Goal 1. Strengthen Arizona’s rural health infrastructure by supporting improvement initiatives across the continuum of care for critical access hospitals and CAH-eligible hospitals.
Goal 2. Promote and support the involvement of an increasing number of Arizona critical access hospitals, CAH-eligible hospitals, SHIP hospitals, EMS systems, and their partner agencies in Flex-sponsored initiatives that will improve patient safety and quality of care through specialized and concentrated training activities, and performance and quality improvement programs.
Goal 3. Provide incentives to CAHs and EMS systems in Arizona to use health information technology systems such as electronic health records, electronic medical records, computerized physician order entry, electronic medication reconciliation systems as tools to improve patient safety and increase quality of care, and also to build efficient financial reimbursement systems using available health information exchange systems.
Goal 4. Seek 100 percent participation of all Arizona CAHs and CAH-eligible hospitals in the 5 Million Lives Campaign. (The 5 Million Lives Campaign is an initiative to protect patients from five million incidents of medical harm between December 2006 and December 2008. The campaign was initiated by the Institute for Healthcare Improvement.)
Goal 5. Develop a virtual rural hospital network in which all rural hospitals and Flex partner agencies will work together to achieve the above goals.
The Rural Health Office (RHO) at The University of Arizona Mel and Enid Zuckerman College of Public Health has implemented the Rural Hospital Flexibility Program in the state since the program’s inception. For FY 2007-2008, the federal grant has six required objectives to which Flex Program activities must be directed. These are:
The Flex Program has supported a variety of quality initiatives for the state’s Critical Access Hospitals. These include contracting with the Health Services Advisory Group (Arizona’s Quality Improvement Organization) to provide training for Quality Managers in clinical protocols related to pneumonia, congestive heart failure, and on patient safety protocols. The Flex Program has contracted with Stroudwater Associates to implement a Balanced Scorecard (BSC) methodology that involves the development of strategy maps that reflect the hospital’s strategic plan and implementing a system to monitor global indicators as well as departmental services using a scorecard approach. As of September 2007, six CAHs have chosen to participate in the BSC. In 2007-2008 one new critical access hospital is expected to be added to this Balanced Scorecard Initiative. The Flex Program also supports the involvement of CAHs in electronic health record systems designed to reduce medication errors, increase patient safety, improve the quality of care, and improve revenues. In 2007-2008, three existing CAHs will be offered the opportunity to participate in a multi-state quality improvement program currently called “Harvesting Quality.” This project offers tools and support for strategic planning and management, and leadership enhancement. Concentrated services will be provided by Bainbridge Associates, including training sessions on board development, and CMS Conditions of Participation for critical access hospitals.
This objective includes technical assistance and financial studies. As of September 2007, there are 21 hospitals in Arizona eligible to be designated as critical access (private, federal, and tribal-638 hospitals). Of these 21, 15 hospitals have received the designation and we continue to work closely with others that are seriously examining whether the designation will benefit the hospital. Of these 15, two I.H.S. CAHS reverted back to their original status because of varying reasons. Thus, Arizona currently has 13 CAHs. The Flex staff provides extensive technical assistance to the hospitals during the designation process. These hospitals are eligible to participate in the program offerings made possible through the Rural Hospital Flexibility Grant Program.
The law defines a rural health network as at least one Critical Access Hospital and at least one hospital that furnishes acute care services. The federal grant program encourages networks to be built in a much more comprehensive and inclusive manner. The Flex staff promotes network development among the state’s Critical Access Hospitals by sponsoring meetings with “network” experts and hospital staff to discuss options. The Flex Program has a Flex Leadership Group to which all Critical Access Hospitals belong, along with other program partners such as Arizona Department of Health Services, the Arizona Hospital and Healthcare Association, the Health Care Cost Containment System (AHCCCS), and the fiscal intermediaries for CAHs. Other network groups that have been formed include Information Technology (IT) coordinators, quality managers, Boards of Trustees, I.H.S. and tribal CAH interests, and CAH CEOs. In combination, these networks will form a virtual large network.
The Flex Program has provided educational training opportunities for EMS personnel, CAH nurses, and other first responders since the inception of the program. For the past three years, the Flex Program has collaborated with the Southeast Arizona Emergency Medical Services Council (SAEMS) to provide training on pediatric trauma, general trauma, and other specific topics. Additionally, due to the cluster of four Critical Access Hospitals in Cochise County, the Flex Program, in collaboration with the Arizona Department of Health Services, has supported an extensive EMS pilot program among the CAHs clustered in Cochise County. An EMS working group was formed composed of EMS representatives from throughout the state, through which an Arizona Rural EMS Agenda for the Future was adopted. In 2007-2008, EMS training will focus on EMS system budget development, management training, and training for Emergency Room physicians working in critical access hospitals.
The Arizona Rural Health Plan was filed with the Centers for Medicare and Medicaid Services (CMS) per the requirements of the Law. CMS approved the plan in November 1999, and also approved minor revisions in May 2001. The RHO revised the Rural Health Plan in December 2004, submitted it to CMS, and received approval in 2005. Under the new Flex objectives, the plan is to be updated again to reflect the specific needs of critical access hospitals and emergency medical systems.
(Last updated October 2007)
