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Rural Health Briefing March 28 2005
National News
1. NRHA Launches Quality Initiative
2. Technical Assistance for Rural Health Clinics
3. Computerized Physician Order Entries Examined
4. Reservations About Mandatory Error Reporting
5. New Dietary Guidelines Released
6. Testing Financial Incentives for Improved Quality in Group Practices
7. Comments Sought on Quality Standards
Across Arizona
1. Dr. Carter Marshall Dies at 68
2. Arizona Rural Health Association Wins Grant to Promote Quality
3. Online Service Allows Arizona Seniors to Find Healthcare Benefits
4. Arizona 2-1-1 Will Offer Online Access
5. Summer Leadership Workshop for Girls with Disabilities
6. Dr. Eden to Retire
Grants and Opportunities
1. 2005 Award for Linkages Between Academia and Public Health Practice
2. Community-Campus Partnerships for Health
3. Creating Better Health Through Innovation
4. Social and Economic Development Strategies for Native Americans
5. Dental Trailers Still Available for Loan
6. New Access Points for Health Centers
7. Scholarships for Students in Health Information
8. Health Disparities Among Minority and Underserved Women
9. Research on Rural Mental Health and Drug Abuse Disorders
Calendar
- April 2, Saturday Academy, Southern Arizona Border Health Careers Opportunity Program (SABHCOP), Tucson
- April 3-8, Southwest PHilfest: Focus on Health Disparities, Tucson
- April 4-10, National Public Health Week
- April 5, Opportunities and Challenges for Public Health at the U.S.-Mexico Border: How Border Communities are Making a Difference, Tucson
- April 5-8, I.H.S. Intentional Injuries/Violence Prevention Course, Albuquerque
- April 6, Make Every Mother and Child Count: An Unmet Challenge, World Health Day Celebration, Brownsville/Matamoros
- April 6-7, Outcome-Based Quality Improvement Workshop, HSAG, Phoenix
- April 13-15, Chronic Disease Disparities in Arizona: From Awareness to Action, Phoenix
- April 16, Governance Basics for Rural Hospitals, Phoenix
- April 19, Arizona Rural Hospital Awards Luncheon, HSAG, Phoenix
- April 22-23, Arizona Public Health Association Spring Conference, Tucson
- April 25-28, Direct Service Tribes 2nd Annual Conference, Albuquerque
- April 25-29, 17th Annual Arizona Indian Council on Aging Conference, Tucson
- April 26- 27, National Public Health Performance Standards Program Training Workshop, Scottsdale, Information available from 202-783-5550, ext. 269, rrajan@naccho.org
- April 28, Public Health and Community Design, Scottsdale
- April 29, Foundation Fundraising: An Introductory Course, Phoenix
- April 29-May 1, 17th Annual I.H.S. Research Conference, Seattle, Washington
- May 1-8, Cover the Uninsured Week, nationwide
- May 8-14, National Women’s Health Week, nationwide
- May 17, Medication Reconciliation Through the Continuum of Care, videoconference in Phoenix and Tucson
- May 17-21, 28th Annual National Rural Health Association Conference, New Orleans
- May 20, EMS Conference, You Bet Your Life, Tucson
- June 8-10, 2005, Third Annual Western Region Flex Conference, Phoenix
Mark Your Calendars!
National News
NRHA Launches Quality Initiative
The National Rural Health Association (NRHA) launched Quality Through Collaboration, a five-year effort to promote access to coordinated, high quality care in every rural community. It comes in response to an Institute of Medicine of the National Academies (IOM) report released in November 2004. The IOM report urges developing quality improvement models that work in the rural environment, engaging federal partners to make rural health care a priority, and supporting rural communities in the areas of health care workforce, financing and information and communication technology. The report emphasizes the need for collaboration (between health care providers and between providers and community members) and the imperative to integrate population health care into personal health services.
Improvement in rural health care quality involves participation from individuals and organizations that impact the entire continuum of rural health care including educators, policymakers, public health administrators, hospital and outpatient care, as well as emergency medical services, home health care providers and primary care providers. To learn more about the NRHA Quality Initiative and how to be involved, visit
www.NRHArural.org/quality . (See related notice of award to Arizona Rural Health Association in Across Arizona section below.)
Technical Assistance for Rural Health Clinics
The Federal Office of Rural Health Policy (ORHP) is offering a conference call series that will provide Rural Health Clinic staff with technical assistance and RHC specific information. Presentations will include RHC billing, quality improvement, best practices, and more.
There is no charge to participate in the series. To sign up to receive announcements regarding call dates, topics, and speaker's presentations, please click here. Each call will be one hour in length and will include a 45 minute speaker presentation with 15 minutes for a question and answer session. All questions and answers will be posted at the ORHP Conference Call Series web site and the National Association of Rural Health Clinics web site, www.narhc.org.
Questions? Please contact the Project Director, Bill Finerfrock at (202) 543-0348 or at info@narhc.org.
Computerized Physician Order Entries Examined
Hospitals have come under pressure from patients and health insurers to lower the rate of medication errors and adverse drug events. A small but growing number have purchased computerized physician order entry (CPOE) systems. These systems, credited with lowering medication errors by up to 81%, can flag harmful drug-drug interactions, eliminate mistakes due to illegible handwriting, and reduce the likelihood of errors that stem from drugs with similar names.
Instead of preventing such mistakes, a new study finds that a widely used CPOE system actually fostered 22 types of medication error risks, some of them with disturbing frequency. The study appears in the March 9 issue of the Journal of the American Medical Association (JAMA).
The article cautions that hospitals should make sure that the system is installed and maintained in a way that fits with good medicine.
Problem patterns emerged from two sources, the study found. One was information errors caused by the fragmentation of key clinical data and by the failure to integrate the hospital's various computer and information systems. The second pattern was human-machine interface flaws that occurred because the CPOE system did not correspond with clinicians' usual work behavior or work organization.
An accompanying editorial calls for a meticulous approach to adopting these methods.
"[A]n information technology (IT) in and of itself cannot do anything, and when the patterns of its use are not tailored to the workers and their environment to yield high-quality care, the technological interventions will not be productive. This implies that any IT acquisition or implementation trajectory should, first and foremost, be an organizational change trajectory.” JAMA. 2005; 293:1197-1203, 1261-1263
Reservations About Mandatory Error Reporting
A survey of hospital leaders found that nearly 70 percent believed that a non-confidential, mandatory system would discourage staff from reporting patient safety incidents to their hospital's own internal reporting system, and almost 80 percent thought it would encourage lawsuits. The AHRQ-funded study was published in the (same issue as above item) March 16 issue of JAMA.
The researchers also found that more than 80 percent felt the names of both the hospital and involved staff members should be kept confidential, although respondents from states with mandatory, non-confidential systems already in place were more willing to have hospital names released. Over 90 percent said their hospital would report serious injuries to their state hospital licensing agencies, but far fewer would report moderate or minor injuries. However, the hospital leaders surveyed generally did favor disclosing patient safety incidents to patients who were involved.
New Dietary Guidelines Released
An updated edition of Dietary Guidelines for Americans has been published jointly by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases. Sections include weight management, nutrition, physical activity, fats, carbohydrates, sodium and potassium, alcoholic beverages, and food safety. An Executive Summary (in English and Spanish versions) and the full report (English only) are available at: http://www.healthierus.gov/dietaryguidelines/
Testing Financial Incentives for Improved Quality in Group Practices
CMS has initiated a demonstration program in which ten large physician groups across the U.S. will participate in the first pay-for-performance initiative for physicians under the Medicare program. The Physician Group Practice demonstration gives physician groups an opportunity to demonstrate that improving care in a proactive and coordinated manner also saves money.
This program will assess both quality performance and quality improvement. It will focus on common chronic illnesses in the Medicare population, including congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, as well as preventive services, such as influenza and pneumococcal pneumonia vaccines and breast cancer and colorectal cancer screenings.
Physician groups will implement care management strategies designed to anticipate patient needs, prevent chronic disease complications and avoidable hospitalizations, and improve quality of care. Depending on how well these strategies work in improving quality and avoiding costly complications, physician groups will be eligible for performance payments.
Further information on the demonstration is available at
http://www.cms.hhs.gov/researchers/demos/pgp.asp
Comments Sought on Quality Standards
The National Committee for Quality Assurance (NCQA) is seeking comments on draft standards for Quality Plus — a new voluntary program designed to identify organizations that adopt innovative practices which promote quality care. The draft standards emphasize wellness and prevention, management of chronic illnesses, complex case management, physician and hospital performance measurement and other promising strategies for improving health care quality. Comments on the Care Management and Health Improvement and Physician and Hospital Quality standards sections of Quality Plus are due by April 18.
NCQA is a private, non-profit organization dedicated to improving health care quality which accredits a wide range of health care organizations and offers recognition programs for physicians and physician groups. Full details here.
Across Arizona
Dr. Carter Marshall Dies at 68
Carter L. Marshall, MD, MPH, Vice President of Clinical Quality Assessment at Health Services Advisory Group (HSAG) since 1992, died of pancreatic cancer on February 18, 2005. The son of a physician, he graduated magna cum laude from Harvard College in 1958, from Yale Medical School in 1962, and received his MPH from the Yale School of Public Health in 1964.
Dr. Marshall moved to Tucson in 1990. In addition to his work at HSAG, he was Clinical Research Professor in the Department of Family Medicine at the University of Arizona and Adjunct Professor at the School of Health Administration and Policy at Arizona State University. HSAG will commemorate Dr. Marshall by naming its annual rural hospital quality award for him. The first Carter L. Marshall Rural Hospital Quality Award will be given in April 2005.
Arizona Rural Health Association Wins Grant to Promote Quality
The Arizona Rural Health Association (AzRHA) was awarded a $9,500 grant by the National Rural Health Association to focus on promoting health care quality in rural areas. It was one of eight grants to state associations. The grants are intended help state rural health associations implement recommendations of the recent Institute of Medicine (IOM) Report Quality Through Collaboration: The Future of Rural Health.
The AzRHA project will sponsor a statewide forum of policy leaders on rural recruitment and retention issues. It proposes to review the workforce aspects of the IOM report as well as related strategic goals of the Arizona Rural Health Plan. It will then develop an action plan. Further details on AzRHA can be found here.
Online Service Allows Arizona Seniors to Find Healthcare Benefits
Benefits Checkup is an interactive, on-line program that enables seniors to determine what types of public and private benefits might be available to meet various health and social needs. It links seniors directly to the agencies that offer services and greatly simplifies the complex maze of services by indicating the benefits for which they are eligible. The project is a collaboration between the Governor’s Office and three Arizona foundations: the Virginia G. Piper Charitable Trust, BHHS Legacy Foundation and St. Luke’s Health Initiative. The National Council on Aging estimates that older Arizonans leave as much as $260 million in unclaimed benefits on the table each year. These could be in the form of financial aid, prescription drug coverage, volunteer opportunities, health care, home energy and nutrition assistance, and more. Visit the Benefits Checkup Arizona site for a demonstration.
Arizona 2-1-1 Will Offer Online Access
Arizona 2-1-1 is a statewide initiative that will give improved web-based access of health and human services and emergency resources. Arizona 2-1-1 Online should be available via the internet in late spring. The Arizona 2-1-1 team is starting outreach meetings across the state. In addition, volunteers are being invited to test the system. People can email az211@azgita.gov to indicate their interest in participating.
Arizona 2-1-1 Online will also serve as an official source for disaster response and homeland security information. For complete information, see http://www.az211.gov/.
Summer Leadership Workshop for Girls with Disabilities
Leaders for a Lifetime will offer a summer skill-building program in Tucson for 9th and 10th grade girls with physical, sensory, cognitive, emotional and learning disabilities. Activities will help students develop the capacities for leadership and success in areas of goal-setting and achievement, problem solving, decision making, negotiation, conflict resolution and self-advocacy. The program will take place in two tracks, Monday/ Wednesday or Tuesday/Thursday from June 6 – July 29, 2005. Scholarships are available.
The Aurora Foundation is the sponsor and will host information sessions on April 6, 11 and 14, 5:30 - 6:30 p.m. at their office, 48 N. Tucson Blvd.
Click here for details.
Dr. Eden to Retire
Governor Janet Napolitano has announced the retirement of Arizona Department of Health Services Director Catherine Eden at the end of the current legislative session.
She has held the position since May 2000. Eden also served as a member of the Arizona House of Representatives from 1990 to 1994, serving on the House Appropriations, Health, Judiciary, Insurance and Banking Committees.
Earlier, she was director of the Department of Administration, chaired the Governor's Cabinet and also was instrumental in establishing AHCCCS.
Grants and Opportunities
2005 Award for Linkages Between Academia and Public Health Practice
Application deadline: April 8, 2005
The Council on Linkages Between Academia and Public Health Practice recognizes exemplary community-based collaborative activities between public health practice agencies and institutions of higher learning. The 2005 Linkage award is focused on efforts to better recruit and retain public health workers. A one-page abstract of the project is required for entry for awards ranging from $1,000 - $250. The awards will be made to public health practice agencies. Details at: http://www.phf.org/Link/Call_for_abstracts2005.pdf
Community-Campus Partnerships for Health
Application deadline: April 15, 2005
Community-Campus Partnerships for Health, a nonprofit organization that promotes better health through partnerships between communities and institutions of high education is accepting applications for its 8th annual Introductory Service-Learning Institute, which will be held June 17-20, 2005, in the Cascade Mountains of Washington State.
The Summer Service-Learning Institute is designed for both new and experienced service-learning practitioners (faculty, staff, and community partners). National experts in service-learning serve as institute presenters and mentors.
Past institutes have drawn participants from a wide variety of disciplines and professions, including medicine, dental hygiene, dentistry, nursing, pharmacy, public health, physician assistant, physical therapy, pre-health professions, residency, and social work programs, as well as those from public health agencies and community-based organizations that have service-learning partnerships with such programs. Space is limited to twenty-three participants.Click here for complete details.
Creating Better Health Through Innovation
Letter of Intent deadline: April 18, 2005
Full proposal invitations: May 13, 2005
The VHA Health Foundation invites health care providers to submit their best, most innovative programs for funding consideration. The Foundation will award grants ranging from $100,000 to $250,000 to support promising initiatives at the local level that represent a novel and/or significantly better approach to solving a problem or need related to health and/or health care. The program encourages creativity, innovation and the adoption or adaptation of new ideas and practices in the health care industry. Programs selected for funding represent innovations that are beyond the concept stage, ready to implement, expand or further refine and are candidates for replication in other markets. Complete details: www.vhahf.org.
Social and Economic Development Strategies for Native Americans
HHS-2005-ACF-ANA-NA-0003
Application deadline: April 19, 2005 HHS’Administration for Children and Families (ACF) through the Administration for Native Americans is seeking proposals to strengthen Native American Families and healthy communities under three initiatives: (1) Projects that support rural communities; (2) projects that provide prevention and intervention programs for youth and Families; and (3) projects that promote healthy relationships to strengthen Families in concert with ACF's goals and objectives. Eligible community and faith-based organizations are invited to submit applications that provide services directly to Native American people. ANA's FY 2005 program goals and areas of interest are focused on expanding community-based, culturally appropriate economic development, social development and governance activities. ANA is interested in projects designed to grow Native American economies, strengthen Native Families, and decrease the high rate of social challenges caused by the lack of community-based business, social, and economic infrastructure. Approximately $20 million will fund between 110-120 awards.Click here for details.
Dental Trailers Still Available for Loan
Application Deadline: May 1, 2005
The Office of Oral Health (OOH), Arizona Department of Health Services (ADHS) has available dental trailer to assist communities with underserved populations in establishing permanent facilities or programs. The trailers are leased for a nominal fee.
Each 8ft. by 40 ft. dental trailer will be delivered to the qualified recipient furnished with two patient chairs, an x-ray unit and processor, an autoclave and other small miscellaneous equipment items. The recipient will be responsible for providing dental staff, instruments and supplies.
Although oral disease has declined in many populations, other groups still are needlessly afflicted with oral disease that can be prevented or treated effectively.
Click here for details.
New Access Points for Health Centers
HRSA 05-101
Application deadline: May 23, 2005
The New Access Points program supports the establishment of new service delivery sites for each type of Health Centers funded under Section 330 of the Public Health Service Act. Each application for support to establish a new site must identify a population in need of primary health care services, and propose a specific plan to increase access to care and reduce disparities identified in the population or community to be served. The program includes: 1) Community Health Centers, section 330(e); 2) Migrant Health Centers, section 330(g); 3) Health Care for the Homeless program, section 330(h); 4) Public Housing Primary Care, section 330(i); and 5) School Based Health Centers, section 330.
Full details available here.
Scholarships for Students in Health Information
Application deadline: May 27, 2005
American Health Information Management Association’s Foundation of Research and Education (FORE) offers merit scholarships to outstanding undergraduate students ursuing degrees in health information administration and health information technology. Scholarships are also available to credentialed health information management (HIM) professionals pursuing graduate degrees to further their careers in HIM. Scholarships range from $1,000 to $5,000 and are awarded based on academic achievement, work and volunteer experience and the quality of references provided. Click here for details.
Health Disparities Among Minority and Underserved Women
PA-04-153
Application deadline: June 1, 2005
This initiative aims to stimulate research aimed at reducing health disparities among racial/ethnic minority and underserved women. More specifically, it seeks applications for: (1) research related to health promotion or risk reduction among minority and underserved women age 21 and older; and, (2) intervention studies that show promise for improving the health profile of minority and underserved women.
Proposals should focus on enhancing the body of knowledge of a variety of factors (e.g., social, economic, demographic, community, societal, personal, cultural) influencing the health promoting and health compromising behaviors of racial and ethnic minority women and underserved women and their subpopulations. Full details here.
Research on Rural Mental Health and Drug Abuse Disorders
PA-04-061
Application deadline: June 1, 2005
The purpose of this program is to stimulate research on mental health or drug abuse problems in rural and frontier communities that will enhance understanding of structural (including community risk and resilience factors), cultural, and individual factors that may limit the provision and utilization of prevention and treatment services in these communities. It also proposes to generate knowledge for improving the organization, financing, delivery, effectiveness, quality, and outcomes of mental health and drug abuse services for diverse populations in rural and frontier populations.
Applications may focus exclusively on mental disorders, drug abuse disorders, or on the co-occurrence of these and related disorders. Sponsors are the National Institute of Mental Health and the National Institute on Drug Abuse. Full details here.
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 discerning comments, invaluable suggestions or enigmatic questions are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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