This report describes how the climate of Casco Bay watershed in Maine has changed over the past century and how the future climate of the region is likely to be affected by human emissions of heat-trapping greenhouse gases that are warming the planet. Overall, the region has been getting warmer and wetter over the last century, and these trends have increased over the last four decades. To generate future projections for Portland, Farmington, and Lewiston, simulated temperature and precipitation from four climate models were fitted to local, long-term weather observations. Unknowns regarding fossil fuel consumption were accounted for by using two future scenarios. The scenarios describe climate in terms of temperature and precipitation for three future periods: the near-term, 2010-2039, mid-century, 2040-2069, and end-of-century, 2070-2099. All changes are relative to a historical baseline, 1970-1999. Some future changes are inevitable, so smart choices must be made to ensure our society and our environment will be able to adapt to coming change. But with prompt action, many of the most extreme consequences of climate change could be avoided or their worst impacts reduced.
The authors discuss the use of patient safety culture surveys as a means to promote organizational learning and build a culture of safety. Detailed information on the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture and adaptation for use in rural hospitals is available in the Briefing Paper. A listing of additional tools and resources to enhance patient safety culture is provided in both the Policy Brief and the Briefing Paper.
Key Facts:
Establishing a culture of patient safety includes promoting a non-punitive environment of shared accountability (a just culture), encouragement to report errors (a reporting culture), and development of a learning culture.
Research demonstrates a positive relationship between organizational culture and safety outcomes for both patients and employees.
Use of the AHRQ Hospital Survey on Patient Safety Culture has been effective for planning, implementing, and evaluating targeted patient safety interventions in Critical Access Hospitals.
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.
The goal of this project was to expand opportunities for integrated recreational, social and cultural activities in Maine for people with disabilities. The project staff used a multi-faceted approach to raise awareness and inform recreation program owners and managers to improve access and accommodation and to provide communication tools to inform consumers of accessible recreational opportunities. Staff worked to make contacts with existing activities in the state and to link and collaborate with the programs that could offer support and sustainability. Activities proposed included:
1. Establishing a resource network of recreation facilities, school, and community/municipal program administrators and consumers with disabilities who utilize facilities/programs to identify ways to expand access and utilization.
2. Developing and disseminating a web-based Universal Access and Technical Assistance Tool Kit for recreational facilities to improve access.
3. Working with Portland Connections to learn about the model and facilitate the replication of it in three communities in the state.
4. Assembling the information for marketing and distribution in coordination with a consumer-friendly website that lists accessible recreational, social and cultural facilities and activities along with resource links for facilities.
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.
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