The Alaska SORH is working to tie together the initiatives of Healthy Alaskans 2020, a Public Health Initiative grant, MAPP, and CHNA and 2020 for organizations across the state interested in CHNA to create a Community Health Improvement Collaborative including the hospital association, Federal Reserve bank, United Way, and others.
At community level in SE Alaska, community leaders brought together city managers and EMTs to discuss what they do in their communities. This was one of the best meetings ever. The group took it upon themselves to continue to meet and are just beginning to do activities together but need to use data at the community level.
Alaska has just now been able to move into Medicaid expansion and PCMH and workforce. The AK SORH wants to know the workforce needs in states that have expanded Medicaid.
The AK SORH is looking at hospital discharge data through the hospital association to see inpatient, outpatient and ER information. This was a volunteer system and regulations were developed to make it mandatory. Long-term, ambulatory care now have to report so the AK SORH is having to do lots of follow-up.
The AK SORH used discharge data in Fairbanks to look at air quality and asthma rates along with dental health emergencies in the ER to look for preventative approaches.
The Colorado SORH is in the 6th year of their Improving Communications and Readmissions (iCare) quality project. RHCs were added in the 3rd year. The CO SORH is looking at diabetes, communication loop and medication reconciliation as well as working together as a team especially in areas of diabetes, heart failure, pneumonia, transitions of care and follow-up care after discharge.
The CO SORH continues to use Tableau and other database applications with over 400 population health measures. They are working on getting the rest of the rural counties data put into their database so they now can run reports on population, financial, workforce, etc. and have put this information into infographs to have meaningful conversations at the community and board level. The CO SORH presents data at the county and regionally level as well and are trying to make a better process so don’t have to reenter some of the data received.
The CO SORH has created a FFS program to help continue with meaningful use and developed a relationship with Cyberscience that has a business analytic tool that connects to the EMR and acts as a dashboard. It costs hospitals approximately $35,000, plus a monthly fee. They are just beginning to rollout and have 4 hospitals using it now. It will save them staff time especially around quality improvement abstraction.
The CO SORH is working with a couple of communities now on community paramedicine and trying to determine what kind of data can they get out to show value. EMS is the next entity that we are looking to add to our iCARE program.
The CO SORH is also providing CHNAs and working with communities on those areas that need help. This is a fee-for-service program. They are looking at the top 5 strengths and top 5 opportunities of improvement and will put on website and use when talking to legislators. If the areas they are working on connect to our programs we are working to ensure they are engaged in those efforts.
The Montana Office of Rural Health has partnered with the Montana Center to Advance Health Through Nursing (MT CAHN) on a Robert Wood Johnson Foundation (RWJF) grant to create Montana Academic Progression in Nursing (MT APIN). The RWJF grant was created in response to the IOM’s report The Future of Nursing: Advancing Health, Leading Change. MT APIN is currently in its 2nd phase of funding. Focus for phase 2 is: creating working partnerships between 2 and 4 year colleges to create pathways for nurses to transition to higher degrees; mentoring programs; increasing diversity in the nursing workforce; and enhancing employer support for continuing education of current workforce thought preceptor training. This grant is also being coordinated with a new Department of Labor grant in the state (HealthCARE Montana) with regards to curriculum re-design.
The Montana Office of Rural Health shared information and a short video highlighting one of the rural facilities in southeast Montana. Dahl Memorial Healthcare in Ekalaka, Montana is a small, remote hospital that the RWJF spotlighted to show how rural hospitals can, and do promote academic progression in nursing. This was done through a short video which can be viewed here.
The North Dakota SORH, has been involved in working with CAH communities on CHNAs for 25+ years and have stepped up efforts in the past 5 years, given the recent IRS requirement for hospitals through the affordable care act (ACA). This process has not only filled a need for CAHs, but more importantly has been a very positive benefit for the SORH by having a structured activity used to engage local stakeholders, learn about the community, share resources (i.e. HRSA Outreach, Network grants, etc.) to support projects stemming from identified needs and strengthen relationships. Though the recent Flex funding criteria no longer allowed for CHNAs to be ‘conducted’ using Flex funds this office has been planning/revising their process to include more technical assistance around CHNAs, work with communities on strategic and operational plans, beyond the CHNAs, which should meet SORH and Flex criteria. To date, they have conducted 26 of the 36 CAH CHNAs; created an aggregate report and three fact sheets of all rural and urban findings; developed a web-pages where all CHNAs are posted with an interactive map illustrating top identified community needs. The ND SORH is in the process of developing a tracking system/process, modeled off of TruServe, which a designated community liaison would be able to track community progress and access resources; and they are developing an internal manual on how they conduct CHNAs. In addition they are working closely with local public health units, working on accreditation who need community assessments completed, to reduce duplication. Another need for CHNA information is with the Family Medicine Residency Programs that have a GME requirement to provide education on CHNAs, so the ND SORH has offered one ½ day workshop for residents for them to learn about the process.
The ND CAH Quality network is going strong. One member received a Network Development grant. The ND SORH is working with this hospital on behalf of all hospitals. They are working on MBQIP – Emergency department transfer communications (EDTC) measures. A web-based portal for the ED abstraction tool has been developed. The program allows CAHs to enter abstractions for EDTC online. The data is then shared with all ND CAHs for the Flex program reporting.
The Oregon SORH currently is administering three grant programs: (1) The Telehealth Pilot Project grants (in partnership with the Oregon Health Authority), (2) Community Engagement grants and (3) Rural Clinic grants
Five Telehealth Pilot Project grants were awarded in April. They are supported by the federal State Innovation Model (SIM) grant, which Oregon received to fund innovative projects that support the State’s health care system transformation efforts. The grants support innovative projects that demonstrate how telehealth services in Oregon can be improved or expanded. More on the awardees and the grant process can be found on OORH’s website.
Five Community Engagement grants were awarded to Critical Access Hospitals in Oregon to improve care coordination services. Projects range from a grant to provide nutrition services for oncology patients to a grant that brings together law enforcement and health care providers to improve appropriate and integrated care for mental health crisis in the community. These grants are wrapping up in August. More information on the grant projects can be found on OORH’s website in early September.
Rural Clinic grants were awarded to ten small clinics for projects to improve access and coordination. Projects ranged from improving outreach through home visits and public health fairs to creating a program that trained and certified all of the facilities’ medical assistants. The clinic grants are currently being evaluated. Photos and summaries of each of the grant projects will be available on the OORH website in mid-August.
OORH recently completed it’s rural hospital listening tour report based on visits, in partnership with the Oregon Association of Hospitals and Health Systems (OAHHS) and the Oregon Health Authority, to 27 of Oregon’s Rural Hospitals. The Listening Tour Report summarizes the challenges reported by the hospitals, adds data to provide the Oregon context of these challenges where possible, and describes what OHA, OAHHS and ORH are doing around each of these issues. It includes a summary table of the Provider Incentive Programs administered by OORH that were overviewed at the regional meeting (also available on the OORH website). This includes three loan repayment, two loan forgiveness, a tax credit and malpractice insurance subsidy programs. The 2015 Oregon Legislature put a 2018 sunset on all state-funded health care workforce incentive programs pending an interim study to determine the return on investment and relative effectiveness of those programs.
The Office of Emergency Management joined the South Dakota SORH in April 2015. Together, they are working on a series of stakeholder meetings across the state to determine the future of EMS and exploring sustainability.
The SD SORH is collaborating with the Department of Labor on a data collection system as a result of one of the Governor’s Primary Care Task Force recommendations. The data system will gather licensing data on healthcare providers working in SD, which will show the supply and demand of the healthcare workforce.
SD SORH is also collaborating with AHEC on the REHPS (Rural Experiences for Health Professional Students) program, which places university students (medical, physician assistant, pharmacy and advanced practice nursing) into a 4-week experience with preceptors in rural communities. The students are paired together to promote interdisciplinary learning, and are required to complete a community project. The program is now in its 5th year with 30 students participating in 15 communities across the state.
The Utah SORH is busy working with a network of rural hospitals, which has formally incorporated. They are having success in sharing economies of scale in such things as purchasing insurance plans and contracting for services and equipment. Utah SORH (despite their QIO discontinuing efforts to assist because of a new SOW) is showing great improvement in rural hospitals reporting in MBQIP including HCAHPS, pharmacist verification of orders, and emergency department transfer communications. They are also continuing to do well in ICD-10 trainings for both coders and billers as well as physician and other providers.
The Utah SORH is also working on collaboration efforts such as groups they have gotten together some of whom are meeting on a regular basis. One of the most productive has been a group of rural independent hospital directors of nursing. Other attempts have included quality coordinators and Chief financial officers. The most recent success was the creation of a group of human resource managers. The CFO group has chosen not to meet again at this time but the others are sharing successful collaborations.
The Utah SORH has additionally had great success in providing TA and trainings this past year that included great trainings for governing boards and leadership trainings for supervisors and managers. This was part of a successful partnership with large system hospitals who provided, for example, trainings and exchanges for nurses in OB, L&D, ED, and Med Surg. These leadership trainings and the clinical exchanges have been hugely successful and very popular for those choosing to participate.
The Washington SORH Flex program is supporting a diabetes population health project and looking to determine what role CAHs can play in diabetes management.
The WA SORH is working on a new “Blue” facility type to address low volume CAHs in more remote areas to help maintain access to primary, emergency, and in some cases long term care, and increasing telemedicine and integrative planning.
The WA SORH is continuing a statewide STEMI/stoke system. A few CAHs are bypassed.
The WA SORH is rebuilding the MBQIP program. They lost their healthcare quality network, so they are trying to do more in the office. They are hoping to hire a quality person.
Washington received a healthcare innovation grant that is trying to come up with an alternative payment model for CAHs. The WA SORH is also working with the state on a new payment methodology for RHCs and FQHCs.
The Wyoming SORH is working with the REACH program to have 6th to 8th grade kids meet with health workers and learn about careers. They also provide funding to the University of Wyoming AHEC for weeklong health career summer camps for high school students.
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