1. Rural Health Planning and the Kansas Rural Health Plan November 30, 2007 Presented At: State Network Council Meeting, Wichita, KS By: Rochelle Schultz Spinarski, Rural Health Solutions This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered.

2. Overview National Flex Program requirements Planned activities to develop the KS Rural Health Plan Identified issues – what ’ s missing? Other issues/issue clarification Next Steps

3. National Flex Program Rural Health Plan Guidance Use data to drive decisions Include broad stakeholder input Create a working document that is directly related to the Flex Program Focus on CAHs and the communities they serve No approval requirements Completed by May 2008*

4. Overview of Planned Activities Meetings with Flex Program staff Documentation review Presentation and initial input from CAH administrators Key informant interviews Issue groups discussions, planning, & activities/next steps identification Rural Health Plan writing Input from stakeholders Revision Rural Health Plan completion and distribution Planned timeline: Nov 2007 – March 2008

5. Background Information Review Strategic Action Plan, Office of Local and Rural Health, KDHE, December 2004 State of Kansas: A Reassessment of EMS, July 17 – 19, 2007, NHTSA Technical Assistance Team KRHOP Evaluation Project: Administrator Satisfaction, January 2007 KS Rural Health Options Evaluation Project: Performance Improvement, January 2007 Is Flex Making a Difference in Rural KS? An Evaluation Report of the Rural Hospital Flexibility Program in KS, KRHOP, May 2007 KS Flex Program Evaluation, KRHOP, January 2005 KS Flex Program information as reported by the Flex Monitoring Team KS rural health information on the Web (e.g., AHRQ)

6. Rural Health Challenges in KS EMS –Workforce Recruitment Retention Training –Inter-facility transfers –Lack of standards for medical directors of ambulance services, non-transporting agencies, training institutions, and dispatch centers –Medical director/advisor training –Designation of Level IV trauma centers

7. Rural Health Challenges in KS (cont.) Other EMS items/opportunities to consider –EMS budgeting training –Local EMS assessment activities –QI –Statewide plan for public education, information, and injury prevention –Training SIM, CAH/EMS joint training Your thoughts?

8. Rural Health Challenges in KS (cont.) Supporting & Sustaining CAHs –Workforce recruitment and retention Physicians Nurses PT, OT, RT, Lab Dependable and qualified CNAs Pharmacy –96 hour annual average limit –25 bed limit –Survey readiness –Finances –Aging population –Lack of awareness re: services available through KRHOP –HIT –Training –Access to capital –Strategic planning –Lack of specialty care –Smallest rural hospitals –CAH utilization

9. Rural Health Challenges in KS (cont.) Other CAH support items to consider –Use of SNC meetings –Trauma course expansion –KS Recruitment Center Your thoughts?

10. Rural Health Challenges in KS (cont.) Quality Improvement –Patient-centered care –Policies and procedures –Internal communications –Facility and equipment upgrades –CAH leadership and teamwork –Patients ’ perception of the hospital –Infection control –Credentialing –Board training –Employee involvement QI processes –Medication errors

11. Rural Health Challenges in KS (cont.) Other QI items to consider –QHi Data Collection and Benchmarking system –91 % of CAH administrators report the current QI activities should continue –CAH staff buy-in, slow pace of institutional change, time and wearing many hats, benchmarks; establishing best practices, tools, and models; smallest rural hospitals; additional staff/on-site support to help implement the program –Staff dedicated to QI –47 CAHs participate in Hospital Compare Your thoughts?

12. Rural Health Challenges in KS (cont.) Network Development –Support for hospital network projects Improved education Improved communication and coordination –Expanded scope (e.g., including LPH, EMS, RHCs, CHCs) Your thoughts?

13. Rural Health Challenges in KS (cont.) Access issues (?) –OB (41%) –Behavioral health (10%) –Senior health services –Specialty services –Uninsured –Disease prevention services –Health promotion services Other issues –Population decline in some areas/counties –Increase in diversity –Increase in limited- English speaking population Your thoughts?

14. Other Opportunities to Consider Increased coordination between county-owned hospitals and county-operated local public health Establishing a medical home for rural populations Expanded community engagement Your thoughts?

15. Key Informants Jodi SchmidtHays Medical Center Lorene ValentineKUMC/W Gary SmithKS USDA Melissa HungerfordKHA Phil LoweHodgeman County Health Center Robert WallerKBEMS Rosanne RutkowskiKS Trauma Program Lori HowardKS Foundation for Medical Care Dick MorriseyKDHE Charles MooreKDHE -Director Health Facilities Darlene BainbridgeBainbridge Consulting Associates Alison PetersonKS Medical Society Connie SatzlerEn Visage Consulting John LeathermanK-State/KS Rural Health Works

16. Issue Groups (tentative) EMS Networks CAHs Quality Improvement Healthy Rural Communities Workforce

17. Next Steps Rural Health Solutions is a rural health and health workforce research and program development consulting firm located in St. Paul, Minnesota. Find us on the Web at www.rhsnow.com or call us at 651/261-6219.www.rhsnow.com