subsequent summit has added a specific focus. The opioid summit held in March of last year focused on “,” with the goal of encouraging dialog among providers. The October 2017 summit looked at “.” The next summit, scheduled for June 27 of this year, will be focused on “Keeping the Momentum: Are We Hitting the Mark?” and will include naloxone training for overdose treatment.

“All the summits have a rural focus, but it’s been different aspects of rural,” Casper explained. The summits have had an average of 100 attendees and all have been held in the state capital of Springfield, centrally located and within a few hours’ drive for everyone in the state, Casper said. Summits are held twice a year now, she said, because they realized they cannot wait a full year for the next one, there is so much to go over.

Rural stakeholders from across Illinois participate in a 2017 “Opioid Crisis Next Door” summit.

The target audience for the summits includes rural hospitals, rural providers, pharmacists, law enforcement, policymakers, community leaders, and behavioral healthcare providers. In addition to ICRH, the summits receive support from the Illinois Health and Hospital Association, the Illinois Pharmacists Association, the Healthy Communities Partnership, and the Illinois Critical Access Hospital Network (ICAHN).

“We are very fortunate that at the state level the reduction of opioid misuse is a priority for the governor and for the director of the Illinois Department of Public Health (IDPH),” Casper added. (ICRH is part of IDPH). “Nirav D. Shah, M.D., J.D., IDPH Director, has opened every conference and will open the next meeting.”

The summits have offered a variety of speakers, including physicians on treatment options, community leaders and hospital administrators on creating community coalitions, and past opioid users sharing their stories of addiction and recovery.

The opioid summits are funded using a small amount of Rural Hospital Flexibility Grant money, Casper said, with the rest of the cost, mostly for food and the rental of the space, paid by the attendees.

Although opioid misuse may not be as prevalent in Illinois as it is in other states, the number of opioid-related overdoses is growing every year, according to Heidi Clark, IDPH Division Chief of Health Data and Policy. While there were , there were an estimated 2,093 overdoses in 2017, Clark said, a number she attributes to the increasing use of dangerous synthetic opioids like fentanyl and its analogues.

“Opioid abuse is a statewide problem but there are specific issues in different parts of the state and among different demographics,” Clark continued. “In some of the more rural areas, there’s more prescription drug misuse, whereas in urban areas you’ll see more emerging drugs such as new fentanyl analogues. But rates of neonatal abstinence syndrome (NAS) are growing in rural areas in Illinois much faster than urban areas.” NAS is when a baby is born physically dependent on drugs and experiences withdrawal symptoms after it’s born.

IDPH has received a Comprehensive Addiction and Recovery Act first responders grant, Clark said, which is being used to fund naloxone training in 18 rural Illinois counties and to distribute naloxone to law enforcement who have taken the training. It also funds two care coordinators in those counties. “Once someone ODs and goes to the emergency room, they can be connected to a care coordinator who can help them navigate barriers,” Clark said. “If they don’t have insurance, the care coordinator might help them get insurance. If they have insurance, the coordinator will help them find a treatment provider who accepts that insurance and is accepting new patients. The care coordinators are there to make entering treatment an easy choice rather than a scary unknown.”

From her work with the summits, Casper said she has discovered that there are many people in the state who care about those with opioid addictions. “They care about them as people,” she said. “They see that they have value. You know there are a lot of law enforcement who believe that, but they’re not the ones who make the news. It makes you feel really good that there are people out there helping people who are struggling with these issues.”

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Your own Credibility

i Apr 26th No Comments by

Most of us becomes up for a period of time plus desires to be able to do one thing good, useful, and beneficial. Have an individual search for persons who actually want to do cause harm to, damage, etcetera day right after day? If there are like persons, they must be couple of and significantly the start of the exact day is mainly positive plus filled by using onward exploring thoughts. Of which is how it will have to come to be, or else we tend to might not become making be familiar with progress we live experiencing all around issue is a of uniformity. Consider the actual spiral for situations. People get ecstatic by a thought, a strong idea, or possibly an function. We user resolve to take it further. Regularly, such views come to us as soon as we usually are hectic accomplishing something diffrent. Repeatedly, when we tend to have accomplished doing whichever it was initially that any of us was carrying out, often the idea or concept disapears, and many of us will be still left scratch all of our brains pondering actually appeared to be which was hence thrilling. Stuff drive more moreattract confusing whenever you promote the motives using many others. Claims enjoy ‘I morning going so that you can write a arrange the coming year, ‘I ‘m going to allow all my outdated attire to the Salvation Army tend to be heard simply by others along with filed away from. Sooner and also later, anytime those exactly who seen your own déclaration observe that everyone didn’t followup on them all, people handle anyone along with a reduced amount of respect. Your own standing has been tarnished. Standing implies trying to keep your particular term. This is just a function of how believable an individual is. It is actually a measure of a individuals should an individual accomplish constructing trustworthiness? In this article are several ideas: Select reputable peopleThink on the individual (at your home, do the job, club) who also people have esteemed for her reliability. The key reason why do anyone appreciate the pup? How exactly does they are able to maintain his / her concept? Remember that individual intently, watch ways the person goes related to rewarding his obligations. Of an this person. Head out and even talk to the dog. Most, possibly all, credible people will probably be willing that will take a seat plus speak with people. Some might not really all have the ability explicitly no doubt inform you of their inside responses for you to credible residing, but that they will for certain get able towards supply you with useful information in to how they see all their duties, and just how some people go pertaining to fulfilling these products. It is normally a wonderful lesson towards consistentConsistency is normally the trademark of reliability. The individuals everyone work with should feel this you don’t transform colors just like the chameleon from just one position that will another, or maybe display unique behavior ahead of different persons. Consistency entails courage. At this time there will become many occasions when your daring in addition to sincerity are going to be analyzed. These are generally the exact moments in life when the very great are distinguishable from the good. The terrific take the difficult task head on, show courage, and even stick to the correct element. Persons who enjoy the fine high-quality about regularity are usually not affected by just all those who encompass committedCredible men and women are inspired through challenging motivation to everything they do, in this l8rs they are enthusiast never mercenaries about lifestyle. Their whole will hails from their valuable investment in order to their reason thus they could always obtain the courage to manage the odds. Courage shows up from devotion. If anyone are extremely committed to help a reason, people will discover the bravery to facial area chances. Carry Nelson Mandela. He was fully commited, therefore the guy uncovered the very daring to help remain happy and relax in revenge of twenty-seven years involving ended up being usually made available own amazing benefits by the white-colored government representatives to give up his particular crusade. The person refused everytime. That appeared to be empatheticCredibility creates up very easily when one are actually concerned about other folks. Accord implies settling on your own on the various person’s place, and picturing the implications of your certain actions. Considering we all have been individuals, we fairly much currently have similar requires at a several levels. Every one of us experience a will need for really like, caring, a friendly relationship, esteem, and even hope. Responsiveness comes via understanding that When i am strong from inside of , nor possess to harm others to leave them understand. True power is derived from explaining genuine attention and problem for people, particularly if you have the upper hand. One wonderful sort of this unique good quality is certainly Nelson Mandela. Immediately after getting addressed thus monstrously just for way too long, they has confirmed a good degree with compassion several humans happen to be able to be able to can. The person basically forgave folks that perpetrated death, physical violence, together with injustice with some sort of whole nation on the main sappy foundation of epidermis real regarding Mandela’s effecitveness surfaced if he came out connected with the penitentiary, turned Lead designer in the Republic regarding Southern region Africa, along with from the fact that towering couch of electric power, thought we would show virtually no rancor into people today who previously had caused so much personal experiencing for your pet. He simply just forgave them. That appeared to be correct agreement. His or her authority didn’t endure even though his ex-wife ended up being incriminated about unethical ventures. These types of is actually the mesmerism of affinity. Sadly, a lot of of us all miscalculation responsiveness with regard to ‘t play the role of00 what precisely you are generally notWe often seek to assignment personally while somebody else. This cannot give good results, given that we will find found out there. People is unable to mess almost all the people today all the exact time. Also, God has produced each 1 of united states quite unusually. Just have a look at yourself. Who share similar physical features that anyone hold? By simply the similar token, people share precisely the same intrinsic capabilities you get. And ample space with this earth for a couple more enjoy everyone! Thus stop trying to be able to be actually not. As a substitute, start doing what one are, what your strengths happen to be, and what you can apply utilizing them. Your company discovery may amaze you actually. It will certainly give an individual the inside drive to be able to venture what in addition to who seem to you really happen to be. Your expertise will proceed way up by means of leaps and bounds, simply because you usually are projecting what we genuinely usually are. Share your current fearsWe typically choose towards hold our fearfulness towards ourself. When this transpires, the main dreads have a tendency to cultivate in our minds. The main imagination is cast as tricks here, and we are frequently paralyzed. Never let this get lucky and an individual. It is common with regard to individuals to feel terrified. After you experience hesitant connected with something, discuss it again together with few tight allies. This specific is certainly not a symptom involving as well as. The exact trick is based on knowing quite a number of people in whose integrity plus genuine concern for everyone may help these people gives you the sense of being much better when you have embraced your individual dreads together with tend to be some questions to ask anytime building your credibility: Would it worry all of us if my very own actions were created public? Only were for you to learn this unique about one more person who have I store respect, the way would I find myself about your pet as well as your ex? Are usually most unfortunate end result potential residence was to keep my word? The real truth is this humanity could not enjoy every real advancement unless there is enough legitimate people within this earth. Really, the entire world works regarding hope together with have confidence in. Read what on earth is created about the forex bills around your finances – possibly even that will be practically nothing while not authority along with trust. Anytime the fact that have faith in is actually shaken, there’s a operate on the particular currency! At long last, remember the storyline of the main guy who seem to cried bad guy. One time your current standing will be in problem, you get a Himalayan task reparing it. Your own personal credibility are like a good Chinese floral vases. The idea is superb, and respected by most. Drop the idea, and it again is nearly impossible to help reconstruct that. Build your current integrity, as well as then guard it like your life counted upon this, because that really does.
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De autorin olago stellt sich vor ich bin hausarbeit schreiben lassen eine vielseitig interessierte,belesene texterin mit einem diplomabschlu der pdagogik