Rural Health

Developing Program Performance Measures for Rural Emergency Medical Services

Abstract: 

 Prehospital Emergency Care

Developing Program Performance Measures for Rural Emergency Medical Services

Authors: John Gale, MS; Andrew Coburn, PhD; Karen Pearson, MLIS, MA; Zach Croll, BA; George Shaler, MPH

University of Southern Maine, Muskie School of Public Service

Background: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care.

Objective: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program. The measures are intended for use in monitoring rural EMS performance at the community level as well as for use by State Flex Programs and the Federal Office of Rural Health Policy (FORHP) to demonstrate the impact of the Flex Program.

Methods: To evaluate the performance of EMS in rural communities, we conducted a literature search, reviewed research on performance measures conducted by key EMS organizations, and recruited a panel of EMS experts to identify and rate rurally-relevant EMS performance measures as well as emergent protocols for episodes of trauma, ST Elevation Myocardial Infarction (STEMI), and stroke. The rated measures were assessed for inclusion in the final measure set.

Results: The Expert Panel identified 17 program performance measures to support EMS services in rural communities. These measures monitor the capacity of local agencies to collect and report quality and financial data, use the data to improve agency performance, and train rural EMS employees in emergent protocols for all age groups.

Conclusion: The system of care approach on which this rural EMS measures set is based can support the FORHP's goal of better focusing State Flex Program activity to improve program impact on the performance of rural EMS services in the areas of financial viability, quality improvement, and local/regional health system performance. [Journal abstract provided by authors]

Suggested citation:

Gale, J., Coburn, A., Pearson, K., Croll, Z., & Shaler, G. (2016). Developing program performance measures for rural emergency medical services. Prehospital Emergency Care, 1-9. doi: 10.1080/10903127.2016.1218978

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
September 9, 2016
URL: 
http://dx.doi.org/10.1080/10903127.2016.1218978

Understanding the Business Case for Telemental Health in Rural Communities

Abstract: 

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment. [Journal Abstract]

Suggested Citation: Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2015). Understanding the business case for telemental health in rural communities. Journal of Behavioral Health Services and Research. doi: 10.1007/s11414-015-9490-7 [epub ahead of print].

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
December 22, 2015

Exploring the Business Case for Children's Telebehavioral Health

Abstract: 

This brief, authored by John Gale, M.S. and David Lambert, Ph.D. from the University of Southern Maine's Muskie School of Public Service, Maine Rural Health Research Center, explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health services. In the first section, the authors place children’s telebehavioral health within the context and demands of today’s rural healthcare system, where the majority of children’s telebehavioral health services are delivered. They then describe three examples of the use of telebehavioral health to serve children, adolescents, and families in rural communities. The brief concludes by exploring the business case for telebehavioral health including the issues and challenges of service delivery, coordination, and financing. This brief is informed by a national study of telemental health (serving children, adults, and older persons) in rural health systems conducted by the authors and updated to reflect the latest information on three case examples.

For more information, please contact John Gale at john.gale@maine.edu

Suggested citation: Gale J, Lambert D. Exploring the Business Case for Children's Telebehavioral Health. Washington, DC: The Technical Assistance Network for Children's Behavioral Health, The Institute for Innovation & Implementation; March, 2015. Brief.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 2, 2015

Rural and Remote Food Environments and Obesity

Abstract: 

Researchers at the Maine Rural Health Research Center Rural have published a review in the January 2015 issue of Current Obesity Reports describing the rural community, home, and individual food environments and what is known about their roles in healthy eating.

Abstract: Rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities.

Suggested Citation: Lenardson, J. D., Hansen, A. Y., & Hartley, D. (2015). Rural and remote food environments and obesity. Current Obesity Reports. doi: 10.1007/s13679-014-0136-5

Publication Type: 
Journal Article
Publish Date: 
January 30, 2015
URL: 
http://link.springer.com/article/10.1007%2Fs13679-014-0136-5#page-1

Rural Health Clinic Readiness for PCMH Recognition

Abstract: 

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). Researchers at the Maine Rural Health Research Center (University of Southern Maine) present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development.

Key Findings

  • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
  • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
  • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
  • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.

For more information on this study, please contact John Gale.

Suggested Citations:

(Working Paper) Gale JA, Croll Z, Hartley D. Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Working Paper No. 57.

(Policy Brief) Gale J, Croll Z, Hartley D.Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Research & Policy Brief PB-57.

 

Publication Type: 
Working Paper
Publish Date: 
January 30, 2015
URL: 
http://muskie.usm.maine.edu/Publications/rural/RHC-Readiness-for-PCMH-Recognition-Working-Paper

Profile of Rural Residential Care Facilities: A Chartbook

Abstract: 

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook from the Maine Rural Health Research Center presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF).  Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents.  Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs.  Compared to urban facilities, the policies of rural RCFs appear less likely to support aging in place.

Suggested Citation: Lenardson JD, Griffin E, Croll Z, Ziller EC, Coburn AF. Profile of Rural Residential Care Facilities: A Chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014.

Publication Type: 
Report
Publish Date: 
May 20, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/Chartbook-Rural-Res-Care-Facilities.pdf

Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Full report (Working Paper): High Deductible Health Insurance Plans in Rural Areas

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. Rural Residents More Likely to Be Enrolled in High Deductible Health Plans. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Research & Policy Brief PB-55.

Publication Type: 
Research and Policy Brief
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/PB55-High-Deductible-Health-Plans-Rural.pdf

High Deductible Health Insurance Plans in Rural Areas

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Associated Research & Policy Brief: Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. High Deductible Health Insurance Plans in Rural Areas. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Working Paper #55.

Publication Type: 
Report
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/High-Deductible-Insurance-Plans-Rural.pdf

Telemental Health in Today's Rural Health System

Abstract: 

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of telemental health programs. 

Key Findings:

  • The scope and volume of services provided are often modest suggesting that the business case for these programs may be weaker than the clinical case.
  • The programs in our study were able to secure funding and other supports to implement services, but their ability to maintain and expand services to address unmet need is less certain.
  • Telemental health primarily addresses issues related to the distribution of providers and travel distances to care. However, there are underlying practice management issues, common to all mental health practices in rural areas, which pose challenges to the scope and sustainability of telemental health, including reimbursement, provider recruitment and retention, practice economies of scale, high rates of uninsurance, and high patient “no show” rates.
  • It is becoming increasingly apparent that telehealth technology, by itself, cannot overcome service delivery challenges without underlying reform to the mental health service system.

Suggested Citation:

Lambert, D., Gale, J., Hansen, A. Y., Croll, Z., & Hartley, D. (2013). Telemental health in today's rural health system. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

 

Publication Type: 
Research and Policy Brief
Publish Date: 
December 18, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/Telemental-Health-Rural.pdf

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences?

Abstract: 

Adolescent alcohol use is a significant public health problem among U.S. adolescents. Past studies, including our own work, have found that rural adolescents were more likely to use alcohol than urban adolescents. Research suggests that protective factors, such as peer and parental disapproval, may be weaker among youth living in rural areas. This study examines the factors associated with adolescent alcohol use, whether they differ between rural and urban populations, and the extent to which these differences account for rural-urban variations in adolescent alcohol use. This knowledge is crucial to the development of rural-specific prevention strategies, targeted research on rural adolescent alcohol use, and long-term policy interventions. Our findings confirm higher rates of binge drinking and driving under the influence among rural youth than among urban youth. Rural residence is associated with increased odds of binge drinking (OR 1.16, p< .05) and driving under the influence (OR 1.42, p< .001) even when income and protective factors are taken into account. Our findings suggest that adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, since we found urban-rural differences in specific protective factors, these may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches. These are the factors that convey and reinforce consistent messages discouraging adolescent alcohol use from an early age.

Suggested Citation:

Gale JA, Lenardson JD, Lambert D, Hartley, D.  Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences. (Working Paper #48).  Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; March 2012.

Publication Type: 
Working Paper
Publish Date: 
March 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/WP48_Adolescent-Alcohol-Use-Rural-Urban.pdf

Pages

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