The Membership Organization of State Offices of Rural Health
By: Beth Blevins
County-level data—particularly for rural counties—wasn’t always readily available in Nevada. But the Nevada Rural and Frontier Health Data Book (and the associated Nevada Instant Atlas website) changed all that.
Now in its eighth edition, the Data Book, complied by the Nevada State Office of Rural Health (NV SORH), provides comprehensive information on all counties in the state. The data in its more than 100 tables varies from the broad—e.g., county populations—to the more specific, e.g., number of licensed physical therapists by county. Though issued only every other (odd) year, when the Nevada legislature is in session, the data is dynamic rather than static, according to Tabor Griswold, Health Services Research Analyst at the NV SORH.
“Data goes into the Nevada Instant Atlas on our website first, then we pull it out for the Data Book,” Griswold explained. “We continually add or update new points of data to the website.” In addition, the Instant Atlas, which boasts more than 200 users each month, “is unique because it offers time trending,” she said. “When you bring it up visually, there is a bar that shows all the data going back to when we first started collecting it. When possible, the source of the online data is linked between the website and the original source.”
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Griswold said that users can also use the Nevada Instant Atlas to assess the impact of legislation over time. For example, she said, “the expansion of public nursing programs over the past decade, and changes in advance practice nursing scope of practice have led to dramatic increases in RNs and advance practice RNs, which is documented in the Atlas.”
The Data Book is available electronically as a PDF, as well as a limited number of hard copies. “We bring copies of the Data Book to “Rural Health Day at the Legislature” to share with members of the legislature and the governor’s staff, as well as hospital administrators attending the event,” said John Packham, Director of Health Policy Research at the NV SORH.
The first Data Book rose out of the frustration Packham experienced after he arrived at the Nevada SORH, whenever he needed to find rural data. The state was collecting data for Clark County (i.e., Las Vegas), Washoe County (i.e., Reno), “and the ‘balance of the state’,” Packham said. “But the ‘balance of the state’ was the 14 rural counties we worked with on a routine basis. Whether it was for a grant or a county commissioners’ meeting, we would have to mine existing data to try to find out what was going on at the county level.”
Putting that information into the Data Book made everything easier to access, Packham said. But it also made a compelling case for the state to begin collecting and breaking data down by county, he said, “because there were some pretty substantial variations between a healthy county and an unhealthy county—certainly on health workforce data. It also kick-started our practice of going to the 38 state licensing boards for health professions, getting their data, and breaking it out by county.”
The NV SORH has found effective use of the Instant Atlas for two purposes. “For community health needs assessments, one of our starting points is to abstract or pull out the county-level data, and package it in the form of a county-level report,” Packham said. The Nevada SORH also uses its data to help rural county commissioners who are trying to establish or convene local boards of health. “Of the 14 Nevada counties that are rural or frontier, none have local health departments—their public health services are provided through the state of Nevada,” Packham said. “But there’s been an awakening of interest among them to convene local boards of health—or at least put public health issues before their commissioners. Our office is supporting these efforts to the extent that they need data to start the discussion.”
Packham said that the Data Book is funded through a combination of staff partly supported by federal Flex funds, other types of state dollars, and pieces of grants and contracts. In other words, “funding is complicated,” he said. Since the Nevada SORH is university-based, “we train undergraduates in the data collection process and to understand data base development —that’s a win-win,” Packham said. “They’ve been really instrumental in loading and double-checking all of the new data.”
The Data Book has proven a success, used by legislators, county commissioners, and hospital administrators. Perhaps more importantly, according to Packham, it has improved the visibility of the NV SORH. “Over the 15 years we’ve been doing this, people know that this resource comes from the State Office and the School of Medicine at the University at Reno,” he said. “It’s our flagship publication. It has increased the degree that we’re the first resource that people go to, especially on workforce data.”
Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger at ashleym@nosorh.org to set up a short email or phone interview in which you can tell your story.
Keith Clark
Director, Rural Programs
Nevada Office of Rural Health
Keith recently joined the NOSORH Board as a first-time Workforce Liaison. He is also our “Chief Photographer” for the group photo at the Annual Meeting each year. You can look for him photo shopped into last year’s group photo. Keith has an extensive background in photography, but lucky for us, he has a strong connection to his rural health colleagues.
How did you get to where you are now?
I have been with the University of Nevada School of Medicine for about 10 years, serving in many roles, including AHEC Director. I am also currently serving as the President of the Board of Directors for 3RNet.
What is 3RNet working on these days?
If you haven’t seen 3RNet lately, you haven’t seen 3RNet! We are looking at new and innovative ways to attract healthcare providers to rural areas, offer value-added benefits, and be an education source to members.
What is the most important thing you are working on right now?
We have the opportunity to really make a difference in people’s lives. If you can bring one provider to one community, you have changed people’s lives. I live in a rural area of Nevada, so I know firsthand how long it takes (500 miles roundtrip!) to get some of the healthcare my kids need. You can’t deliver a baby in my town.
I’ve been working under the leadership of Gerald Ackerman to expand rural residencies in the state. We have developed one of the first rural residency programs based out of CAHs. We need to increase and duplicate this where we can. We found that if we educate someone in the state and they do residency training here, we keep 80% of them in the state. We need to find places for them!
Frustrated with the lack of media coverage on public health issues, John Packham of the Nevada SORH approached the local Nevada Gazette to establish a bi-monthly column devoted to public health issues. The newspaper was very interested in this idea since they had recently reduced staff and were eager for anyone to provide local content. Since 2008, John has written over 100 articles with topics ranging from health reform to tobacco tax. All the articles can be found here.
John was given wide latitude to write about various topics from local issues to those topics focused more on a statewide level. The only restriction is to keep the article to under 500 words. “This has been a very rewarding process,” John explains. “I am used to writing long reports, so it was tough to distill the information down into 3 to 5 major bullet points. People don’t want to read dissertations, instead I had to focus on writing something relevant, succinct, timely and of interest to rural.”
The column has raised the visibility of issues across the state and with legislators. “At least one or two people each week tell me they read the articles and these are not always people that I would expect,” says John. He continues, “I try to take a fresh take on important issues that are sometimes driven by recent events, such as the recent Supreme Court ruling on the ACA, or I pull from a file folder that I keep full of ideas for future articles.”
To get started, it is as simple as a phone call to the editor of the paper. John encourages people to sell themselves on what they will be contributing is unique. Most papers have a healthcare reporter, but they do not focus on issues of importance for rural health. “Sometimes newspapers will write about medical technology or focus a little on public health promotion at the community level, but rarely do they focus on topics of interest to rural,” according to John.
If you are interested in starting a rural health column, send John an email. “This is such a unique approach to the information dissemination efforts of a SORH. It may not work for every SORH, but I hope that other SORH can consider possibilities like offering a regular column or article to small newspapers or radio stations or checking in with State Health Officers or other state leaders who could be a great voice for rural health issues with local media. Thanks to the Nevada Office of Rural Health for an interesting idea for information dissemination,” according to Teryl Eisinger, NOSORH Executive Director.
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John Packham
John Packham is the flex coordinator for the Nevada SORH. He also serves on the national TASC Advisory Committee and is a Region D Rep and Flex Committee co-chair for NOSORH.
How is your SORH different than other SORHs?
Being university-based, we are enmeshed within a network of researchers and others who do outreach and education on health-related matters. It’s great to be with a mix of colleagues. I think it’s important for people to know that university-based SORHs are part of state government. For example, higher education in Nevada recently was hit by crises and we’ve been affected too. But it’s a collegial environment that I love–and it gives me the opportunity to teach and advise students. I have overseen MPH interns who are helping us with projects in critical access hospitals (CAHs) and rural communities in Nevada. I get to teach a course whenever my schedule allows.
What do you do as a flex coordinator to improve health care in your state?
I have a great job because I get to split my time among various research and technical assistance activities, partnered with Nevada Rural Hospital Partners (NRHP), our state rural hospital association. I feel that my work as flex coordinator keeps me grounded, because it gets me into communities and hospitals where I work on workforce issues, and do data analysis and community health care needs assessments. And I get to help address some of the serious health issues in Nevada right now–like access barriers, health workforce development and understanding the changing health needs of rural communities. Eleven CAHs we work with are, on average, 45 miles from nearest incorporated town and 105 miles from a tertiary hospital. The hospital I worked with on a community-needs assessment recently is 180 miles from my office. Most of the rural areas in Nevada meet the definition of frontier. The Internet and video have broken down some of those barriers, but you’re still a long way from everything.
We have some pretty impressive yet straightforward performance improvement tools, including the capacity to do revenue cycle assessments and improvement, working with NRHP. There’s been a nice coordination of expertise between us. They help us meet the goals and objectives of multiple grant programs.
I hope that my increasing involvement in national boards and committees will provide opportunities for me to share what’s working in Nevada, and to learn from other national rural health leaders in the process.
Impact of the NREMT on Rural Emergency Medical Services in Nevada – January 2008