1. The Critical Access Hospital (CAH) Montana Community Apgar Program Shani Rich North Central AHEC Director MHA…An Association of Montana Health Care Providers

2. Presentation Overview  Purpose/Development  Using the Critical Access Hospital Community Apgar Questionnaire (CAH CAQ)  Montana Overall Year One State Level Results  Action Plan and Next Steps

3. Acknowledgements  Funding provided by AHEC program of Bureau of Health Professions of Health Resources and Services Administration of the U.S. Department of Health and Human Services  Dick Brown, President and CEO of MHA, An Association of Montana Health Care Providers  Kris Juliar, Director, Montana Office of Rural Health & Area Health Education Center, Montana State University  Victoria Cech, Foundation Director, Montana Health Research and Education Foundation, MHA, An Association of Montana Health Care Providers  Kailyn N. Dorhauer, MHA, Montana Office of Rural Health, Montana AHEC Program Office, Montana State University  Original developmental and ongoing funding provided by Mary Sheridan, Bureau Chief, Idaho Bureau of Rural Health and Primary Care  David Schmitz, MD, FAAFP, Chief Rural Officer and Program Director RTTs, Family Medicine Residency of Idaho  Ed Baker, PhD, Professor and Director, Boise State University Center for Health Policy (CHP) Lisa MacKenzie, MHS, Research Associate Logan Kinney, Research Assistant

4. Purpose of the Critical Access Hospital CAQ  A validated tool used to assess a rural community’s assets and capabilities in recruiting and retaining family physicians.  This should accurately correlate to historical community-specific workforce trends.

5. Purpose of the CAH CAQ (cont.)  The CAH CAQ can also be used to track a community’s progress over time, similar to the clinical use of Apgar scores in newborns.  Designed to be a real-time assessment tool providing guidance for the most helpful interventions at the present.

6. CAH CAQ Development  Goal Develop an objective measurement tool (CAH CAQ) to assess the characteristics and parameters of rural Idaho communities related to successful recruitment and retention of family physicians  Process Research the scientific literature Site visits to rural Idaho communities Discussions with rural physicians and hospital administrators

7. CAH CAQ Development  The CAH CAQ Questions aggregated into 5 Classes  Geographic  Economic  Scope of Practice  Medical Support  Hospital and Community Support Each Class contains 10 factors for a total of 50 factors/questions representing specific elements related to recruitment and retention of family physicians in rural areas Three open-ended questions

8. CAH CAQ Development: Class/Factor Examples Geographic Schools Climate Perception of Community Spousal Satisfaction Economic Loan Repayment Competition Part-time Opportunities Signing Bonus Scope of Practice Emergency Care Mental Health Obstetrics Administration Duties Medical support Nursing Workforce Call/practice Coverage Perception of Quality Specialist Availability Hospital and Community Support EMR Welcome & Recruitment Televideo Support Plan for Capital Investment

9. CAH CAQ Development: Montana Sample and Administration  CAH CAQ Target Communities in Montana 16 critical access hospitals 16 hospital administrators and 16 physicians for a total sample of 32  CAH CAQ Administration Participants mailed the CAH CAQ survey in advance with consent form [IRB approval from Boise State University] and one hour interviews scheduled Separate structured one hour interviews for each participant where consent form was reviewed and executed and CAQ completed

10. Use of the CAH CAQ  This assessment allows for identification of both modifiable and non-modifiable factors and also may suggest which factors are most important for a community to address with limited available resources.  The CAH CAQ may be used by communities to assess their relative strengths and challenges, the relative importance of CAQ factors, and to gain a better understanding of which CAQ factors are seen as most important from the physician point-of-view.

11. Making the most of the CAH CAQ Recruiting and Retaining Family Physicians:  community self-evaluation  prioritizing improvement plans  advertising and interviewing  negotiation strategies and contract construction

12. Future of the CAH CAQ  With further research and collaboration, this tool could also be used to share successful strategies communities have used to overcome challenges which may be difficult or impossible to modify.  CAH CAQ surveys may be useful in identifying trends and overarching themes which can be further addressed at state or national levels.

13. States Participating/Interested States Participating in the CAP States Interested in Implementing the CAP

14. Montana Overall Year One State Level Results

15. Class CAH Community Apgar Cumulative Score

16. Top 10 CAH Community Apgar Mean Score

17. Bottom 10 CAH Community Apgar Mean Score

18. Cumulative CAH Community Apgar Score

19. Next Steps  Develop action plan  CAH CAQ administered again in second year  Second administrative team presentation

20. Questions/Comments for Discussion

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