Welcome

Fall is finally here and with it an abundance of activities for the Kansas Office of Rural Health! Staff travels this month to both the National Rural Health Association’s (NRHA) Critical Access Hospital Meeting in Portland, OR and the National Organization of State Offices of Rural Health’s (NOSORH) Annual Meeting in San Antonio, TX. Both meetings provide a close focus on issues specific to our mission and, as expected, health information technology (HIT) continues to be featured at both conferences.

The next two months will also see our roll out of a quality improvement opportunity for CAHs, using Appropriate Care Measures (ACM) and a survey of hospitals that participated in EMS training funded by the Office in the last three years.

Look for us at the Kansas Hospital Association Annual Convention in Wichita on November 12-13. We’d love to have you drop by to say “Hi”.

News Article October 2009 Update
The Kansas Rural Health Options Project (KRHOP) has partnered with the Kansas Foundation for Medical Care (KFMC) to offer hospitals some exciting quality improvement opportunities. In the near future we will be sending out an invitation to small rural hospitals to join us for two informational webinars: November 4th, 2009, noon-1pm, to discuss the new Appropriate Care Measure (ACM) project and December 2nd, 2009, noon-1pm, to discuss the Hospital Leadership and Quality Assessment Tool (HLQAT) project. All eligible hospitals will be receiving an invitation from KDHE along with further instructions on how they can participate free of charge.

A Changing Face for EMS?
In the last couple of months I’ve been part of some interesting conversations about the future of emergency medical services in rural areas. At a recent meeting in Washington, DC, I was a speaker in a session on health care reform that also featured the new Deputy Secretary for HHS, Bill Corr, and the HRSA Administrator, Mary Wakefield. During the panel there was considerable discussion about the role of EMS in the health care system, and the fragility of the system in America’s rural areas.

The same month I was invited to speak at a conference on rural EMS in Utah. One issue that arose several times was the potential for emergency personnel in rural areas to be part of a team-based medical home. In many communities EMTs and paramedics are already helping "fill gaps" in numerous ways, whether providing assistance in the emergency room, participating in wellness fairs, or fitting child car seats. Now some states are taking this concept one step further and are using emergency personnel in preventive and primary care roles. While there are barriers to this approach, there are pilot programs in a number of states (including two Midwestern states, Minnesota and Colorado) to expand the "role" (not the scope) of some emergency personnel.

I don’t want to imply that I think EMS is the "solution" to primary care access issues. However, recruiting primary care providers is likely to become more difficult for rural communities in coming years. This situation will likely be even more challenging (at least in the short term) if the federal government passes a health care insurance reform package. While expanding health care coverage is in itself a good thing, the state "experiment" in Massachusetts suggests that demand for primary care increases dramatically as more lives are covered under insurance plans. If rural areas find it even harder to recruit primary care providers in coming years, some communities may need to explore creative approaches to ensure primary care access in their communities. The use of a "primary care paramedic," whose skill set includes both emergency care and certain aspects of preventive/primary care, may be a viable approach for some.

For those interested in this concept, there are some good resources available at www.ircp.info or feel free to contact me (ctilden@kdheks.gov or 785-296-7439) and I can direct you to additional information.
Chris Tilden

ORHP All Grantees Meeting
I had the pleasure of being in Washington, D.C. for the ORHP All Grantees Meeting the first of September. As you might imagine there was a lot of talk concerning HIT and the impact ARRA will have upon critical access hospitals. We are caught up in a sea of change with ominous signs and uncertainty in which direction to take. Neal Neuberger stated that healthcare is at a crossroads and is in crisis, it is also one of the last industries to become electronic. Something that is repeated often is the need for a HIT champion within hospitals; it is encouraging to see these champions for rural Kansas at all levels and in all places.
Jessica Willard

Our featured partner in this update is Debbie Nickels, RN, BSN and Kansas TRAIN Administrator with the Bureau of Local and Rural Health. Debbie first became interested in public health when she was a nursing student at Fort Hays State University and did a practicum with Shawnee County Health Agency. She is passionate about public health and very committed to its core mission of assessment, policy development and assurance. Collaboration principles are put into practice every day with local, state, and federal partners. One of the exciting things happening is that Kansas will be working towards becoming accredited through the Public Health Accreditation Board sometime in 2011.

Debbie is the driving engine for KS-TRAIN, the state's public health and safety learning management system. She enjoys improving workforce competency by providing educational opportunities. Workforce education is something increasingly important due to stricter quality and reporting standards and made more difficult by the worsening economy. A recent TRAIN data study shows average total cost savings of a minimum of $326 per participant for taking a course online versus a live course. In addition to the cost savings, employees have no travel and no lost productivity time away from work. She believes that by bringing about more training awareness and opportunities through TRAIN we can assure access to quality services in rural Kansas. As a message to remember Debbie had this to say, “Just because it hasn’t happened to you doesn’t mean it won’t, whether it is H1N1, hypertension, diabetes, flooding, or something else. It is our responsibility to not become complacent about the public's health for our families and communities.”

Please check out KS-TRAIN for great educational opportunities!