Among those with the highest levels of mental health need, rural children are more often identified with an ADHD diagnosis than urban children (24.7% vs. 19.8%; p<.05).
The higher prevalence of ADHD diagnosis and stimulant prescribing in rural areas likely results from a greater need for such treatment, based on scores from the Columbia Impairment Scale.
Among those with a possible mental health impairment, rural children are less likely to be diagnosed with a psychiatric illness other than ADHD and are less likely to receive counseling.
Higher rates of poverty, public coverage, and mental health impairment among rural children explain their greater likelihood of a mental health prescription and stimulant use.
Suggested citation: Anderson, N., Neuwirth, S., Lenardson, J.D., & Hartley, D. (2013, April). Rural children experience different rates of mental health diagnosis and treatment. (Research & Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.
This Brief was prepared by Erika Ziller and Trish Riley of the Muskie School of Public Service to inform an April 8, 2013 colloquium convened to explore options and implications of the Affordable Care Act (ACA) for Maine.
Highlights: In addition to increased Medicaid funding, in January 2014, the ACA will provide federally subsidized health care coverage for individuals with incomes up to 400% for Medicaid in a state, coverage will be subsidized by federally funded tax credits through health insurance exchanges, now known as the “Marketplace.” Those under 100% FPL are not eligible for Marketplace subsidies but could be eligible for Medicaid, depending upon state decisions.
Even if Maine does not choose to cover all those newly eligible under the ACA, beginning in 2014, MaineCare must extend eligibility for children aging out of foster care until they are 26, regardless of income. An estimated 46,000 uninsured individuals, nearly all of whom will be adults without children, would be newly eligible for Medicaid should Maine decide to participate in the ACA optional Medicaid coverage.
If Maine chooses not to participate in the ACA optional Medicaid program, the 14,000 uninsured childless adults with incomes between 100% and 138% FPL referenced above would be eligible to participate in subsidized coverage through the federal Marketplace, although there is disagreement over the affordability of these plans for this group. The 32,000 uninsured childless adults with incomes below 100% FPL would be ineligible for any subsidy through the Marketplace.
Continued coverage for currently eligible populations in Maine is uncertain. Maine must comply with a significant number of ACA provisions related MaineCare. These new requirements must be in place in all states, whether or not states extend eligibility in the Medicaid program or operate a health insurance Marketplace.
This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as "Obamacare". These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care Forum breakfast session, Feb. 26, 2013 at the Senator Inn in Augusta,sponsored by the Maine Health Access Foundation.
Research has shown that essential information is often missing during transfer of nursing facility residents to the ED, and communication problems between nursing facilities an EDs are one of the most cited barriers to providing quality patient care. Tools, such as tranfer forms and checklists, that improve communication between settings of care help improve patient safety and quality of care.
This Policy Brief includes an appendix of transfer forms from 11 organizations.
Transfers to the hospital emergency department (ED) are common for many nursing facility (NF) residents, with over 25% experiencing at least one ED visit annually, and many encountering repeat visits.
Communication issues, including incomplete information during transfer, impact clinical care of the elderly NF resident transferred to the ED.
Several studies strongly recommend the use of standardized transfer forms as a way of improving communication, which ultimately improves patient safety and quality of care. However, standardized transfer forms, in and of themselves, are not sufficient to solve communication issues between the sites of care (NF, EMS, ED).
The establishment of ongoing relationships between hospital, EMS, and nursing facility staff help facilitate effective communication regarding patient needs during the transfer process and encourage the development of a systems approach to the transition of care.
Why are standardized transfer forms helpful?
For Nursing Facilities: they help facilitate accurate exchange of information, reduce potentially avoidable hospitalizations, and provide a record of the patient's condition upon return.
For Nursing Facility residents: they help to increase the efficiency and effectiveness of transfer and treatment and may help the resident avoid additional health complications and emotional trauma.
For EMS: they provide the needed information to treat the patient en route and facilitate an accurate and comprehensive handoff report to the hospital.
For Hospitals: they help facilitate effective assessment and treatment of the patient in the ED, minimizes time spent in the ED, and reduces unnecessary admissions.
For Policymakers: to help reduce costs associated with unnecessary hospitalizations and longer ED lengths of stay.
Suggested citation: Pearson KB, Coburn AF. Emergency Transfers of the Elderly From Nursing Facilities to Critical Access Hospitals: Opportunities for Improving Patient Safety and Quality. (Policy Brief #32). Portland, ME: Flex Monitoring Team; January 2013.
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.(http://flexmonitoring.org/documents/BriefingPaper30_Patient-Safety-Cultu...) A listing of additional tools and resources to enhance patient safety culture is provided in both the Policy Brief and the Briefing Paper.
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.
This policy brief is part of a series of policy briefs by the Flex Monitoring Team identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and Critical Access Hospitals. Key Findings:
Hospital falls are a serious patient safety problem, accounting for nearly 84% of all inpatient incidents.
Most falls commonly occur as a result of medication related issues, toileting needs, and hospital environmental conditions.
Effective falls interventions target both intrinsic (e.g. physiologic) and extrinsic (e.g. environmental) risk factors.
Effective falls prevention teams are interdisciplinary and ideally include pharmacists, nurses, physical therapists, medical, and quality officers and are imbedded in a culture of patient safety.
Education for and communication across all staff contributes to successful falls prevention programs.
Reporting falls data to one of the national organizations allows for benchmarking.
Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This working paper and policy brief provide information on prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.
Critical Access Hospitals play an important role in the provision of long term care (LTC) services in rural communities, and are more likely than other rural and urban hospitals to provide "core" LTC including skilled and intermediate care nursing services. Trends over time showed a greater decline in CAHs than other hospitals in the provision of LTC services, suggesting that changes in LTC reimbursement policies could affect LTC access in rural communities.
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.