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Rural Health Briefing, July 1, 2006
National News
1. IOM Says Emergency Requires Care
2. Rural Clinics Innovate in Diabetes Care
3. A Binational View of Immigrant Health
4. Medical and Economic Impact of CAHs
5. Collecting Race, Ethnicity Data for Quality Studies
6. Rural Hospital Bill Introduced in Senate
7. Breast Cancer Resources Online in Spanish
8. Health Award for Rural Leader
Across Arizona
1. Rural Domestic Violence Forum Report
2. Arizona Rural Women’s Health Initiative Formed
3. Funding for HIT
4. Native American Resources Online
5. Research Targets Health Disparities in Arizona
6. Dealing with Summer Heat
7. Study Aims to Reduce Native American Alcoholism
8. Contreras Named Governor’s Policy Advisor
Grants and Opportunities
1. Emergency Preparedness for Health Centers
2. Aligning Forces for Quality
3. Health Vision Community Awards
4. Grants for Early Treatment of Mental Illness
5. Health and Society Scholars Program
6. Conference Grants for Public Health
Calendar
July 10-12, AHRQ’s Translating Research into Practice and Policy , Washington, D.C.
July 10-12, 2nd Annual Rural and Community Hospital Symposium and Management Conference , Las Vegas, Nevada
July 12-13, IHS HIV/AIDS Collaborative Regional Training , Phoenix
July 14, Crucial Decisions: Emergency Treatment in the First 10 Minutes , Flagstaff
July 17-19, 10th Anniversary 340B Coalition Conference , Washington, D.C.
July 18-19, Public Consensus Conference on Successful Practices for State-level RHIOs , Arlington, Virginia
July 19-21, 33rd Annual Arizona Rural Health Conference , Bisbee
July 26, Creating Space for Culture and History in Indian Health Care , Los Angeles
July 26-28, National Association of County and City Health Officials Annual Conference , San Antonio, Texas
July 26-29, NRHA’s 2nd Annual Quality Conference and 1st Annual Clinical Conference , Denver, Colorado
July 31-August 2, 7th Annual Health IT Trends Conference , Cambridge, Massachusetts
August 2, 2nd Annual Performance Improvement Summit for Arizona Rural Hospitals, Tucson
Mark Your Calendar
September 18-20, 1st National Conference on Health Information Capture , Las Vegas, Nevada
September 21-23, Health Information Technology: A Rural Provider’s Roadmap to Quality , Kansas City, Missouri
September 25-27, 4th Annual Public Health Information Network Conference , Atlanta, Georgia
October 3-6, NRHA’s Rural Health Clinics and Critical Access Hospitals Conference, St. Louis, Missouri
October 26-27, National Prevention Summit: Prevention, Preparedness, and Promotion, Washington, D.C.
National News
IOM Says Emergency Requires Care
Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to effectively treat seriously ill people.
Three new reports of the Institute of Medicine (IOM) reach that alarming conclusion.
In rural communities, emergency departments may be the main source of health care for a widely dispersed population.
As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money.
The report concludes that fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency.
All three reports (with a useful search function) are available online from these links:
* Hospital-Based Emergency Care: At the Breaking Point
* Emergency Medical Services: At the Crossroads
* Emergency Care for Children: Growing Pains
Rural Clinics Innovate in Diabetes Care
A new system of diabetes care is turning around a very bad situation in poor areas of Mississippi. In several clinics around the state - three in the rural Mississippi Delta where diabetes numbers soar - patients have reduced their risk for complications by 70 percent in just six visits.
Adapting a collaborative model developed at the University of Mississippi Medical Center, nurse practitioners, RNs, diabetic educators, pharmacists and dietitians all work as a team to teach and care for patients. Nurse practitioners and pharmacists manage diabetes care much as a physician specialist would.
Another innovation is the use of telemedicine. Dr. Marshall Bouldin, director of the program, meets via the telemedicine network with clinic staff and also for training local physicians. This approach uses physicians sparingly and that’s important in regions where physicians are scarce.
Adapted from Virtual Medical Worlds, June 2006
A Binational View of Immigrant Health
A recent report, Mexico-United States Migration Health Issues, joined researchers from CONAPO (Consejo Nacional de Población, Mexico’s demography bureau) and UCLA to examine common health concerns. It found that the naturalized Mexican immigrant population health insurance coverage rate of 70 percent is only slightly lower than that of Mexican-Americans at 73 percent. Coverage for both groups is far behind that of the U.S.-born white population at 87 percent.
In addition, Mexico is paying more attention to the access to health care of its citizens who migrate north. This has boosted interest on both sides of the border in establishing low-cost health insurance that can be used by Mexican immigrants and their families, with most of the high-cost services being provided in Mexico. One indication of this is that in Mexico, people who go to the United States are not referred to as ‘Mexican immigrants’ like people who’ve left the country. They are called ‘Mexicans in the U.S.’ In other words, people who emigrate to the U.S. are still Mexicans.
Click here for the three-part report and fact sheets on demographics and disparities in both English and Spanish.
Medical and Economic Impact of CAHs
A study of Critical Access Hospitals in Illinois reports that in addition to providing a broad range of services to medically vulnerable populations, particularly the elderly, CAHs are major financial contributors to their local economies. CAH designation and access to associated financial benefits have enabled many of these 51 hospitals to remain open. They often still face the challenge to update obsolete facilities and equipment. The Economic Impact of the Critical Access Hospital Program on Illinois Communities was conducted by the Regional Developmental Institute at Northern Illinois University.
Click here for the four page summary or 56 page report.
Collecting Race, Ethnicity Data for Quality Studies
The Robert Wood Johnson Foundation has reported in a policy brief that it is legal to collect data on patients’ race and ethnicity for quality improvement purposes. It has urged HHS to issue data collection guidelines that encourage this. The report by researchers at George Washington University School of Public Health and Health Services states that racial and ethnic data are critical to measuring quality in diverse populations.
Click here for the report.
Rural Hospital Bill Introduced in Senate
Rural Hospital and Provider Equity (HoPE) Act of 2006 was introduced in the U.S. Senate on June 13, 2006. It would amend title XVIII (Medicare) of the Social Security Act to preserve access of Medicare beneficiaries in rural areas to health care providers. Provisions include: (1) the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals; (2) extension of the temporary increase in payments to certain rural hospitals (Medicare hold harmless provision) under the prospective payment system for hospital outpatient department services; (3) the definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment; (4) critical access hospitals; (5) extension of the Medicare incentive payment program for physician scarcity areas; (6) extension of the 1.00 floor on Medicare work geographic adjustment to payments for physician services; (7) Medicare home health care planning; (8) rural health clinics; (9) use of medical conditions for coding ambulance services; (10) extension of increased Medicare payments for ground ambulance services in rural areas; and (11) coverage of marriage and family therapist services and mental health counselor services under Medicare part B.
It would also amend Medicare regarding the extension of: (1) wage index reclassifications for certain hospitals; and (2) reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.
Furthermore, it proposes to amend the Public Health Service Act for: (1) a capital infrastructure revolving loan program; and (2) community health center collaborative access. It also would authorize (1) pilot projects to provide incentives to home health agencies to utilize remote home monitoring and communications technologies; and (2) facilitate the provision of telehealth services across state lines.
Click here to follow the bill.
Breast Cancer Resources Online in Spanish
Latina breast cancer patients have a new online resource of Spanish-language materials. A Web site launched by the University of Wisconsin-Madison's Center of Excellence in Cancer Communications Research offers culturally relevant information for Spanish-speaking patients and serves as an information clearinghouse for Spanish-language resources.
The site features information translated from an English-language site called the Comprehensive Health Enhancement Support System, which has demonstrated positive impacts on the outcomes of breast cancer patients who participated in the program.
Click here for more information.
Health Award for Rural Leader
Kristy Nichols, Director of the Bureau of Primary Care and Rural Health in Baton Rouge, Louisiana and a leader in the NRHA, received one of ten Robert Wood Johnson Community Health Leadership awards recognizing "ingenuity, perseverance and social commitment that is moving the needle to improve the health and well-being of people in their communities and giving a voice to those who may need help in raising their own."
After Hurricane Katrina hit, Nichols worked with other state officials to get supplies, doctors and nurses to hundreds of Louisiana clinics and shelters. At the same time, she helped local residents create recovery plans so that scarce federal resources would get to the state's hardest hit parishes.
Across Arizona
Rural Domestic Violence Forum Report
Over 140 participants plus 21 speakers/facilitators gathered in Rio Rico on April 26 for presentations on domestic violence and sexual assault in women's lives in rural communities. In small groups, participants also worked through a Gaps Analysis and Action Planning Session facilitated by Jean McClelland of the Rural Health Office, Montserrat Caballero of Su Voz Vale (SACASA), and Jennifer Peters of the Rural Health Office.
Results of the session are available online at
http://www.rho.arizona.edu/Programs/azrwhi.htm.
Nine of Arizona's 15 counties were represented at the forum: Apache, Cochise, Coconino, Maricopa, Mohave, Pima, Pinal, Santa Cruz and Yuma. Attendees represented social service and behavioral health agencies; hospitals and clinics; law enforcement; county and tribal health departments; health educators; women’s health advocates; and health consumers.
The forum was made possible with funding support to the Arizona Rural Health Association from the National Rural Health Association and the Region IX HHS Office of Women’s Health. Co-sponsors were the Rural Health Office, the Arizona Association of Community Health Centers and the Southeast Arizona Area Health Education Center.
Arizona Rural Women’s Health Initiative Formed
Rural Health Office has created the Arizona Rural Women's Health Initiative in collaboration with the Rural/Frontier Women's Health Coordinating Center of the Arizona Association of Community Health Centers. The Initiative will be featured at the Arizona Rural Health Conference, July 19-21, in Bisbee.
Click here for details.
Funding for HIT
The Arizona legislature has approved $1.5 million to encourage rural health care providers to implement health information technology. Sharing medical information electronically has the potential to reduce errors and improve timely access to patient information. Details on the distribution of the $1.5 million are not yet available.
The State of Arizona has also been awarded a federal grant of $350,000 to explore privacy and security issues related to e-Health. In partnership with the National Governor’s Association, its aim is to assess business practices that affect the safe exchange of electronic health information. The Arizona Health-e Connection will then identify ways to enable the electronic exchange of health information.
Native American Resources Online
ArizonaNativeNet is a new website devoted to the nation building and higher education needs of Native American communities in Arizona and the United States, plus Native Nations throughout the world. It aims to provide Native American communities access to research, executive education, and distance learning resources. Key features include breaking news, simulcasts and videotaped lectures, workshops and conferences, as well as up-to-date research, analyses and resources on Native Nations governance, law, health, education, language and culture. The site is designed for use by tribal leaders, policymakers, students, educators, media and the general public.
Visitors to the site can also subscribe to ArizonaNativeNet’s electronic newsletter.
The project is led by Robert A. Williams, Jr. and is a collaborative effort of the University of Arizona’s Native Nations Institute for Leadership, Management and Policy (NNI) at the Udall Center for Studies in Public Policy; the Indigenous Peoples Law and Policy Program (IPLP) at the James E. Rogers College of Law; and the Native People Technical Assistance Center.
Click here for more information.
Research Targets Health Disparities in Arizona
Five innovative research projects will address health disparities among Arizona Hispanics and Native Americans.
The Animadora Project, directed by Maia Ingram, is a community-based study to determine the factors that motivate Hispanics with diabetes to exercise on a regular basis. Groups from the Elvira and Sunnyside neighborhoods in Southside Tucson are participating. Each walking group has a volunteer known as an animadora who leads the group. Many participants have tried walking in neighborhood parks but have been discouraged by the lack of lighting, uneven walking surfaces and loose dogs. As a result of the support of the animadoras and their walking partners, they are now walking longer and faster.
The Media Wise Families program uses a family- and community-based empowerment education intervention to build community capacity to deal with substance use and abuse issues through media analysis, activism, and advocacy. Family members participate in workshops on how to effectively evaluate the messages they see in the mass media regarding alcohol and tobacco use/abuse. Lynda Bergsma, PhD, guides this project.
Few studies have been conducted among Native American youth asking their opinion of their own health and well being. The goal of this pilot study is to collect qualitative and quantitative self-report information that will shed light on how young Navajo people of Hardrock see their lives. About 200 youth, ages 8 -16, will be asked about their joys, hardships, dreams and future plans. They will identify coping strategies used in dealing with adverse experiences involving alcohol, drugs, violence and forced parental relocation. It will be led by Xenia King, PhD.
Promotoras (community health workers) have made significant culturally relevant contributions to reducing Hispanic health disparities. However, the effectiveness of the promotoras in promoting self management behaviors among persons with diabetes has not been evaluated. This study, with the direction of Marylyn McEwen, PhD, will examine this with an educational and social support program in Tucson’s Sunnyside and Elvira neighborhoods.
Young people from Hardrock on the Navajo Nation will take oral histories and use other creative arts to focus on local strengths that are protective factors against substance abuse. The project will use descriptive ethnographic methods to understand the meaning of these activities related to constructions of hope, coherence and resiliency. Denise Wolf leads the project.
The projects are funded by the Center for Health Equality at The University of Arizona Mel and Enid Zuckerman College of Public Health.
Dealing with Summer Heat
Surviving Arizona Summer Heat, a printable, two-sided brochure is now available on line at http://www.azdhs.gov/phs/oeh/protect_from_heat.htm. English and Spanish versions can be found there. The previously posted Heat Emergency Response Plan is also available at that link. It is provided by ADHS’ Office of Environmental Health.
Study Aims to Reduce Native American Alcoholism
Nicole Yuan, PhD, of the University of Arizona Mel and Enid Zuckerman College of Public Health, has been awarded a $500,000 research award from the National Institute on Alcohol Abuse and Alcoholism, for a five-year study of alcoholism and violence among Native Americans.
Yuan will also continue her analysis of the Ten Tribes Study (originally conducted in the 1990s) to measure genetic and environmental factors that may contribute to alcoholism among Native American tribes. The project will investigate gene-environment interactions in the development of alcohol dependence. Cultural factors that contribute to alcohol disorders and violence between intimate partners will be explored in a pilot study followed by an examination of the relationship between alcohol use and intimate partner violence.
The goal of the research is to improve the public health of Native Americans by reducing alcoholism and related violence.
Contreras Named Governor’s Policy Advisor
January Contreras is taking the position of policy adviser for health-related issues to Governor Janet Napolitano. Most recently, Contreras served as Intergovernmental Affairs Assistant Director at Arizona Health Care Cost Containment System (AHCCCS) handling intergovernmental relations with the legislature, CMS, tribal governments, and other state agencies. She previously worked as a prosecutor for Maricopa County, where she handled drug, robbery, theft and other criminal cases.
Grants and Opportunities
Note: Technical assistance is available for the development of grant proposals and other funding applications from the professional staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peters.
Emergency Preparedness for Health Centers
Applications due: July 10
Many health centers are currently working with States, local public health departments, hospitals, etc., in developing appropriate plans for emergency response. HRSA’s FY 2006 National Bioterrorism Hospital Preparedness Program (NBHPP) invites collaborative participation through each State.
Organizations interested in obtaining Federal funds directly from Federal preparedness grants, including NBHPP, are required to be National Incident Management System (NIMS) compliant to receive those funds. Community collaboration may require integration with the community’s Incident Command System (ICS), which is a standardized on-scene emergency management construct specifically designed to provide a definite chain of command and the adoption of an integrated organizational structure without being hindered by jurisdictional boundaries. Health centers are not required to be NIMS compliant as a grant condition for health center funds but are encouraged to be familiar with ICS and NIMS and understand the framework for its use.
Health centers interested in obtaining Federal funds directly from Federal preparedness grants, including NBHPP, through sub-awards are encouraged to become NIMS compliant. Health centers should consider the NIMS compliance activities in the NBHHP FY 2006 guidance when determining NIMS compliance with specific emphasis on elements 7, 9, 10, and 11.
The guidance is at http://apply.grants.gov/agency/GetGrantFromFedgrants?cfda=&opportunity=HRSA-06-067&competitionid NIMS compliance will likely be required for entities receiving preparedness funds through sub-awards beginning in FY 2007.
Aligning Forces for Quality
Registration deadline: July 14
Application Deadline: September 7
Aligning Forces for Quality: The Regional Market Project of the Robert Wood Johnson Foundation is offering substantial funding and technical assistance to help communities dramatically improve the quality of the health care they provide for chronic diseases in ambulatory settings. The program will help up to six communities align three key drivers of quality improvement:
-- performance measurement and public reporting;
-- capacity to help physicians in the community improve the quality of ambulatory, chronic illness care; and
-- consumer engagement.
The program will accept only one proposal per community.
To help ensure that only one organization per community applies, all applicant organizations must register with the program on or before July 14, 2006.
Applicants must be an organization that represents multiple community stakeholders, including substantial representation from the following community health care market stakeholders: health care providers, including physicians and safety net providers; health care plans; employers; and consumers.
Click here for complete details.
Health Vision Community Awards
Application deadline: August 31
The National Eye Institute has announced the 2007 Healthy Vision Community Awards which will fund health education and health promotion activities that support the Healthy Vision 2010 objectives and the Healthy People 2010 goals to reduce health disparities and improve quality of life.
The 2007 focus includes dilated eye examinations, vision screening for children, impairment, occupational eye injury, protective eye wear and vision rehabilitation services and devices.
Nonprofit organizations are encouraged to apply, including community-based organizations and agencies, minority-based organizations, schools, faith-based organizations, civic and fraternal groups, community clinics, local Agencies on Aging, and local health departments and agencies.
Click here for more information.
Grants for Early Treatment of Mental Illness
Application deadline: September 1, 2006
The American Psychiatric Foundation is seeking applications for public education projects that promote the early recognition and treatment of mental illness. Grants may be for new initiatives or expansion of current programs. Requests must be for educational, informational or outreach efforts targeting the public. Efforts may focus on a specific mental disorder, mental illness in general or target a specific population.
Click here for application details.
Health and Society Scholars Program
Application deadline: October 13
The Robert Wood Johnson Health & Society Scholars Program, provides support to improve health by training scholars to 1) rigorously investigate the connections among biological, behavioral, environmental, economic, and social determinants of health; and 2) develop and disseminate interventions based upon integration of these determinants. The program is intended to produce leaders who will change the questions asked, the methods employed to analyze problems, and the range of solutions offered to reduce population health disparities.
To be eligible, scholars must have completed doctoral training by the time of entry into the program in one of a variety of disciplines, ranging from the behavioral and social sciences to the biological and natural sciences and health professions; have significant research experience; and clearly connect their research interests to substantive health concerns. Up to eighteen scholars will be selected for two-year appointments that will begin in the fall semester of 2007.
Click here for the RFP.
Conference Grants for Public Health
Application deadlines: December 11, 2006 and March 7, 2007
The purpose of CDCs’ conference support funding is to provide partial support for specific non-Federal conferences in the areas of health promotion and disease prevention information and education programs, and applied research. $2.6 million in total funding is expected to be made in approximately 100 awards.
Click here for details.
Contact Your Representatives
a. Arizona Congressional Delegation: Links to Arizona members of the U.S. House of Representatives are available at: U.S. Representatives. Links to Arizona members of the U.S. Senate are available at: U.S. Senate
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 or follow links at Arizona Legislature.
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the UA Zuckerman College of Public Health, and supported through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Your questions (and answers) are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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