Using a national inventory of facilities providing substance abuse treatment services, the authors identified rural detox providers and surveyed them to examine their characteristics, access issues for detox services, and the fit of rural detox services within the substance abuse treatment system. They also examined the geographic distribution of these providers among large rural towns, small rural towns, and isolated rural areas. The results of the 2008 survey indicate that most rural residents (82%) live in a county without a detox provider and that providers are concentrated in large rural towns. While rural detox providers offer care across a number of substances, the full range of professionally-recommended detox services is incomplete in rural areas. Travel distances to detox services are lengthy and access to specialty programs for patients with specific needs (e.g., adolescents) is limited.
This study investigated inpatient psychiatric units in small rural hospitals to determine their characteristics, the availability of community-based services after discharge, and the impact of the new Medicare payment system on these units. METHODS: Unit managers in all rural hospitals with fewer than 50 beds that had a psychiatric unit in 2006 (N=74) were surveyed on the telephone. RESULTS: On average these units had ten beds and 230 admissions per year. Medicare was the major payer (median of 84%). Typical staffing includes no more than one staff member from each category: psychiatrist, psychologist, social worker, counselor or therapist, and nurse practitioner. Common diagnoses reported were depression (74% of units), schizophrenia or other psychoses (42% of units), and dementia or Alzheimer's disease (57% of units). CONCLUSIONS: Hospital staff reported little difficulty obtaining postdischarge care, and most staff clinicians provided outpatient services locally. Thus mental health services infrastructure appears better in these communities than in most rural communities, but it may be weakened by recent closures reported by some units, caused, in part, by changes in Medicare reimbursement.
Under contract with the Robert Wood Johnson Foundation, researchers at the Muskie School of Public Service are evaluating the community outreach and training efforts of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). This Year One report (8/15/2007 - 8/15/2008) provides an overview of the initiative and the five demonstration sites; a description of the evaluation framework and design; the evaluation questions and methods; preliminary evaluation results; and a summary of preliminary findings and next steps.
Preliminary Findings:
Outreach and training efforts are reaching the intended audiences;
Trainings are a critical component of the outreach model;
EDIPPP is perceived as a credible program;
Most referrals are appropriate and given by a professional;
Several factors are associated with intentions to refer;
EDIPPP operates in different community and policy contexts.
This study, conducted on behalf of the Emergency Department Use Work Group of the Maine Advisory Council on Health System Development provides an analysis of visits to hospital emergency departments in Maine that took place in 2006. The study relied on two sources of data: a comprehensive file of hospital discharge records provided by the Maine Health Data Organization; and comprehensive claims records for most privately insured residents in Maine and most MaineCare members. The 2006 data used for this analysis pre-dated some of the initiatives undertaken by the Department of Human Services to improve access to primary care and reduce emergency department use among MaineCare members.
Key findings with regard to emergency department (ED) use:
Maine's emergency department use in 2006 was, in aggregate, about 30% higher than the national average.
Maine's rate of use in every age cohort was higher than the national average for the same age cohort.
The highest prevalence of frequent ED users (4 or more visits in a year) is found among infants, and 19 to 24 year olds.
Use of emergency department care for outpatient care by MaineCare members is more than three times as high (918 outpatient visits per 1000) as rates of use by privately insured residents (284 per 1000).
The uninsured are responsible for 9 percent of emergency department visits. ED visits by uninsured patients are concentrated among young adults. Between the ages of 15 and 44, 15 percent of emergency department visits are generated by the uninsured.
Rate of emergency department use varies substantially by health service area; Geographic variation in emergency department use rates is seen among both privately insured and MaineCare members with substantial overlap of high and low use areas for these two populations, suggesting that use rates are affected by area-specific health system factors that affect the total population.
A review of diagnoses frequently seen in emergency departments in Maine suggests that a substantial number of visits are made for conditions that could be appropriately treated in office or clinic settings.
Following up on the Environmental Scan report (http://muskie.usm.maine.edu/Publications/rural/Barriers-to-Integration-E...), the authors interviewed representatives from Maine's business community, payers, purchasers, professional associations, state legislators, advocacy organizations, state government, and provider organizations. The interviews provided a context to understand the barriers to integration in Maine and develop recommendations to overcome them. This Final Report presents key findings from the study, recommendations for addressing barriers, and next steps for moving forward. This study recognizes the need for integration of behavioral and physical health services in all settings. Although most discussions of integration focus on the development of behavioral health services in primary care settings, this study acknowledges the challenges faced by individuals with chronic and/or severe behavioral health problems in obtaining vital physical and primary health care.
One of four issue briefs related to the full length report entitled "Shaping Youth Behavior: Impact of School Environments on Physical Activity and Food Choices" designed to reinforce the points presented in this report in a concise and accessible format. These issue briefs contain best practices, relevant action steps, and a resource list that points the reader to supporting information. They are ideal for printing and distributing to stakeholders, policymakers, and other interested parties.
One of four issue briefs related to the full length report entitled "Shaping Youth Behavior: Impact of School Environments on Physical Activity and Food Choices" designed to reinforce the points presented in this report in a concise and accessible format. These issue briefs contain best practices, relevant action steps, and a resource list that points the reader to supporting information. They are ideal for printing and distributing to stakeholders, policymakers, and other interested parties.
This briefing paper examines the project activities proposed by states in their Fiscal Year 2004 Flex Program grant applications (September 2004-August 2005) and highlights recent trends in State Flex Program planning, development, and implementation.
Of the forty-five state grant applications reviewed, funding requests were greatest for activities related to network development (18%), quality improvement (21%), and supporting existing CAHs (22%). Some states provided funding directly to CAHs under state administered mini-grant programs to support hospital specific activities while others chose to use funds to support more statewide and/or regional activities to address the needs of CAHs through conferences and meetings, training and education initiatives, technical assistance services, recruitment and retention initiatives, operational assessments, and community needs assessments among others.
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