1. Linda Jones, M.S.P.H. Director, State Office of Rural Health Texas Department of Rural Affairs

2.  177 of 254 counties in Texas are rural counties (70%)  89 of these have a population of less than 10,000  15% of state’s total population is rural

4. Population of Texas 2010 census

5. Population % Change, 2000 to 2010

6. Coleman County

7. Projected Population Among Older Texans Source: Texas State Data Center, 2000-2004 Projection Scenario

8. Percent of Persons Aged 65 Years and Older in Texas Counties, 2000 Census and 2040 Projected 20002040

9. ◦ Population growth ◦ Urbanization ◦ Increased racial and ethnic diversity ◦ Increasing longevity ◦ More uninsured ◦ Higher obesity rates ◦ More diabetes ◦ More people with self- care limitations ◦ More persons needing access and transportation to health care

10. Texas State Office of Rural Health Currently located in the Texas Department of Rural Affairs The only state agency dedicated to rural Texas

11. Vision - Strategic allocation of resources to provide and support services, and to develop, and implement programs that build on previous efforts and proven models Mission - To strengthen local healthcare infrastructure and systems of care to better meet the needs, challenges and priorities of rural Texas

12.  Recruitment and Retention - ~ $1.2 million  Rural Hospital Support – ~ $3 million  State Office of Rural Health - ~ $1.3 million

13.  Outstanding Rural Scholar Recognition Program (ORSRP)  Rural Communities Healthcare Investment Program (RCHIP)

14. Physicians per 100,000 by Metro & Border Status for Counties, 2009 Sources: Census 2009 Estimates Department of State Health Services, Health Professions Resource Center Database

15.  $584,782 – GR (matched by communities)  Provides matching funds to scholar studying to become a healthcare professional who agrees to serve in a rural community after graduation

17.  $112,000 – Tobacco Fund  Provides stipend or loan repayment assistance to non-physician healthcare professionals who agree to practice in medically underserved areas.

18.  TDRA supported  51 in 2009 and  67 in 2010.

19.  Rural Health Facility Capital Improvement Loan Fund  Small Rural Hospital Improvement Program  Medicare Rural Hospital Flexibility Program

20.  $1,935,150 from GR – Tobacco Fund  Provides grants to rural hospitals for capital improvement, purchase of equipment, construction of new health facilities  TDRA makes ~40 awards per year @$50,000  Applications submitted in January, then scored, awards in February, contracts in March

21. Capital Improvement Loan Fund $19 million awarded to rural hospitals 2002-2010 Examples of Equipment Purchased Autoclaves CT Scanners Hospital beds Nurse call systems

22.  $971,685 from Health Resources and Services Administration (HRSA)  Grants to hospitals with 49 beds or less in rural areas for quality improvement and other hospital-specific needs  Last year TDRA awarded 117 grants @ $8,305  TDRA receives proposals which are included in HRSA application; funds received and distributed in September

23.  $635,413 from HRSA  Provides support for Critical Access Hospitals (CAHs)in 4 areas: 1. Quality improvement 2. Operational and financial improvement 3. Health system development and community engagement 4. Conversion to CAH status

25.  Patient care and safety – 20 hospitals use the Health Data Integration (HDI) tool to report data which is then reported to CMS’s Hospital Compare  Nurse quality and patient safety collaborative – 10 hospitals participate  Continuing education through TTUHSC – 440 online courses accessed 35,000 times  Remote Pharmacy Pilot Project

26.  Estimated 98,000 preventable deaths  Despite landmark 1999 study, not much improvement  1 in 3 patients admitted into a hospital suffer a medical error or adverse event (Health Affairs, April 2011)  1 in 7 Medicare beneficiaries is harmed in care process, costing ~$4.4 billion/year  1 in 5 Medicare patients discharged from the hospital is readmitted within 30 days – ~ 2.6 million seniors at a cost of $26+ billion/year

27.  Cost the economy ~ $2 billion each year  Harm >1.5 million people every year  400,000 in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics  7,000 estimated deaths each year

28.  Omission error  Improper dose/quantity  Extra dose  Unauthorized drug  Wrong time  Prescribing error  Drug prepared incorrectly  Mislabeling  Wrong dosage form  Wrong patient  Wrong route  Wrong administration technique

29.  All errors  Errors that may or may not (“near miss”) have reached the patient  Errors that reached the patient  Errors that reached the patient and caused harm/death

30.  Pharmacist review of orders within 24 hours  Double check of transcription to record before initial dose  Independent double check of medication within pharmacy before administration  Verification of 5 rights of medication administration by nurse at bedside

31. 1.Right patient 2.Right drug 3.Right dose 4.Right route 5.Right time

32.  CAH summer conference with TORCH  Board of Trustee education – 52 CAHs and 153 trustees over past 3 years

33.  Comprehensive Advanced Life Support (CALS) training for rural trauma teams  Support of training for EMS providers and designation of CAHs as Level IV trauma facilities  Purchase of EMS equipment

34. Data Source: http://soupfin.tdh.state.tx.us/death10.htm

35.  Provision of technical assistance  Support for feasibility studies

36.  ICD 10 Project  Rural Community Economic Impact Assessments  Nursing Peer Review Program  Patient Safety Organization Assistance  Nursing Skills Enhancement Program

38.  Community connectivity grant  Regional Health Information Organization  Chambers County generator  Sutton County CAT scan

39.  Increase visibility  Build and strengthen partnerships  Support for health information technology and meaningful use  Complete rural health work plan  Investigate foundation funding

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42. State Office of Rural Health P.O. Box 12877 Austin, TX 78711 Headquarters: 512-936-6701 FAX: 512-936-6776 www.tdra.texas.gov