1. How technology plays an important role in providing quality care to our community. Lindsey Saunders NURS 7350 July 24, 2013

2. Approximately 44% of Alabama residents live in rural areas. Manufacturers, construction workers and farmers make up the majority of rural Alabama workers.

3. 61 out of 67 counties in Alabama are considered medically underserved. 9 counties are without any type of hospital. In 2011, the poverty rate for rural Alabama was 21.8%. 14% of Alabama residents lack medical insurance.

4. The average commute time to the nearest hospital is about 24.1 minutes. Public transportation is not an option for most Alabamians due to unavailability or financial reasons.

5. In rural Alabama, deaths from heart disease are 47- 78% higher than urban areas. Deaths from cerebrovascular accidents are 56% greater in rural areas. Motor vehicle accident victims have a 65% greater chance of losing their life if in a rural area.

6. The ability to meet the needs of patients hinges on the hospital’s advancement in technology. In 2008, less than 3% of community hospitals were utilizing electronic medical records. Many rural facilities lack important diagnostic testing and/or someone to interpret the results. They lack many life saving procedures and frequently transfer patients to urban facilities causing a prolongation in treatment.

7. STEMI patients being transferred from rural hospitals are associated with longer “door to balloon time” and a higher incidence of major adverse cardiac events such as death, stroke, and recurrent ACS.

8. To determine the severity of patients from rural communities admitted to an urban hospital due to transfer from another facility or from bypassing a local hospital because of lack of resources and technology.

9. 1. Determine the percentage of patients from rural communities that the Cath Lab/ CV Recovery Unit at Baptist Medical Center South serve. 2. Gather and analyze data to determine the top reasons for transferring and averting from rural facilities. 3. Identify the needs of hospitals and patients in the rural setting to decrease the number of avoidances and transfers to other regions. 4. Develop strategies to aid the rural facilities and population in obtaining the resources and technology needed to provide better patient care.

10. Sample population: 12 patients from rural areas transferred to BMCS for cardiac procedures. Top reason for Transfer: Use of the Cardiac Cath Lab Diversion: Low level of trust with rural hospitals Improvements: Equipment Quality of Care Specialty of Physicians

11. Low incomes and socioeconomic status Insurance Coverage Lack of transportation Poor medical care Stressful/ physically demanding jobs Lower level of education

12. Obesity Diabetes Cancer Heart disease Other injuries Smoking Physical Inactivity Poor diet Limited use of seatbelts

13. 1. Patient Education Smoking, Diet, Lifestyle, Medications When do I need to go to the hospital? Education needs to be simple and continuous 2. Rural Healthcare Education Diagnostic Testing Protocols for STEMI & CVA

14. 3. Rural Healthcare Funding Funding is needed to facilitate better technology and education. U.S. Department of Agriculture Healthcare Reform 4. A new innovative approach is to outsource rural hospitals' IT infrastructure to another larger, more technologically advanced hospital in their region.

15. The rural health epidemic is continuing to grow as practitioners are becoming scarce. This population deserves safe, quality care. Future strives and the use of advanced practice nurses in this area can hopefully make a difference in this underserved population.

16. Deshmukh, A., Hilleman, D., Haroom, S., Bansal, O., Smer, A., Kanuri, S., … Esterbrooks, D. (2013). Outcomes in patients undergoing rural interhospital transfer of st elevation myocardial infarction for percutaneous coronary intervention. JACC: Cardiovascular Intervention, 6(2). Reddy, M.C., Purao, S., Kelly, M. (2008). Developing it infrastructure for rural hospitals: a case study of benefits and challenges of hospital-to-hospital partnerships. Journal of American Medicine and Informatics, 15, 554-558. Doi: 10./197/jamia.M2676 Shepard, B. (2012). Uab creates statewide network to expand healthcare in rural alabama.. UAB News. Retrieved from: http://www.uab.edu/news/latest/item /2694-uab-creates- statewide-network-to-expand-health-care-in-rural-alabama Surgenon, S.D., Corwin, H.L., Clerico, T. (2001). Survival of patients transferred to tertiary intensive care from rural community hospitals. Critical Care, 5(2). The opportunities and challenges for rural hospitals in an era of health reform. (2011, April). American Hospital Association: Trendwatch.

17. Topic Possible PointsPoints Earned Introduction or Background5 Assessment Tool20 Factors affecting overall health20 Health Disparities Identified5 Strategies--- suggested; not required to be implemented25 Well-crafted, scholarly PPT15 References on last slide5 Submitted by due date and time5 TOTAL100.p o i n t s