Rural Health Planning and the Kansas Rural Health Plan November 30, 2007

1. 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. Rural Health Planning and the Kansas Rural Health PlanNovember 30, 2007 Presented At: State Network Council Meeting, Wichita, KS By: Rochelle Schultz Spinarski, Rural Health Solutions

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. 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 Rural Health Challenges in KS (cont.)

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. 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 Rural Health Challenges in KS (cont.)

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. 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? Rural Health Challenges in KS (cont.)

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

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.