A review of the 45 grant applications submitted to the Federal Office of Rural Health Policy for Fiscal Year 2005 demonstrated that the State Flex Programs are committed to quality and performance improvement, with 30 percent of requested funding across the states going toward a variety of quality and performance improvement activities spanning a range of clinical, operational, and financial themes. Categories of quality improvement activities included improving clinical, operational, and financial performance; financial and organizational performance; promoting a culture of quality improvement; participating in national quality efforts; implementing health information technology (HIT) systems; and addressing patient safety and satisfaction issues.
State activities acknowledge the different quality measurement needs of rural hospitals through the development of benchmarks and transfer protocols specific to CAHs and other small, rural hospitals. Some state programs proposed activities to build in-state knowledge and capacity and to assess current conditions, particularly in the areas of balanced scorecards, HIT, and patient safety. The Flex Program?s grant-making capacity supports a wide range of local initiatives designed to improve the quality of patient care and hospital operations.
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.
Well-designed wellness programs can keep healthy employees healthy, support employees with health risks to improve their health behaviors, and facilitate organizational efforts to achieve workforce performance goals. Productivity lost through absenteeism, sickness, and injury was a key driver for the development of the Maine Department of Transportation (DOT) Region 5 wellness program, offered since 2004. In 2008, the Maine DOT engages the University of Southern Maine's Muskie School of Public Service to create a more robust and sustainable evaluation process for their employee wellness initiative, as assist in planning to replicate the Region 5 program across the state. The Muskie School evaluation team developed a logic model as the cornerstone for determining the components for program evaluation. The desired outcome of a "safe, injury-free work environment that costs less to maintain and operates at full capacity" provided the direction to develop activities, inputs, outputs, and short-term outcomes.
This paper describes the EMS-related projects that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially. Because of the variability across states in the specifics of EMS activities proposed in grant applications, a method was sought that would create a logical framework for classifying activities, in order to better understand the types of EMS challenges that states are trying to address with Flex funding. The project team identified the Rural and Frontier EMS Agenda for the Future (R/F Agenda) as an appropriate guide document for cataloging and describing state proposed activities. The EMS activities were assigned to one or more of fourteen EMS attributes from the R/F Agenda. State Flex grant funds are not sufficient to ameliorate all rural EMS problems. Use of the R/F Agenda for classifying state Flex activities not only allows for identification of EMS problem areas that are most frequently being addressed with the use of Flex grant funds, but also identifies those challenges that likely need to be addressed through other mechanisms. This report will provide the EMS, rural health, and federal policy constituencies with an overview of the extent to which nationally recognized rural EMS challenges are being addressed with Flex program funding.
The purpose of this study was to identify whether and to what extent there are rural-urban differences in underinsured rates among the privately insured, and, where differences exist, to understand what characteristics of rural residents are related to their likelihood of being underinsured. Using the 2001 and 2001 Medical Expenditure Panel Survey (MEPS), the authors examined the annual out-of-pocket health care expenditures for U.S. residents under age 65 that were continuously insured by a private plan in either 2001 or 2002.
Findings showed that, despite having private health insurance coverage, those who use medical services continue to pay for a substantial portion of their own health care costs, particularly those living in rural areas. The average rural non-adjacent individual paid for 39% of their care in 2001 or 2002, compared to 35% for rural adjacent and 32% for urban individuals. Additional findings showed that one out of eight non-adjacent residents is underinsured (12.4%), compared to 10% of rural adjacent and 7% of urban residents.
The Shaping Youth Behavior report addresses the relationship between policies and environmental variables in schools and the eating and physical activity behaviors of children and youth. It is designed to be used as a resource on the following topics:
Nutrition Education in Schools
The School Food Environment
Food Marketing Within the School
Incorporating Physical Activity and Quality Physical Education in Schools
This report, prepared for the Maine Hospice Council and funded by the Carpenter Foundation, presents findings of a qualitative study of barriers to hospice utilization. This study includes the perspectives of all 26 Medicare certified hospice providers in Maine. Significant findings of the qualitative study include
A continuing need to educate the general public about hospice and the Medicare benefit.
Maine health care providers have low referral rates to the hospice programs and often misunderstand the regulations and guidelines of the hospice benefit.
The referral process to hospice programs is based on fragile systems of communication, fraught with potential miscues, misunderstandings, and missed opportunities.
Providers indicate a strong interest in coming to the table to collectively address the underutilization of the Medicare hospice benefit in Maine.
Active consumerism may be an important key to increased dialogue and acceptance of end-of-life care--demand for hospice services may not increase until the consumer is engaged in the conversation.
Certain components in the Medicare hospice benefit appear open to varying interpretation and application, causing confusion for consumers and referring physicians, and may be a potential source of tension between certified agencies.
Significant workforce issues impact the ability of Maine hospice programs to meet even the current demand for services.
Provision of hospice in long-term care facilities is both an opportunity and a challenge.
Objective: Develop rural-specific assessment tools to be used by researchers and practitioners to measure the activity-friendliness of rural communities. Method: The tools were created through a mixed-methods investigation into the determinants of physical activity among rural populations. This informed the development of a conceptual framework defining activity-friendly rural environments. Questions were generated to reflect applicable existing urban-based variables and rural conceptual model elements. Pilot testing was conducted in seven rural US communities during the fall of 2008. Inter-rater reliability was assessed. Results: The Rural Active Living Assessment (RALA) Tools include three components: Town-Wide (18 town characteristic questions, and inventory of 15 recreational amenities), Program and Policy (20 questions), and Street Segment (28 questions). We found that the Town-wide and Program and Policy tools were feasible for community members to implement. The observed agreement and k statistic across all items for the Street Segment Assessment were substantial (91.9% and 0.78, respectively). Conclusions: The RALA Tools were shown to be feasible and reliability was supported. They assess features believed to be supportive of active living in rural environments, offer users a resource to assess rural environments for activity-friendliness, and may also inform the design of interventions to help rural communities become more active and healthy. [Journal Abstract]
More than twenty years of research has demonstrated that rural residents are
at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas.
Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic characteristics of the rural and urban
uninsured. Section IV examines differences in the employment
characteristics of the rural and urban uninsured. The final section discusses policy implications for covering the rural uninsured.
Methods and an appendix of data tables provide source material for the chartbook.
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