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.


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Saiba como aumentar o tráfego do sitio através de um bom desenho de site

i Jul 11th No Comments by

Um bom design de website é absolutamente crítico se você deseja atrair tráfego máximo. Para que seu site se destaque, foi preciso produzir algumas coisas, como seus próprios pincéis na loja de fotos, conjuntos por ícones gratuitos, papéis do parede gratuitos, arte vetorial livre, padrões gratuitos e fontes gratuitas.

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Por benefício, entenda de que você pode vir a aumentar significativamente o tráfego do seu site se você utilizar um porreiro design por web. Igualmente é um fato que você têm a possibilidade de diminuir este fluxo de tráfego usando muita destreza se não for cuidadoso com o design do seu sitio. Você deve saber de que tanto os spiders destes mecanismos do busca quanto os utilizadores de mecanismos de parecer são bastante exigentes quando visualizam sites. Eles gostam muito dos sites que gostam e repetidamente vêm até eles. Existem certos erros normais de design de sitios que os spiders destes mecanismos por busca e os utilizadores de mecanismos de parecer abominam e que você deve inferir quais são e evitá-los. Alguns dos projetos comuns de sitios que você deve impedir são o uso excessivo por programas que consomem muita largura do banda, alguns gráficos usando carga intensa, obstáculos de design como quadros e navegação ambígua. Os sitios baseados em quadros só devem ser usados para Intranet (um site somente para funcionários da empresa) e não para a Internet. Acompanhe regularmente as classificações do seu mecanismo de pesquisa e o tráfego do site. Já que um site é indexado, um bom web designer deve voltar e aumentar a qualidade as páginas que não obtiveram classificações elevadas em palavras-chave. Pelo menos uma vez em três meses, faça questão de realizar algumas pequenas alterações em cada página da web. Os sistemas de pesquisa gostam do ver que as alterações estão a ser feitas em um sitio e não gostam de inativos nenhumas atualizações.

É verdade de que os spiders dos sistemas de busca e estes usuários por mecanismos de busca são um grupo difícil de satisfazer. Eles são críticos em termos de qualidade e quantidade quando estamos falando de design de sitios. Se o visitante tomar alento para evitar esses enganos de design da Web e, em vez disso, se concentrar na criação de sitios bem desenhados que atraiam aranhas e pesquisadores, o visitante teria criado um sitio de tráfego intenso. Uma maneira garantida de promover o tráfego do sitio é enviar o seu site para projetar galerias. Existem várias galerias por design de sites bastante populares, onde os usuários podem votar nos projetos do sitio. Mas o visitante terá que ter certeza de que seu design é especialmente igual a, se não melhor do que os da galeria de que você está enviando. Se o design do seu site for bem classificado, muitos desses sites exibirão seu website em sua página inicial, pelo menos por um tempo, este que pode certamente impulsionar o tráfego para seu site.

A maioria dos web designers não possui nem a inclinação nem o tempo para saber como adquirir rankings elevados em múltiplos mecanismos do busca. Eles fazem lances em projetos e sabem que é demorado criar um sitio que obtenha altos rankings. Como a maioria dos clientes não sabe o de que deve ser feito para adquirir um incremento no tráfego do sitio, os web designers fazem um pequeno trabalho e projetam somente um site que este cliente achará atraente.

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