The purpose of the project described in this paper was to assess and describe the food environment facing public assistance clients in a rural county in Maine. Using the concept of a "food desert" and an objective tool for rating participating food outlets, the research team developed a spatial model of client access to healthy foods. The final map shows that most rural residents are within acceptable distances of well-rated stores, though these may not be supermarkets. Research Highlights: "Food Deserts" are defined by distance to supermarkets as sources of healthy food. Stores of all types can be objectively rated for fresh, reasonably priced healthy food. Food deserts re-assessed through ratings may not be true deserts. Information campaigns based on ratings can identify local places and foods to meet consumer needs
Close to two-thirds of children in Maine under the age of five need child care while their parents work. The quality of child care is a critical policy concern, since research tells us that early childhood experience plays a major role in later-life success for individuals. The authors report on findings from three studies regarding child care arrangements in Maine and the quality of child care in the state and nationally. They describe the development and implementation of Maine's new Quality Rating System (QRS) for child care facilities, Quality for ME, and the role that it can play both in improving child care and in helping parents chose quality care.
Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in 8 small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of 3 patient safety interventions: the Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey, use of personal digital assistants (PDAs), and sharing of emergency room protocols. The experience suggested that a collaborative model between rural hospitals, a payer, a hospital association, a quality improvement organization, and academic institutions can effectively support patient safety activities in rural hospitals. Successful implementation of the 3 patient safety interventions depended on leadership provided by nursing and patient safety/quality managers and open, trusting communications within the hospitals. [article abstract]
Context: National data demonstrate that mental health visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture this issue.
Purpose: This study investigates the use of Critical Access Hospital (CAH) ERs by patients with mental health problems to understand the role these facilities play in rural mental health needs, and the challenges they face.
Methods: We collected primary data through the combination of a telephone survey and ER visit logs. Our sampling frame was the universe of CAHs at the time the survey was fielded.
Key Findings: 43% of CAHs surveyed operate in communities with no mental health services, while 9.4% of all logged visits were by patients identified as having some type of mental health problem. The most common problems identified were substance abuse, anxiety and psychotic disorders. Only 32% of CAHs have access to onsite detoxification and 2% have inpatient psychiatric services, meaning that patients in need of these services typically must leave their communities to gain treatment.
Conclusions: The lack of community resources may impact CAHs ability to assist patients with mental health problems. Among those with a primary mental health condition 21% left the ER with no or unknown treatment, as did 51% of patients whose mental health condition was secondary to their emergent problem. Patients in need of detoxification or inpatient psychiatric services often must travel over an hour to obtain these services, potentially creating significant issues for themselves and their families
Background: A study was conducted in 2004 to determine if 26 interventions?distributed among nine patient safety areas and as recommended by an expert panel as relevant to rural hospitals?would be validated in terms of relevance and implementability for small and rural facilities.
Methods: The chief executive officers (CEOs) and/or key managers responsible for patient safety activities in a diverse group of 29 small and rural hospitals assessed the potential effectiveness and feasibility of the 26 interventions. Representatives of 25 hospitals participated in structured, follow-up phone discussions.
Results: Adverse drug events were the highest-priority area for 14 hospitals, followed by patient falls (selected by 5 hospitals). Some hospitals had already implemented intervention 1 (use at least two patient identifiers) and intervention 6 (read back of verbal orders) and thus ranked them highly, especially for implementability. Intervention 3 (24-hour pharmacist coverage) was ranked low, especially on implementability. Interventions involving health information technology were ranked lower by the hospitals than by the expert panel.
Discussion: Safety interventions should reflect the general state of the science of safe practices while incorporating relevant contextual issues unique to rural hospitals. The results have important implications for survey and accreditation activity, and the focus of technical assistance and research efforts.