ALASKA

Alaska State Hospital & Nursing Home Association (ASHNHA)

D06RH04308
Randall Burns
ASHNHA / ASHPIN
943 West Sixth Avenue, Suite 120
Anchorage, AK 99501
Phone: (907) 269-4595

Fiscal Year 2005 2006 2007
Grant Award $180,000 $180,000 $180,000

The Alaska Small Hospital Performance Improvement Network (ASHPIN or Network) is a rural hospital network with eleven of Alaska's smallest frontier hospitals. Rural hospitals formed the Network to improve the quality of healthcare in their communities. ASHPIN received an ORHP RHND Planning Grant in 2003 to assist in formation of the Network. The Alaska State Hospital and Nursing Home Association (ASHNHA) now provides continuing support to the Network.

Substance abuse and suicide in Alaska are at two and three times the national rates. These rates are even more disparate in the Alaska Native population and especially for young males. Alaska also struggles with violence and abuse rates above national norms. In addition, an abundance of dangerous occupations often place Alaska's occupational injury (and related death) rates above national norms. Over the last ten years, many of Alaska's rural hospitals have found themselves between a rock and a hard place, facing a downturn in the economic well-being of their communities and a concomitant rise in their healthcare costs, manpower concerns, and the need to replace aging hospital facilities.

ASHPIN's goal is to advance the Network by focusing on strategic planning that develops new network tools to overcome the hurdles presented by Alaska's unique frontier environment (i.e., Alaska's size, transportation issues, isolation, high cost of living, etc.) or tailors existing network enterprise programs. In order to support this goal, the project will: 1) back ASHPIN's development as an increasingly important voice on behalf of rural hospitals/rural communities in healthcare policy circles in Alaska through support for ASHPIN's ongoing organizational and administrative maturity; 2) seek expertise to assist ASHPIN's desire to lead an effort to create the statewide healthcare provider recruitment collaborative called for by distressed employers; 3) complete the work started in 2003 with respect to the creation by ASHPIN of the Alaska Rural Telehealth Network, beginning with the short-term goal of providing state-of-the-art teleradiology services to those Network hospitals and partner clinics who either have lost, never had, or have tenuous service at this time, and the longer term, more broad telehealth goal of providing distance education through real time video conferencing, telepharmacy, specialty consults, emergency consults, etc.; and 4) carry out financial and strategic planning.

CALIFORNIA

North Coast Clinics Rural Health Network

D06RH00223
Tim Rine
North Coast Clinics Network
517 3rd Street, Suite #36
Eureka, California 95501
Phone: (707) 442-6066

Fiscal Year 2003 2004 2005
Grant Award $198,995 $198,864 $198,856

The North Coast Clinics Network (NCCN) is composed of eight federally qualified health centers (FQHCs), two rural health clinics (RHCs), a family planning clinic, and a county public health agency. The network's service area is approximately the size of New Jersey and encompasses three northern California counties. Humboldt and Del Norte Counties on the Pacific Coast and Trinity County to the east extend from 200 miles north of San Francisco to the Oregon border.

Hidden among the area's natural beauty of unspoiled beaches and ancient redwood forests are pockets of economically depressed, socially disenfranchised, and medically underserved residents who depend on NCCN's clinics for health care. Low education levels and lack of alternative employment have impeded economic recovery from the decline in the area's timber and fishing industries. In addition to economic depression, the area also experiences problems with violence, substance abuse, and mental illness at levels usually associated with inner cities. Poverty, mountainous topography, harsh winter weather, and lack of public transportation pose significant barriers to health care for area residents. In addition, telephone and other
communication and connectivity devices are often marginal or unreliable. These constraints, along with limited staff time and resources, impede coordination and information-sharing between clinics without the intermediation of the network. More than one-third of the service area population depends on member network clinics for primary health care. These clinics are small, widely dispersed, and often understaffed and overworked. They depend on NCCN to assist them in information-sharing, community education, joint purchasing, technical assistance, staff training, and planning and expanding capacity.

The major purpose of NCCN's proposed project is to build and strengthen network fiscal and operational capacity while fostering parallel growth and development in each of the network's member clinics. Most importantly, the project strives to respond to the needs and concerns of patients to build confidence and trust in the community. Specifically, the project will create and implement an integrated disaster preparedness and emergency response plan; create a networkwide staff training plan to ensure that staff are appropriately trained in emergency response and disaster preparedness, financial management, and administration; and offer continuing education for health care providers. Other project activities include establishing an employee training and development center that also will be open to health and human service providers; extending the availability of basic telehealth and telemedicine training and operations to all clinics; and expanding network capacity to provide access to specialists, workshops, and conferences outside the area that are not now available. The network will ensure its own sustainability by updating and expanding its strategic plan and developing alternative income sources, including fees for services, fiscal sponsorships, rents, and service contracts, thereby decreasing its dependency on grants.

Rural Health Design Network

D06RH04192
Kathy Yarbrough
Rural Health Design Network
P.O. Box 1542
San Andreas, California 95249
Phone: (209) 754-4181

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Rural Health Design Network (RHDN) is a seven-county integrated network of rural
California hospitals comprising hospital leaders, health care professionals, trade organization representatives, State agency representatives, facility design representatives, and rural community leaders. RHDN acts under governing bylaws to explore a uniform approach to using compliance with SB 1953 (California's current legislation pertaining to hospital seismic safety) as a "disruptive innovation" opportunity to redesign how and where health care is delivered in rural California. RHDN seeks to work in collaboration with 12 California rural hospitals, providers, and organizations to establish a health care delivery model that will (1) provide continued access to appropriate and affordable primary medical, dental, and behavioral health services, (2) promote positive changes in communities with respect to economic and personal health, and (3) establish linkage with specialty and tertiary centers. Using established criteria to identify the most at-risk rural facilities in the State, the network implemented membership standards to include hospitals that have an average daily census of fewer than 15 patients, are farther than 30 miles or longer than 30 minutes from the nearest acute care facility, and are not meeting seismic regulations.

Approximately 75 percent, or 117,000 square miles, of California's landmass is rural. Health care in this vast area is delivered in an uncoordinated manner by small rural hospitals, community-based clinics, sole practitioners, and allied health professionals who provide service to approximately 2.6 million residents. These rural hospitals and clinics serve a culturally diverse and ignored population, many of whom are underinsured or uninsured. Inadequate capitalization, narrow operating margins, and sweeping legislative changes further challenge rural health care providers. Poor financial conditions mean that rural hospitals do not have the resources to stay technologically current or to compete for dwindling professional resources, such as registered nurses, respiratory therapists, radiology technologists, pharmacists, and
clinical laboratory scientists.

The RHDN project plan is to establish a framework for the redesign of rural health delivery. The framework is based on engaging communities to participate in specific research data, service inventories, analysis of existing and potential linkages, needs assessments, and economic impact analysis. Results of the research will be used to redesign rural community services and their delivery, including the design of a rural core health facility to serve as the hub of the new system. In short, the project hopes to create a stabilized health care continuum that ensures access to basic health and wellness services throughout rural California.

Health Leadership Network

D06RH00258
Susan Jen
Sutter Lakeside Hospital
3274 Skyline Drive
Kelseyville, California 95451
Phone: (707) 279-8827

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Health Leadership Network (HLN) is a consortium of 10 health care service providers in Lake County, California, dedicated to improving the health of pregnant women and young children. The network aims to serve as a think tank, infrastructure builder, quality enhancer, and systems integrator to support programs and policies that will elevate the well-being of the network's target population, thereby creating a healthier community overall. Specifically, the network's goal is to ensure delivery of prenatal care and access to oral and mental health services for the county's scattered pockets of people living at or near the poverty level. Through its activities, the network's members hope to make a positive impact on the essential development that transpires during a child's earliest years.

HLN members represent both of the local hospitals and all of the key organizations that interface with children and pregnant women in the community. They include Sutter Lakeside Hospital, Adventist Health Redbud Community Hospital, Lake County Department of Health Services, Children and Families Commission/First Five, Sutter Lakeside Community Services, Easter Seals, Lake County Office of Education, Employment Development, and two direct-care providers. Because resources are limited, these entities already work together in some way. However, a no formal structure in the community identifies shared goals, a common vision, or a mission to interlink and coordinate services, pool resources, and develop consistent, holistic health policies. The network grant will be used to create such a formalized network to provide these activities in Lake County. The grant will support development of a comprehensive strategic plan to identify service priorities, duplication and gaps in service, outreach and intervention methodology based on the county needs assessment, shared services tracking, coordinated marketing activities, and development of a sustainable infrastructure for countywide health promotion programs.

Lake County's population of 55,300 enjoys an environment of natural beauty with a lake view from nearly every perspective. However, Clear Lake, the picturesque centerpiece of the community, is also a major transportation barrier, making access to health services difficult. It is nearly 100 miles around Clear Lake's periphery, and 45 percent of residents do not have adequate transportation. In addition, Lake County currently ranks 55 among 58 counties for the poorest health status in the State of California. The most recent statistics from the Lake County Children's Report Card indicate that an estimated 56 percent of the area's children live in families without self-sufficient income, and an estimated 30 percent live in poverty. The county recently ranked lowest for late or no prenatal care. Approximately 50 percent of mothers younger than age 15 receive no prenatal care in their first trimester; 18 percent of the county's total births are to teen mothers. More than half the mothers enrolled in the Family Resource Center Birth to Five programs suffer from depression, as determined by a standardized depression screen, and incidents of domestic violence and child abuse and neglect are on the rise. These factors, coupled with the area's depressed economic conditions, have led to Lake County being labeled the Appalachia of the West.

FLORIDA

Healthcare Services Integration Demonstration Project

D06RH00252
Kelly Johnson
Heartland Rural Health Network
1200 West Avon Boulevard, Suite 109
Avon Park, Florida 33825
Phone: (863) 452-6530

Fiscal Year 2003 2004 2005
Grant Award $199,008 $193,008 $193,008

The Heartland Rural Health Network consists of more than 25 organizations, including 1 Critical Access Hospital and 4 other hospitals, all of the county health departments from the 5-county service area, the Area Health Education Center, federally qualified community health centers, and representatives from consumers, local government, and other organizations. The network covers an area of 4,870 square miles of some of the most rural counties in Florida-Highlands, Hardee, DeSoto, Polk, and Charlotte; nearly all of the five counties are Medically Underserved Areas and Health Professional Shortage Areas. The region depends on a strong agricultural base and therefore has a significant number of migrant and seasonal workers. Patient outmigration is rampant. In Hardee County alone, 92 percent of inpatient hospital care is rendered outside the county, resulting in a $42 million annual loss.

In 1993, the State of Florida passed legislation authorizing the creation of rural health networks. That legislation was very specific in delineating the purpose of these networks: (1) to provide an effective continuum of care for all patients in the network, (2) to ensure the availability of a comprehensive array of services, (3) to reduce outmigration and increase the use of rural health care providers, (4) to enhance access to and efficient delivery of high-quality health care, (5) to support the economy and protect the health and safety of rural residents, and (6) to serve as laboratories to determine the best way to organize rural health services.

Believing that few, if any, rural health networks in Florida have come close to meeting the intent of this legislation and that networks need to reinvent themselves, the Heartland Rural Health Network Health Care Services Integration Demonstration Project will use network grant funds to conduct a 3-year pilot study. The network will become a "laboratory," as suggested by Florida legislation, and organize into an integrated health care delivery system, initially in the two most rural counties in the network, Hardee and DeSoto. The network designed the Health Care Services Integration Model, which if properly implemented will ensure that the network effectively meets the legislative intent for which it was created. Specifically, network leadership and staff will work side by side with health care providers in resolving delivery issues common to all rural areas. It will also align network activities with the needs and interests of its members, thus ensuring sustainability. The project strives to reduce outmigration, expand services, increase revenues to local providers, greatly enhance access to care, and ensure efficient delivery of care. The network's goal is to create a model so effective that other networks in Florida will want to replicate it.

Rural Health Network of Monroe County (RHNMC)

D06RH02564
Mark Szurek
P.O. Box 4966
Key West, Florida 33041-4966
Phone: (305) 293-7570

Fiscal Year 2004 2005 2006
Grant Award $200,000 $200,000 $200,000

RHNMC is an established and mature network working to address its two most challenging strategic goals: 1) the establishment of a comprehensive and county-wide network for oral health targeted at the uninsured, and 2) the establishment of an endowment fund to ensure future operations / services and to directly support a health insurance task force to create an equitable and affordable insurance product for all residents. RHNMC has already made significant strides as a single-county rural health network. RHNMC consists of 36 agencies and individuals. It includes the county's three hospitals, three physician-hospital organizations, state and county government representation, the county health department and health providers, the faith community, consumers, mental health and substance abuse treatment facilities, special healthcare providers (i.e. AIDS, woman and children), three chambers of commerce, and members at large. RHNMC offers health planning, primary care and oral health services over a 120 mile area. RHNMC plans to enhance its network development and complete the final stages of its infrastructure capacity building in addition to supporting a four part system for county-wide oral healthcare.

GEORGIA

Turner County Connection Health Network

D06RH00262
Brenda Lee
Turner County Board of Education
330 Gilmore St.
Ashburn, Georgia 31714
Phone: (229) 567-8762

Fiscal Year 2003 2004 2005
Grant Award $196,160 $195,210 $198,099

The Turner County Connection is a 501(c) (3) grassroots community collaborative consisting of representatives from safety net providers, government agencies, civic organizations, ministerial associations, the business community, consumers, and service organizations in Turner County, Georgia. Through grant funding, the Turner County Connection supports a variety of local health, education, and social services projects. The Turner County Connection Health Network functions as a committee of the collaborative and comprises all of the more than 20 local and regional health care providers and key service organizations. Turner County, Georgia, has no local hospital. Like so many other rural areas, the county suffers from high rates of poverty and unemployment, lack of health insurance, and health provider shortages. All these factors contribute to a lack of access to adequate health care and social support services for area residents. Because of decades of ignoring prevention activities and the effect of deleterious decisions made during childhood and adolescence regarding lifestyle and personal behavior, many of the county's residents have deteriorated health status by middle age. Cardiovascular disease, stroke, and diabetes are all causes of death that can be delayed or prevented through education and a change in lifestyle choices.

In response to the region's serious health care access issues, the Turner County Connection Health Network has developed a three-pronged local health care strategic plan that includes (1) community health education, screenings, and enrollment, (2) comprehensive case management services for individuals with special needs and chronic conditions, and (3) community service coordination and resource development. With network grant funds, the project will develop an infrastructure that maintains an integrated health system and coordinates care for the area's underinsured and uninsured residents. Specifically, the project will seek to enroll 100 percent of Turner County school system students and at least 20 percent of adults in health screening and education classes, workshops, and activities yearly. In addition, the project will provide access to appropriate community health support services for 100 percent of the adults enrolled in chronic -disease case management programs. Other project activities involve establishing a community volunteer program and preparing five grant proposals, including a Health Resources and Services Administration (HRSA) Community Access Program (CAP) grant proposal. The project also will develop a chronic -disease case management database capable of long-term tracking of enrolled patients and will create an accepted set of shared clinical protocols and a standard enrollment/patient intake process for local comprehensive interdisciplinary case

Coastal Medical Access Project (CMAP)

D06RH04305
Francis Selgrath
Goodwin Community Health Center, Inc.
PO Box 1357
Brunswick, Georgia 31521-1357
Phone: (912) 554-3559 ext.11

Fiscal Year 2005 2006 2007
Grant Award $180,000 $180,000 $180,000

The Coastal Medical Access Project (CMAP) network includes a regional health system, health departments, private physicians, local employers, school systems, a technical school, city and county governments and the faith community. The mission of CMAP is to generate improvements in health status and access to care for local residents through the development of a comprehensive and coordinated system of care in Camden, Glynn and McIntosh Counties for the under and uninsured. CMAP has systematically worked to support access expansions through the formation of horizontally and vertically integrated systems of care. The goals of CMAP include:

• Create a focus for coordination and development of cost effective regional chronic disease prevention and treatment services that are easily accessible for consumers and providers
• Assure a continuum of services and programs from pre screening and risk factor reduction through intervention and rehabilitation,
• Expand access to chronic disease services so that they are available to all, regardless of insurance status
• Involve the community in the planning, implementation and evaluation process of CMAP.

Georgia Healthcare Systems (GHS)

D06RH04307
Herman Thompson
East Georgia Healthcare Center, Inc.
316 North Main Street
Swainsboro, Georgia 30401-3535
Phone: (478) 237-2638

Fiscal Year 2005 2006 2007
Grant Award $180,000 $180,000 $160,000

The Georgia Healthcare Systems (GHS) is a statewide, horizontal network of 330 funded Community Health Centers created in 2003. Originally, GHS addressed integration of a practice management system among each network member in support of risk management activities, patient support systems and strengthening primary care provider capacity. This project will take the GHS into its next phase. Funding will support a regional pilot of four of GHS's rural member health centers in conjunction with the Network to develop and implement a collaborative electronic medical record system. The project goals are to:

• enhance technical and financial support to 4 member-organizations in the GHS network as a pilot project to implement and evaluate the use of Electronic Medical Records (EMR);
• provide state-level technical expertise in support of collaborating network members for tracking improved health status among patients in the Eastern region, which indicates many of the worst health indicators in the state;
• convene opportunities that assist providers within the piloted project in maximizing access to more comprehensive, accurate and timely electronic patient information.

The implementation of a pilot electronic medical record system will afford testing on a small scale and in an area where resources remain most scarce and are hardest hit during Medicaid budget crisis. It will also allow the GHS to learn about and determine the needs for statewide implementation.

ILLINOIS

Community Health Action Team Technology Network

D06RH00236
M. Elaine Wilcoxen
Graham Hospital Association
210 West Walnut Street
Canton, Illinois 61520
Phone: (309) 647-5240 ext. 2726

Fiscal Year 2003 2004 2005
Grant Award $188,914 $188,914 $186,928

The Community Health Action Team (CHAT), a partnership between Graham Hospital, the Fulton County Health Department, and the Fulton-Mason Crisis Service, was formed in 1995 to conduct health care needs assessments and to address priority health needs in rural Fulton County, Illinois -population 38,250. Priority health care issues identified through the assessments were (1) the need for an improved health care delivery system for the medically indigent, e.g., access to health information and services, (2) the need to decrease the incidence of chronic diseases such as heart disease, cancer, and respiratory disease, and (3) the need to reduce the incidence of domestic violence. An ongoing needs assessment by CHAT's steering committee also indicates a lack of service connection between providers and consumers. Inadequate access to health information and services, combined with no central location for storage and dissemination of updated information that can aid providers in referring a client to appropriate services, results in vulnerable populations being left alone to navigate a frustrating maze of services. Failure to provide referrals during the time of expressed need leads to unresolved health issues that manifest as untreated chronic illnesses, financial deterioration, and social isolation. Other factors that serve as barriers to adequate health coverage coordination include Fulton County's large geographic area (866 square miles), lack of public transportation, aging population (18.3 percent aged 65 and older), increasing unemployment rates, lack of health insurance, high incidence of family violence, and absence of a countywide computer network.

In response to the need to effectively connect consumers with health information and services, CHAT formed a technology committee consisting of five major social service agencies, a hospital, a public health department, a college, emergency medical services, a pharmacy, the CHAT coordinator, the regional office of education, and a computer technology consultant. With network grant monies, the project will develop a computer network to connect service providers, create a Web site and a provider intranet service, and utilize Palm PCs for home visit programs. The project's key components will include Web site promotion, online service updates, enrollment of member organizations, long-term sustainability planning, assessment of unmet needs, and seamless access to services for consumers-especially vulnerable citizens in Fulton County.

INDIANA

Affiliated Service Providers of Indiana, Inc.

D06RH00230
Kathy Lynn Cook
Affiliated Service Providers of Indiana, Inc.
d.b.a. ASPIN
1015 Michigan Avenue
Logansport, Indiana 46947
Phone: (574) 722-5151

Fiscal Year 2003 2004 2005
Grant Award $199,680 $199,698 $199,694

ASPIN is a 6-member network of providers in 32 rural Indiana counties, with a total population of approximately 1 million persons. The network aims to sustain and enhance mental health services for residents and providers through training and cost-effective cooperative administrative measures. A serious barrier to accessing mental health care services in the area is the distance residents must travel to a midsized city to see mental health providers. On average, rural residents are separated from care by up to a 45-minute drive. A lack of public transportation leaves rural residents isolated from centrally located health care providers who often serve multiple counties. Three of the counties are designated Mental Health Professional Shortage areas. An additional barrier for many rural residents is the stigma of receiving care for mental health needs. Anonymity and privacy are lost when a person passing by a rural community mental health center can recognize every care or truck in the parking lot. Another barrier is the high turnover rate of caseworkers and other midlevel mental health professionals in rural centers. Rural isolation interferes with services, patients find it difficult to navigate the maze of social services, and case managers face language barriers and cultural differences -the Hispanic population has increased by 202 percent in the past decade.

The network has developed a program to respond to the mental health needs of uninsured and indigent residents and to improve the lot of mental health care providers in the rural communities of Indiana. The focus of the program is to provide education and training on how to diagnose behavioral health disorders, understand the treatment options available, and use cost-effective cooperative administrative measures. In particular, the program will explore the possibility of voice, video, and data systems to enhance education and training opportunities for rural mental health workers and will aim for a 10-percent reduction in staff turnover. The first year of the program will include evaluation and development of training needs, broadening strategic plans for the network, and setting initial plans for group purchasing and combined administrative needs. The second and third years will focus on implementing and evaluating the program initiatives. One goal is to increase the number of case managers by 20 percent over the 3-year period.

IOWA

AgriSafe Network

D06RH04306
Natalie Roy
AgriSafe Network
1200 1st Ave E
Spencer, IA 51301-4342
Phone: (712) 264-6579

Fiscal Year 2005 2006 2007
Grant Award $179,592 $179,404 $179,198
The AgriSafe Network is a 501 (c) 3 organization representing 23 rurally-based hospitals, health clinics, and county health departments that provide preventive occupational health services to Iowa farmers. These organizations operate AgriSafe clinics staffed by nurses who have received specialized training in the field of agricultural occupational health. AgriSafe clinic nurses provide early detection and prevention of agriculturally-related health and safety problems through clinical screenings, environmental assessments, appropriate referrals and educational programs.

The objective of this project is to meet the following goals outlined in the Network's strategic plan:
1) Increase the network's financial capacity to serve AgriSafe providers.
2) Ensure that educational programs meet the needs of the health and safety professionals.
3) Increase the number of farmers served by AgriSafe providers.
4) Promote of AgriSafe network and clinic services.
5) Increase clinic membership to the AgriSafe network.
6) Provide quality assurance for AgriSafe providers.

In addition to the 23 member AgriSafe clinics, the Network will collaborate with State Universities, mental health organizations, migrant health providers, farm commodity
associations and other public health entities to accomplish these goals. The anticipated outcome of reaching these goals is increased access to affordable and effective AgriSafe services for farmers in Iowa. The Network's sustainability plan is based on diverse revenue from corporate sponsors, foundations, health insurance companies and increase utilization of services.

Patient Safety Health Care Network of North Iowa (PSHCN)

D06RH00283
Denise Dow
Mercy Medical Center - North Iowa
1000 4th Street SW
Mason City, Iowa 50401
Phone: (641) 422-5429

Fiscal Year 2003 2004 2005
Grant Award $199,943 $199,467 $199,913

The Patient Safety Health Care Network of North Iowa (PSHCN) is a coalition of nine small primary care hospitals and a larger secondary referral center. The network serves 14 sparsely populated counties in north-central Iowa. These counties have a very high percentage of elderly residents (19 percent), a depressed farm and agricultural business economy, and low wages. All 14 counties are Health Professional Shortage Areas and 7 also are Medically Underserved Areas. The network seeks to develop, implement, and evaluate an integrated patient safety plan that will significantly improve the quality of patient care and reduce medical errors in network hospitals, clinics, and pharmacies. Many factors make patient safety a high priority for network members and necessitate an integrated, system-wide approach to patient safety. These factors include the area's high percentage of elderly residents at risk for experiencing medication errors, especially adverse drug reactions, who have limited transportation options and inadequate knowledge of their medications; the language barrier in the small but growing population of Spanish-speaking residents; a shortage of nurses, surgeons, and pharmacists; budget deficits that lead to staff cuts, leaving remaining network staff with too many responsibilities; and the relatively low occurrence of serious medical errors, making them especially difficult to track in small health care facilities.

During the past 5 years, all network hospitals and clinics have monitored some types of medical errors in their facilities. These monitoring efforts have improved patient safety in scattered areas and raised awareness of patient safety among providers. However, because of a lack of standardization, these improvements have not adequately or substantially increased patient safety across the network. PSHCN will develop standardized documenting, tracking, and data analysis systems that will generate accurate, actionable information about sources and types of medical errors; establish common benchmark goals; implement and evaluate best clinical practice guidelines and protocols to improve major patient safety processes and reduce medical errors; and prepare a well-researched plan to acquire and implement targeted, cost-effective, and appropriate information technologies to support safe patient care. Through these efforts, PSHCN hopes to lessen pain and suffering, save lives, minimize lost productivity and household income, improve confidence and satisfaction in the rural health care system, and reduce medical costs over time.

Tri-Co Health Network

D06RH02563
Jean Drey
Sioux Central Community School
P.O. Box 98
Albert City, Iowa 50510
Phone: (712) 843-5416

Fiscal Year 2004 2005 2007
Grant Award $199,723 $199,420 $199,305

The Tri-Co Health Network is comprised of 22 members, including local hospitals, public health, mental health, human service and education agencies. The geographic area served consists of thirteen small communities, all under a population of 1,900, located in northwest Iowa in the three rural counties of Buena Vista, Clay and Pocahontas. The health care network builds on the concept that school districts are the connecting point between children and local community health care and human service providers. The vision of the Tri-Co Health Network is to develop and implement a collaborative streamlined network providing all children, ages three through eighteen and their families, with access to balanced health care. The purpose is to expand and formalize current efforts to increase access to health care for youth residing in the network area. The mission is to weave health care supports for children and families into an integrated, comprehensive system of health, human service and education systems. The design for the TriCo Health Network is simple, yet the implementation of this project is unique. All parents will complete an annual health screening during school registration each fall. The form gathers basic data about access to care, recent services, and health promotion items. The purpose of gathering this data is for the Tri-Co Health Network to fully implement a prevention-focused, school based identification and referral system through which every child in the thirteen target communities are assessed regarding the annual status of their health care. This involves analyzing the way families currently access health care services, bringing health care and service providers together to examine the systems and to recommend ways to streamline service delivery to children and their families.

The data collected will be used for purposes as defined by the following four components. Component #1 will focus on students in need of service who will be prioritized for care and assisted in finding medical and dental homes. Network staff will make referrals, assist with appointments, and provide case management. In component #2, health promotion data will be used to plan and implement family and community education sessions and to adapt existing K-12 curriculum to help students take responsibility for their health care. Through component #3 efforts, all parents will receive a report card telling them whether or not their child has attained the recommended health standards and benchmarks for their age group. In addition, the community will receive regular information on the health care status of all children in the community. Component #4 is the heart and soul of the project. Project data will be regularly shared with physicians, dentists, and other health care providers for use in community planning efforts. Not only will the data collected in this project help connect students to services; the data will be used to support a community planning process.

KANSAS

Northwest Kansas Health Alliance

D06RH00218
Jodi Schmidt
Hays Medical Center
2220 Canterbury Drive
Hays, Kansas 67601
Phone: (785) 623-2301

Fiscal Year 2003 2004 2005
Grant Award $179,849 $173,227 $151,575

The Northwest Kansas Health Alliance, founded in 1991 in response to the Essential Access Community Hospital/Rural Primary Care Hospital (EACH/RPCH) Program, serves 15 counties and is composed of 14 Critical Access Hospitals and Hays Medical Center, the support hospital. All of the partner members are located in northwest Kansas except for one, which is in southcentral Nebraska. As small rural hospitals face more and more financial challenges, addressing quality-of-care issues is a priority for these hospitals, regulators, and consumers. A major concern in rural communities is access to high-quality patient care services, especially in light of the closure of nearly 200 rural hospitals over the past decade. After 11 years of successful operation, the Northwest Kansas Health Alliance has the capability and commitment to develop a performance improvement (quality of care) model that is responsive to the needs of its member hospitals and the communities they serve. Using a network approach, the alliance will develop a sustainable, replicable model by which rural hospitals can create and sustain strong performance improvement programs. The alliance will use the network grant to offer participating hospitals the ability to improve their delivery of health care services by restructuring and stabilizing their performance improvement programs to meet the challenges of today's demanding health care environment.

While young people migrate from small towns across America to the large cities in search of employment, middle-aged and elderly residents tend to stay put. This situation holds true in northwestern Kansas where between 1990 and 2000, each of the 15 counties in the project service area lost population, except for 1, which increased by 6 people. During that time, the average net population loss in northwest Kansas was 6.33 percent. As the region's population decreases, the average age of residents increases. Concurrently, the number of employed residents decreases, thus reducing the area's tax base. As a result, even Critical Access Hospitals in northwest Kansas are experiencing financial difficulties. In this environment, it is a challenge for rural hospitals to remain open. Working as a partnership to leverage resources, expertise, and commitment, the Northwest Kansas Health Alliance will develop tools, techniques, and practices to support improvement programs at individual rural hospitals. The project will address the area's specific top-10 trouble areas as identified by the alliance that originally placed hospitals in the network at risk. In addition, the alliance will share the lessons learned from this project with other rural communities and health care providers nationwide so that others can benefit from these efforts.

MICHIGAN

Medical Care Access Coalition (MCAC)

D06RH05060
Stacie Kucera
Medical Care Access Coalition, Inc.
1414 W Fair Ave STE 26
Marquette, Michigan 49855-2675
Phone: (906) 226-4400

Fiscal Year 2005 2006 2007
Grant Award $180,000 $180,000 $180,000

The Upper Peninsula (UP) of Michigan is a low income rural region sitting just below Lake Superior. With a population of over 300,000 persons and largely designated as underserved and severely underserved, the UP lacks medical services in both direct care and medical infrastructure. The result is that the uninsured, especially the chronically ill, must navigate transportation issues, lack of uniform charity services, lack of government services, and a lack of organization among volunteer services.

Upper Peninsula Health Care Access Consortium (UPHAC) is a network of access agency coalitions. Each access agency's mission is to increase access to health care for the uninsured and underinsured residents of the counties they serve. UPHAC's overall vision is that all residents of Michigan's Upper Peninsula (UP) have access to quality health care with dignity.

Upper Peninsula primary care and specialist physicians who currently volunteer their time to care for low-income/Medicaid ineligible persons often experience fragmented intake/eligibility processes, lack of administrative support, absence of equitable distribution of uninsured persons, lack of available ancillary services, lack of appreciation/recognition, and lack of medications to complete their care for the uninsured. The UPHAC will work to meet needs of these physicians. UPHAC's multi-county direct care program approach consists of leveraging and expanding healthcare for the low-income uninsured through the coordination of donated and volunteer medical services in a UP community. The project will foster regional coordination that is necessary for the volunteer medical programs that provide effective and organized medical care to every uninsured/Medicaid-Medicare ineligible person under 200% of the Federal Poverty Level. Overall, it will establish, expand and integrate the volunteer medical programs in the Upper Peninsula of Michigan to increase access to quality health care for residents of the UP.

Upper Peninsula Health Care Network (UPHCN)

D06RH04342
Gerald A. Messana
Upper Peninsula Health Care Network, Inc.
228 West Washington Street, Suite #2
Marquette, Michigan 49855-4823
Phone: (906) 225-3146

Fiscal Year 2005 2006 2007
Grant Award $179,934 $179,991 $179,977

Managing Prescribing Cost and Quality seeks to strengthen the viability of health care entities by addressing one of the factors influencing the financial challenges of health care organizations - the rising cost of pharmaceuticals. The issue of drug expenditures was chosen because pharmaceuticals are currently the most influential driver of health care inflation. For hospitals, pharmacy services represent 5.2% of direct hospital expenses - the third largest component of hospital costs. After years of double-digit increases, drug costs were projected to increase in 2003 by 10-12% for inpatient settings and 14-16% for outpatient settings.

The providers to be served by this project include 16 independent health care organizations that are members of the Upper Peninsula Health Care Network (UPHCN). This Network includes eight Critical Access Hospitals, five rural hospitals, a regional referral center, a behavioral health organization and a tribal health center. The viability of the partners will ultimately serve 317,616 residents in Michigan's Upper Peninsula (UP) through access and quality of care. On an outpatient basis, the region's only Medicaid managed care plan is has the.

This project joins the UPHCN with the Upper Peninsula Health Plan (Plan), a state-designated qualified health plan serving the Medicaid population of Michigan's Upper Peninsula, which had the highest per member per month pharmaceutical costs in Michigan. The union will promote rational, clinically appropriate, safe and cost-effective pharmaceutical care to residents of Michigan's Upper Peninsula.

Process objectives are to develop and implement a region-wide cooperative pharmacy formulary management system and to implement evidence-based clinical practice guidelines that include pharmaceutical recommendations for a target of 10 disease states associated with major drug classes. Outcome objectives seek to increase the percent of Network drug expenditures on negotiated contract from 58% to 75%, and reduce the Plan's per member per month pharmaceutical costs to 3.7% below the state average (currently 42% above).

Northwest Upper Peninsula EMS Network

D06RH 04344
Gary Wadaga
Baraga County Memorial Hospital
P.O. Box 1
Baraga, Michigan 49908
Phone: (906) 353-6196

Fiscal Year 2005 2006 2007
Grant Award $144,900 $152,145 $159,752

The purpose of the Northwest Upper Peninsula EMS Network (Network) is to promote optimal care of injured patients in the Northwest Upper Peninsula region of Michigan, by ensuring the availability of high quality, accessible, and affordable emergency medical services. The northwest region of Michigan's Upper Peninsula is a rural, sparsely populated region. The counties targeted by this grant are served by two federally designated Critical Access Hospitals (CAH) and five private ambulance services. As the economy has reduced the county's ability to subsidize local ambulance services, as insurers have reduced payments, and as fewer people are willing to volunteer, all rural ambulance services are faced with finding a way of doing more with less. In particular, both Counties share problems in the recruitment, retention, and training of their EMS volunteers and in the maintenance of equipment. At the same time, numerous statewide initiatives in Bioterrorism response, EMS Medical Control responsibilities, homeland security issues, and new protocols for Michigan's trauma care system all combine to overwhelm local EMS resources that are scarce and volunteer-based to begin with. As a result of these factors, two of the region's five emergency medical services are expected to close within the next two years.

The Network's goals for year one of the project include:
1. Organizing the Regional EMS Network.
2. Providing EMS training programs for EMS staff and volunteers.
3. Conducting a coordinated volunteer recruitment / marketing campaign to increase EMS volunteers in their local communities.
4. Assessing the operational and financial viability of all EMS services in the region.
5. Assessing regional improvements and enhancements to local EMS medical control.
6. Conducting an EMS strategic planning process.
7. Seeking Federal and State funding support for implementation activities identified in the regional EMS strategic plan.

In years two and three of the project, the Network will:
1. Implement the goals and activities detailed in the EMS strategic plan;
2. Continue to assess the region's EMS needs, issues, and the results of strategic initiatives;
3. Assess the inclusion of additional counties and organizations as consistent with the regional EMS the strategic plan.

Grand Traverse Regional Health Care Coalition

D06RH05052
Arlene Brennan
Grand Traverse Regional Health Care Coalition
3155 Logan Valley Rd.
Traverse City, Michigan 49684
Phone: (231) 935-0799

Fiscal Year 2005 2006 2007
Grant Award $179,720 $179,720 $179,720

The Grand Traverse Regional Health Care Coalition (GTRHCC) will build on an existing volunteer-based health services program to increase both the number of low income, uninsured individuals served and the efficiency of the services provided. The service area includes three counties in rural, northern Michigan (Benzie, Grand Traverse and Leelanau Counties). Membership in the GTRHCC includes representatives from an existing community-based clinic, the public health departments, a regional hospital system, a dental clinic, the chamber of commerce, faith-based organizations, a medical society, a family practice residency, a state family service agency and a regional telehealth network. Members of the network share a strong collaborative history and demonstrate a commitment and vision to improve the currently fragmented health care system for the low-income uninsured residents of rural, northern Michigan. The GTRHCC was created in 2003 to develop and implement a system of care to serve the low-income uninsured persons who live in Grand Traverse, Leelanau and Benzie Counties. Within these three counties, slightly over 10% or 10,279 of the 98,146 residents under 65 years of age do not have health insurance. Additionally, 5,895 persons under 65 years of age are living below the Federal Poverty level and nearly 30% of these persons have no health insurance.

During the course of this project, GTRHCC will formalize the network by implementing a strategic and financial sustainability plan, implement a system of care to provide the low-income uninsured population with access to quality health care, develop a dental network, expand the pharmacy program and operate an effective and efficient network for the uninsured that will include systems of evaluation and monitoring of both end users (providers and network partners).

MINNESOTA

Northern Minnesota Network

D06RH04346
Jackie Ann Moen
Northern Minnesota Network
908 Rum River Drive
P.O. Box 328
Cambridge, MN 55008-0328
Phone: (763) 444-8283

Fiscal Year 2005 2006 2007
Grant Award $180,000 $180,000 $180,000

The Northern Minnesota Network consists of three members that operate 20 sites providing primary health care services to the uninsured, underinsured, migrant and seasonal farm workers in rural areas of Minnesota and eastern North Dakota. The centers are often the only primary care providers in the area. The health centers in the Network provide care to approximately 25,800 people annually with over 102,200 patient encounters. The combined service delivery areas of the Network centers encompass more than 14,000 square miles.

Community and Migrant Health Centers are widely separated and often isolated by geographic features and winter weather conditions. The geographical distance between health care centers in the Northern Minnesota Network and the isolation of rural areas present two needs regarding access to quality health care. One is timely access to a patient's medical record. The second problem is tracking and managing medical information with a patient population that is transitory and widely scattered across the state. In order to improve access to and delivery of health care to people in rural, sparsely populated areas, the Network will implement a "medical informatics" approach. This approach integrates medical records and information technology expertise in the context of quality assurance to better manage patient information, tracking, and ultimately, care.

The Network's strategy to accomplish these goals is to establish a single network-wide Management Information System (MIS). The MIS will include shared network hardware and software as well as discrete partner hardware and software. The process of moving to the network-wide system involves implementing a unified practice management system, and standardizing all partner clinical sites' local area networks (LANs) in order to develop a wide area network (WAN). The significant outcomes anticipated from this project include an increased capacity for the collaborators to manage and track medical information, enhance the continuum of care, share staff expertise across network members, and achieve economies of scale and cost efficiencies with information management systems integration and centralized purchasing.

Central Minnesota Health Information Network

D06RH02553
Douglas Reker
Central Minnesota Health Information Network
1424 S. Broadway, Suite 271
Alexandria, Minnesota 56308
Phone: (320) 634-3704

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Central Minnesota Health Information Network (CMHIN) is a 7-county consortium of rural health care providers composed of 10 hospitals and 3 medical centers. CMHIN was formed to respond to the tenuous survival of rural health care facilities in central and west-central Minnesota. Over the past 20 years, more than 30 rural hospitals have closed in the State of Minnesota. Currently, 20 percent of rural Minnesota hospitals are financially troubled and face increased emphasis on cost containment because of a general decline in vital resources. Specifically, the lack of access to information technology causes expensive inefficiencies, professional staff shortages, and measurable declines in reimbursements. In addition to the decline in resources, local rural facilities are finding it difficult to respond to the complex health care needs of an aging population. (An average 19 percent of the seven-county population is older than age 64 with three counties ranging from 22 to 26 percent.) At the same time, local rural facilities are struggling to meet the demands of a changing health care environment that requires more sophisticated services, cost accountability, and expanded documentation of health outcomes. The Minnesota Hospital Healthcare Partnership reports that 5 of the hospitals in the network with 50 beds or fewer average a 2.9 percent bottom line, leaving them with insufficient funds to invest in electronic technology or to attract the professional workforce needed to serve their local communities.

Geographic conditions and the remote locations of the seven counties mean that many communities in the target service area do not have access to primary health services. All seven counties are Medically Underserved Areas (MUAs), and three communities in the region are Health Professional Shortage Areas (HPSAs). Distance issues also make connectivity a financial impossibility for most small providers in the network. CMHIN is developing a strategic plan for the formation of a health information network that will (1) implement connectivity between providers, (2) bring contemporary electronic information technology exchange to the rural environment, (3) support providers in the design of systems that comply with security and information privacy requirements, and (4) provide a regional intranet for data-sharing and online access to information resources for health care providers and students. Using network grant funds, CMHIN will enable providers to work collaboratively and efficiently with each other and help them overcome the barriers of limited financial, technical, and information resources that will ultimately enhance the continued viability of central and west-central Minnesota health care providers.

Itasca County Health Network

D06RH00278
Lois McCarron
Itasca County Health and Human Services
1209 SE 2nd Avenue
Grand Rapids, Minnesota 55744
Phone: (763) 784-9773

Fiscal Year 2003 2004 2005
Grant Award $198,965 $197,841 $197,327

The Itasca County Health Network involves key participants from a broader network of health care providers who participate in the Itasca County Medical Care (IMCare) program. The IMCare program has been operating in Minnesota for 20 years and has established extensive collaboration and cooperation among all the health care providers in Itasca County. However, communication and coordination among network service providers are currently limited to physical and facsimile transfer of information. The network grant will enable the Itasca County Health Network to cooperatively design an electronic information system to support and expand provider communication protocols, consumer information and education, and an enhanced continuous quality improvement system. Electronic transmission of information will increase the efficiency and viability of health providers. The network also seeks to increase the use of telehealth technologies for electronic transmission of client and system information. This improvement is especially important in a county that has only 11.3 physicians per 10,000 residents.

Itasca County, located in the central part of northern Minnesota, has a population of 43,992 and covers 2,665.06 square miles. Of 21 communities in the county, only 5 have a population greater than 900 residents. The area's median annual family income is $6,000 below the State average, and the county frequently experiences the highest unemployment rate in northeastern Minnesota.

The Itasca County Health Network members include the newly merged Itasca Medical Center and Grand Rapids Clinic, Northern Itasca Health Care Center, Northland Counseling Center, a dentist, a pharmacist, and the Itasca County Health and Human Services Department. A design team, with participants from each network member, will develop the information system, which can then be expanded for use among all IMCare program providers and all health care consumers. The first phase of development will target families and children; the second phase will target persons with chronic and mental illness; and the third phase will target the elderly. The project also will produce a Web site to provide health information, education, and resources for consumers and providers.

MISSISSIPPI

G.A. Carmichael Family Health Care Clinic

D06RH00277
John Bierma
G.A. Carmichael Family Health Care Clinic
1668 West Peace Street
P.O. Box 588
Canton, Mississippi 39046
Phone: (662) 347-0209

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Greater Delta Health and Human Services Network (GDHHSN) is a collaborative of more than 40 health, education, and social service provider organizations involved in the development and implementation of an integrated health and social services support delivery system in a 10county area of the Mississippi River Delta. In support of GDHHSN efforts, the G.A. Carmichael Family Health Care Clinic, a 330-bed federally funded health center, together with the Delta Area Health Education Center, Delta State University, and Delta Health Ventures, is spearheading an initiative to develop and implement a coordinated case management and outreach system among network members. The initiative will enhance patient and client access to quality primary health care, human support services, and follow-up by linking network members electronically.

High poverty levels, low educational status, low accessibility to health care, and a large African American population characterize the Mississippi River Delta. Health outcome indicators in the area reveal infant mortality and chronic disease rates that far exceed those in the rest of the State and the Nation. Recently, Mississippi earned the dubious distinction of having the most obese population in the United States. Statistically, the Mississippi River Delta region is the poorest in the Nation.

Throughout the 10-county region, the project strives to develop a coordinated case management protocol for patient/client assessment, referral, and follow-up; provide training for using the system; identify and train 20 community volunteers as lay community outreach workers to facilitate the case manager's service plan; connect network providers electronically using a wide area network (WAN) to enhance communications and the sharing of information; and develop a video conferencing/distance learning network for staff training. The project also will deliver a consumer-based education and training service and provide orientation and training to member organizations' staff regarding HIPAA rules and regulations and their implications for electronic transfer of information. Project stakeholders believe these goals and activities correlate with the purpose of the integrated rural health network, which is "to foster collaboration and integration of functions among network entities to strengthen the rural health care system.

MISSOURI

Mercer Putnam Sullivan Rural Network Consortium

D06RH00281
Martha Gragg
Sullivan County Memorial Hospital
630 West Third Street
Milan, Missouri 63556
Phone: (660) 265-4212

Fiscal Year 2003 2004 2005
Grant Award $199,437 $203,455 $200,216

The Mercer Putnam Sullivan Rural Network Consortium (MPSRNC) seeks to establish a rural health network in Mercer, Putnam, and Sullivan Counties in Missouri. The consortium's primary goal is a vertically integrated health care system in the three-county area that enhances coordination and continuity of care, improves access to quality health services for the underserved population, and ultimately provides better health status to residents. The consortium comprises nine nonprofit health care and social service agencies located in rural north-central Missouri.

All three counties in the target service area are designated geographic and low -income Health Professional Shortage Areas. According to the 2000 census, population density in Mercer, Putnam, and Sullivan Counties is 8.3, 10.1, and 11.1 residents per square mile, respectively, compared with the overall State density of 81.2 persons per square mile. Approximately 20.5 percent of the population in the three-county area is 65 years of age and older compared with the State level of 13.5 percent. Sullivan County has a very high Hispanic population compared with the State (8.8 percent versus 2.1 percent). The poverty level in all three counties is higher than the State average. The two hospitals serving these three counties, Sullivan County Memorial Hospital and Putnam County Memorial Hospital, are Critical Access Hospitals. Mercer County does not have a hospital. Additional barriers to care include prescription medicine costs for the elderly, a language barrier in the Hispanic population, lack of transportation, lack of reimbursement, travel times, and lack of communication among health care providers due to a lack of linkage.

MPSRNC will develop information systems to support patients and clinicians in decisionmaking, analyze practices, and explore opportunities for improvement. The consortium also will develop and establish evidence-based patient education services and care management services to provide coordination among and information support to health care providers and agencies. Other specific activities include developing nursing care assessment and patient education tools; initiating accessibility to software at local hospitals, clinics, health departments, and the Latino Center to identify sources of free pharmaceuticals; developing and providing bilingual (English-Spanish) patient instruction during care services; and providing education and training for clinicians who care for the Hispanic population. Lastly, the consortium will be open for enlargement and will continuously seek new partners for health care improvement in the tri­ county area.

MONTANA

Montana Health Research and Education Foundation

D06RH05059
Kipman Smith
Montana Health Research and Education
PO Box 5119
Helena, MT 59604-5119
Phone: (406) 442-8802

Fiscal Year 2005 2006 2007
Grant Award $178,570 $178,545 $179,840

The grant will be used to support extensions of the Montana Rural Healthcare Performance Improvement Network (PIN) activities in Montana's rural hospitals. Specifically, grant funding will be used to address expansion of rural-relevant, context-appropriate clinical peer review studies and implementation of a "modified" Balanced Scorecard management system in low-volume, frontier hospitals.

Since February 2001, MHREF and Montana's Critical Access Hospitals (CAH) have been working together through a voluntary network to ensure Montana's CAHs have the ability to meet Medicare Conditions of Participation related to quality assurance/improvement. During the nearly four year history of the Network, membership has grown from the original 14 members to the current 39.

Given the rapid growth in membership, the success of initial activities and mounting pressures from national quality initiatives, the Network began a strategic planning process in December 2002. This planning effort resulted in adoption of a three-year strategic plan and a new governance structure to allow PIN members to move forward with an aggressive work-plan. Several PIN activities focus on Healthy People 2010 goals and objectives. Planned PIN programs are specifically designed to address increased national attention on quality of care and patient safety issues while recognizing that many of these initiatives need to be modified if they are to be relevant and applicable to low-volume, rural providers. The purpose of this grant is to assist the PIN in moving these plans forward into reality.

Nationally, a "Framework for Rural Quality" has been proposed by the Roundhouse Group. The Network works to accomplish two of the Framework's agenda items - developing relevant measures for quality and performance in the rural/low volume health care environment and developing quality/performance improvement programs. Montana is an excellent laboratory for demonstrating these agenda items.

NEVADA

Nevada Public Health Foundation, Inc.

D06RH00219
Rota Rosaschi
Nevada Public Health Foundation, Inc.
305 N Carson St, Suite 200
Carson City, Nevada 89701
Phone: (775) 884-0392

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Carson City Network for Health was established in 2002 with the goal of procedurally linking and integrating the health services in Carson City, Nevada. Although network members represent a wide variety of health service providers and have been working together for years, to date their services have been fragmented. Even among agencies providing similar or complementary services, lack of coordination can lead to duplication of services. The inefficiencies created by this lack of linkage result in barriers to complete service, a health system that is difficult to navigate, and hardships for clients and providers alike. This project strives to provide collaborative relationships among all health organizations to increase efficiency, cost-effectiveness, and quality of care for clients in Carson City. Members of the network include the Nevada Public Health Foundation, the Consolidated Municipality of Carson City, the Carson City Mental Health Coalition, Carson-Tahoe Hospital, Nevada Health Centers, Inc., HealthSmart, and the Nevada State Health Division Bureau of Community Health.

Carson City, the capital of Nevada, is located in northwestern Nevada at the foot of the Sierra Mountains. In terms of area, the Consolidated Municipality of Carson City (both a city and a county) is Nevada's smallest county, with 146 square miles. But the growing population- 52,359 in 2000, up 23 percent from 1999-makes Carson City the third largest county and the largest rural county in the State. Carson City's population density of 346 residents per square mile is 2 times and 5 times greater than Clark and Washoe Counties, respectively, the only 2 counties in Nevada classified as urban. Roughly 10 percent of Carson City residents and 13.7 percent of its children live in poverty; 17.6 percent are uninsured. The growing population puts a strain on government services in this uniquely "urban" rural area because revenues have not kept pace with population growth. In addition, the city has enough water to support a population of only 80,000.

To allay some of the burden on the Carson City government, the Carson City Network for Health strives to achieve unity of health care services. The project will create two products to improve health care delivery to all Carson City residents. The first product is customer-oriented, no wrong-door entry and referral procedures that simplify client navigation of Carson City health services, improve coordination among agencies, and improve access to services, especially for the area's underserved residents. The no-wrong-door system will allow clients to obtain all the services they need in an efficient, cost-effective manner, no matter where they enter the system. The second product is a strategic plan for continuous maintenance and improvement of the network. The strategic plan will provide Carson City with a systematic approach to evaluate future improvements to the health services system and an assessment tool to evaluate Carson City's capability to create a regional health district. The project also plans to provide a needs assessment and a blueprint for developing a public health department for Carson City and its vicinity.

Nevada Rural Hospital Partners (NRHP)

D06RH00275
Robin Keith
Battle Mountain General Hospital
535 South Humboldt St.
Battle Mountain, Nevada 89820
Phone: (775) 827-4770

Fiscal Year 2003 2004 2005
Grant Award $199,705 $192,139 $180,629

The Nevada Rural Hospital Partners (NRHP) is a consortium of all 11 of Nevada's small, rural, not-for-profit hospitals serving 13 counties over a vast geographic area of 58,000 square miles. The target service population is 200,000 people, with a density of approximately 3.4 persons per square mile. Distance, isolation, and low population density create challenges to Nevada's rural health care delivery system; the rural hospitals in the network are the only hospitals serving the target service area. Ten of NRHP's 11 member hospitals will participate in the NRHP Shared Information Technology Project to address the basic "dis -integration" of management information systems, a technologic issue common to small rural hospitals. Management information systems often are cobbled together from disparate components because the facility lacks the necessary financial resources to buy a fully integrated system or because the fully integrated system does not serve departmental needs. The resulting management information systems are inefficient and lead to an increased risk of error in patient information, a reduction in staff productivity because a tremendous number of staff hours are dedicated to inputting patient information by hand, billing errors and increased claims rejections, and a squandering of resources that could be spent on clinical rather than administrative issues.

The NRHP Shared Information Technology Project builds on network successes using shared database technology and internal, hospital-specific solutions. Upon completion, the project expects that patient identifier and billing information in at least 3 departments in the 10 participating network hospitals will be automatically posted to billing software, greatly increasing productivity and decreasing cost. Using an existing virtual private network and an existing wide area network (WAN), the project will provide access to centralized, shared database information. The WAN enhances the network's ability to increase focus on delivery of health services in two ways. First, it brings greater technologic and administrative integration to the frontier and rural hospital system. Second, coupled with NRHP members' commitment to the strength of group effort, it opens the door to shared information system applications that enable individual member hospitals to improve the integration of internal management information systems and to share more complex applications. Existing interactive compressed video technology will be used to communicate and coordinate the project.

NEW HAMPSHIRE

North Country Health Consortium (NCHC)

D06RH02571
Martha McLeod
646 Union Street, Suite 400
Littleton, NH 03561
Phone: (603) 444-4461

Fiscal Year 2004 2005 2006
Grant Award $198,863 $195,706 $193,275

The North Country Health Consortium (NCHC) was developed in 1997 and is a vertically integrated health and human services network located in Northern New Hampshire. The network is composed of four Critical Access hospitals, one rural hospital, two community health centers, a region-wide network of community mental health centers, two home health agencies and the Community Action Program that serves the area. NCHC members are safety net providers serving patients that display all the characteristics of an under-served population including morbidity and mortality considerably higher than the state average and household income 30 percent below the state average. In addition, a substantial portion of the population has no access to health care reimbursement. Thirty-seven percent of the NCHC service area lies within the boundaries of the White Mountains National Forest. The rural, mountainous terrain creates substantial barriers to the services enjoyed by the residents of the rest of the state. The Consortium has been successful in developing initiatives ranging from the development of the North Country Health Information Network to programs focusing on community care coordination and public safety. In accomplishing these activities, NCHC members have displayed a willingness to adopt a regional, collaborative approach to reducing barriers to access while attempting to keep their individual organizations financially viable.

The Goal of the NCHC is to build on the success already achieved by the vertically integrated NCHC. The initiative will strengthen the health care delivery system available to North Country residents by strengthening the viability of NCHC members, all of which are safety net providers. NCHC will leverage individual and collective resources to create programs that are regional in nature and will respond to the special needs of the rural population. Three objectives are envisioned for the project. 1) Develop community and public health initiatives to increase wellness and decrease disease. Initiatives will include chronic disease management with emphasis on obesity, diabetes and asthma. 2) Develop the infrastructure necessary to expand the capacity of NCHC provides and allow regional delivery of services such as oral health to populations in need. 3) Develop education and training to North Country health care providers by focusing on the use of telemedicine technology to improve access to care and decrease cost for providers.

NEW YORK

Genesee Valley Health Partnership

D06RH00254
Reid Perkins
Livingston County Department of Health
10950 County Road 92
Wayland, New York 14572
Phone: (585) 728-5738

Fiscal Year 2003 2004 2005
Grant Award $200,000 $126,460 $121,460

The Genesee Valley Health Partnership (GVHP) consists of 32 government and human service organizations, health care providers, insurers, and educational institutions in Livingston County, New York. GVHP's guiding mission is to improve the health outcomes of Livingston County residents through collaboration, education, prevention, and practice. Specific partnership objectives include strengthening the local health system by building community coalitions and using the Mobilizing for Action through Planning and Partnership (MAPP) process, and improving health care access for residents, including prehospital care, primary care, hospital, and aftercare health services.

Livingston County, located directly south of Rochester, New York, has a population of 64,328 and comprises 17 towns and 9 villages. More than 11 percent of the general population lives below the poverty level; 16.1 percent of the region's children live at or below poverty. Forty physicians and 21 dentists practice in Livingston County, but none accepts new Medicaid patients. Using health assessments, GVHP and the local health department have identified the region's most significant health care problems. They include chemical dependency, lack of immunization, violence, mental health problems, teen pregnancy, inactivity and poor nutrition, lack of respite care, inadequate access to health care, exposure to toxins and infectious agents, and five leading screenable causes of death.

Past, current, and future partnership activities are driven by studies conducted in the county. They include lack of nonemergency transportation to and from health care appointments; difficulty recruiting and retaining volunteer emergency medical services personnel; difficulty in retaining health care professionals; a lack of dentists accepting Medicaid; lack of an efficient, user-friendly referral system between aging service providers; lack of health prevention and education for school-age children addressing violence, teen pregnancy, and substance abuse; and lack of outreach materials concerning environmental health hazards. The 5-year-old partnership strives to continue offering services to Livingston County that fill the gaps in these community services.

OREGON

South Coast Rural Health Integrated Provider Team

D06RH02565
Kathy Laird
Waterfall Clinic, Inc.
1890 Waite St., Suite 1
North Bend, Oregon 97459
Phone: (541) 756-6232

Fiscal Year 2004 2005 2006
Grant Award $180,035 $136,185 $125,095

South Coast Rural Health Integrated Provider Team (SCRIPT) is a two-county regional network which is comprised of the members of three smaller, community-based networks. The members of SCRIPT include three rural hospitals (two of which are critical access hospitals), two public health departments, one free-standing safety net primary health clinic, three participating Rural Health Act clinics and an area Health Education Center. The network has engaged in strategic planning and has developed a logic mode, project matrix, and strategic plan that will focus on governance, operations, personnel, and programs. The network will develop resource development and sustainability plans which will be superimposed on the existing strategic plan to create a single document.

The project is situated in Coos and Curry Counties of southwestern coastal Oregon. Collectively, these two counties comprise a rurally-isolated area of 3,277 square mile and support a population base of 83,916 of which 35% are publicly-insured through Medicaid and Medicare; 16.7% are medically uninsured; and 29% have health insurance with deductible limits that exceed 10% of household income. The region is classified as health professional shortage and medically underserved areas. As a result of unmet need, the population has multiple health disparities at rates which are significantly above Oregon statewide means. The project will work to solidify horizontal integration of four classes of members; build teamwork and expertise that evolves around the creation of a learning community; work toward the eventual attainment of vertical integration; integrate primary and mental health care with the safety net system of care; and engage in feasibility and program planning related to health professional recruitment and retention. The learning community will focus on practice management strategies that enhance organizational efficiencies thereby constraining the costs of providing healthcare. The project's evaluation plan calls for summative and formative processes which measure five outputs, four outcomes, management functions, cost-to-benefit ratios, and levels of engagement among network members.

PENNSYLVANIA

The Susquehanna Valley Rural Health Partnership

D06RH00259
Susan Browning
Jersey Shore Hospital
1020 Thompson Street
Jersey Shore, Pennsylvania 17740
Phone: (570) 321-3000

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The Susquehanna Valley Rural Health Partnership (SVRHP) is a three-county network comprising The Williamsport Hospital (TWH), Muncy Valley Hospital (MVH), Jersey Shore Hospital (JSH), and Bucktail Medical Center (BMC). This horizontal network of providers has a long history of working together to improve health care in rural north-central Pennsylvania and sharing similar patient demographic and health statistics. Although network development is a relatively new concept for providers in rural Pennsylvania, SVRHP believes that further collaboration will enhance the sustainability of the fragile local rural health infrastructure. One of the network members, TWH, has been ranked among the 100 Most Wired Hospitals every year since 2000 and is committed to sharing its expertise with rural providers in the region. The network's three other members transitioned to Critical Access Hospitals in the last year and use TWH as their network facility.

The tri-county service area served by SVRHP covers 2,576 mainly rural square miles. Over the past 10 years, rural health care providers in the Susquehanna Valley of north-central Pennsylvania have experienced trends common to rural providers throughout the United States. Reductions in reimbursement levels and a shift from inpatient to outpatient care have diminished cash flow, resulting in shortages of nurses and allied health professionals. These financial and staff constraints bridle the ability of individual rural hospitals to provide easy access to primary and specialty health services, invest in technology, provide preventionfocused outreach, and comply with regulations such as HIPAA. Working together, the network strives to benefit the local community by providing an integrated electronic information system that will (1) improve inpatient care by allowing even the most rural health care providers in the network to access accurate medical record information simultaneously, (2) improve access to specialty physicians, (3) develop a referral network that expedites patient care, and (4) enhance the ability of network members to share resources and information on compliance issues and other patient/administrative concerns. The project also strives to conduct joint recruitment and retention of key medical personnel and to improve patient care through the development and implementation of collaborative performance improvement initiatives based on the balanced scorecard methodology. In addition, Web portals will be implemented throughout the network to provide access to a medical digital library and lifetime clinical records of network patients.

TENNESSEE

Community Health Network

D06RH00235
Keith Williams
P.O. Box 14083
Bolivar, Tennessee 37814
Phone: (423) 587-5263

Fiscal Year 2003 2004 2005
Grant Award $199,479 $199,479 $199,479

The Community Health Network is composed of 13 separately owned community health centers serving 23 counties in rural Tennessee. The membership consists of eight federally funded health centers located in Tennessee, one federally funded health center in Mississippi, two rural health clinics, two federally qualified health center (FQHC) look-alikes, and a network of birthing centers. All of the network members provide primary health care services. The consortium was formed to address the economic burden placed on Tennessee's rural community health centers by the demand for constant attention to information systems used for billing, record-keeping, and data reporting. The expense of maintaining and upgrading hardware, training staff, choosing vendors, purchasing software, and troubleshooting network and connectivity problems has put significant strain on network members' financial and personnel resources.

The Community Health Network will serve as the central organization that handles information system needs for the entire network. Acting as a collective, the network will purchase in quantity to receive lower prices, bargain with vendors for services and software, maintain a centrally located training and help desk, and share a chief information officer. Using network grant funds, the project will integrate the health centers' systems beginning with business technology. The anticipated benefits include achieving economies of scale and cost efficiency; sharing staff expertise across network members; improving access to capital and new technologies; and enhancing members' ability to respond to changes in business and health care reporting requirements, such as HIPAA, shifts in reimbursement, and new Government regulations. Though still in its formative stage, the network will use Federal funding to become a selfsustaining organization that strengthens the health care delivery system in rural and medically underserved communities in Tennessee.

TEXAS

East Texas Behavioral Healthcare Network

D06RH00238
Rex Menasco
The Burke Center
4101 South Medford Drive
Lufkin, Texas 75901
Phone: (936) 634-5557

Fiscal Year 2003 2004 2005
Grant Award $200,000 $200,000 $200,000

The East Texas Behavioral HealthCare Network (ETBHN) is a 7-member collaboration of community mental health and mental retardation centers. The centers serve 34 counties in rural East Texas with a total population of approximately 2 million residents. Because of the rural nature and low income of many parts of the service area, privately funded services for persons with mental illness or mental retardation are not available or are inadequate. More than 17 percent of the total population in the service area live below the Federal poverty level and depend solely on the community mental health centers for services and medication. State funding limitations add to the challenge of providing mental health care services to the target population of adults and children diagnosed with mental illness, serious emotional disturbance, mental retardation, or developmental disability. In addition, behavioral health professionals of all types are significantly underrepresented in rural East Texas.

The network partners face unique challenges in delivering care effectively and efficiently to the region's residents. The mission of ETBHN is to improve the quality of service, enhance the operating efficiency, and expand the capacity of behavioral health care in the communities of East Texas. This goal will be achieved through greater integration of center clinical and administrative activities. ETBHN will provide services in the areas of increasing access to care, ensuring continuous quality improvement, cost savings, data gathering and reporting, and coordinating center efforts. Services range from 24-hour crisis care, including crisis stabilization and respite, to supported employment opportunities, supported housing, in-home assistance, and more. Among the expected outcomes are an integrated telemedicine system, provider service evaluations, best practices, a community needs assessment, a cultural and linguistic competency survey, and pharmacy benefit management. A specific project goal is the establishment of a remote patient monitoring and interactive video system for center patients in inpatient facilities.

East Texas Health Access Network (ETHAN)

D06RH04304
Carlene Wilson
Jasper Newton County Public Health District
108 West Lamar Street
Jasper, Texas 75951
Phone: (409) 384-2099

Fiscal Year 2004 2005 2006
Grant Award $105,630 $199,783 $195,089

The ETHAN was formed to assist residents of five rural and economically disadvantaged counties gain access to medical services at the most appropriate and cost-effect level of care. The service area encompasses approximately 3,600 mille and includes Jasper, Newton, Sabine, San Augustine and Tyler counties. Located in deep East Texas along the Texas/Louisiana border, the counties exist in relative geographic isolation from the major medical centers of Houston and Galveston. The ETHAN service area is in rapid economic decline with unemployment and uninsured rates significantly higher than the states average rates. The counties of Sabine, San Augustine and Tyler are classified as Health Professional Shortage and Medically Underserved Areas. In the 2000 HRSA Community Health Status Report, all five counties received an unfavorable rating with respect to heart disease. Medical and social services in these counties have been focused solely on acute resolution of medical or emergency need rather than prevention and coordination of care.

ETHAN was formed in 2001 as a multi-county collaborative to address the issues which prevent county residents from accessing health care and social service programs at the most cost effective and appropriate level of care. ETHAN includes representatives from each of the five counties, a public and state health department, a federally funded health center, three rural hospitals, a hospital based rural health clinic, a home health agency, a dialysis center, a woman's health nurse practitioner, various social service agencies and a faith based non-profit organization. The members have been collaborating for over two years to develop an integrated system of care that can effectively triage patients in to primary, secondary, and tertiary levels of care. ETHAN is further developing its capacity to assume a lead role by developing and implementing activities such as: recruitment of additional ETHAN staff; development of leadership within the community and among ETHAN members to support future sustainability; linkage between safety net providers through the use of web-based information system; expansion of current health promotion and prevention activities; implementation of a chronic disease case management system targeting the uninsured and underinsured; and the improvement of the health status of the target population by implementing a patient tracking, evaluation and program adjustment system.

VIRGINIA

Our Health Network's Community Health Initiative (CHI)

D06RH00232
David Ziegler
Our Health, Inc.
329 N. Cameron St., Suite 200
Winchester, Virginia 22601
Phone: (540) 535-1551

Fiscal Year 2003 2004 2005
Grant Award $191,468 $199,927 $195,114

Our Health Network's Community Health Initiative (CHI) is a 13-member consortium that aims to expand and improve health and social service delivery to underserved rural, uninsured, low income, and minority populations in Frederick and Clark Counties in Virginia, as well as the City of Winchester. Network membership includes public and private health care providers; government, human, and social services; and one health screener. Through a three-phase process, the network will use the grant to execute a capacity-building, marketing and outreach, and program/service refinement and expansion initiative among the region's major health and social service providers.

The target service area population is 95,000, and the network expects to serve 20,000 residents annually. According to the 2000 census, more than 13 percent of the Winchester population lives below the Federal poverty level compared with the Virginia State poverty rate of 9.6 percent and the U.S. poverty rate of 11.3 percent. Poverty and lack of education represent the primary factors in a population's hardships, particularly in terms of its health, and also pose significant barriers to access to health care services. Many medical visits and expensive procedures can be avoided by providing citizens, especially parents of young children, with access to information and basic medical services.

To reach its target clients, the CHI project will be headquartered in the new, state-of-the-art, 27,000 square foot Community Services Building (CSB), located in a low -income area of downtown Winchester, Virginia. The CSB will be home to 7 of the 13 Our Health Network members and will offer an innovative one-stop-shopping model for service delivery. CHI's major goals are to increase the number of underserved residents receiving health and social services in a quality manner; to enhance public awareness of the CHI, the CSB, and their services; and to improve health and social service provider productivity and efficiency. The network will achieve these goals by expanding its infrastructure and organizational capacity, conducting a comprehensive marketing and outreach effort, and refining and improving the area's health and social service delivery network so that it is more productive, cost-effective, and focused on quality customer service.

WASHINGTON

Twin Harbors Pharm-Assist Network

D06RH00227
Gary Rand
Mark Reed Hospital
2409 Pacific Ave SE
Olympia, Washington 98501
Phone: (360) 493-5563

Fiscal Year 2003 2004 2005
Grant Award $197,460 $197,460 $199,054

Twin Harbors Pharm-Assist is a formative, vertical network created to address the growing problem of access to pharmaceutical drugs for the underinsured and uninsured populations in four rural counties of southwestern Washington State. Using the network grant, the project will engage in strategic development, pilot telehealth equipment, and manage network expansion that will culminate in improved access to pharmacy services for residents in four rural counties. In the first year of the project, network membership will include rural Grays Harbor and northern Pacific Counties, with phased expansion into two neighboring counties in the second and third years. The members are Mark Reed Hospital of McCleary, Shoalwater Indian Tribal Clinic, Willapa Harbor Hospital of South Bend, South Bend United Pharmacy, Coastal Community Action Program of Grays Harbor County, and CHOICE Regional Health Network.

Residents of the sparsely populated Grays Harbor and Pacific Counties are sicker, poorer, and more likely to be uninsured than residents in other parts of Washington State. Lack of health insurance, high poverty rates, decreasing Medicaid reimbursements to pharmacists, lack of prescription drug coverage for Medicare enrollees, and the threatened solvency of local pharmacies all contribute to fewer and fewer people having consistent access to the prescription medications they need. Low -income and elderly residents are especially affected by these factors.

The Twin Harbors Pharm-Assist project strives to address and ameliorate the medication challenges faced by residents in these rural areas. Because the project is still in its formative phase, the network does not yet have a strategic business plan or specified activities. However, network members have experience in developing business plans and will complete one within the first 10 months of the project. Specific goals are to develop a network to collectively implement a prescription assistance program in the target service area; centralize the application, certification, and reorder processes for manufacturers' pharmacy assistance programs (PAPs); improve pharmaceutical access capacity for rural areas; identify efficiencies and opportunities for expanded access as a result of the project's initial work; and investigate and pilot infrastructure and resources to accommodate sites for telehealth and other developing technologies.

Eastern Washington Rural Critical Access Hospital Network

D06RH00270
Ronald Gleason
Lincoln Hospital
10 Nichols Street
Davenport, Washington 99122
Phone: (509) 725-7101

Fiscal Year 2003 2004 2005
Grant Award $200,000 $195,680 $193,243

The Eastern Washington Rural Critical Access Hospital (CAH) Network is composed of six federally designated CAHs in four rural counties of eastern Washington State. Each hospital faces common challenges and opportunities in the areas of Government regulation, organizational administration, and service delivery. By addressing these challenges and opportunities in the form of a collaborative rural network, CAH Network members will achieve significant economies of scale, cost efficiencies, continuous quality improvement, enhancement of local continuums of care, and stabilization of local rural health care systems for the service area's entire population. To achieve these goals, the CAH Network plans to develop a shared chief financial officer resource to implement a standardized financial system; create centralized network resources, standards, and systems to improve clinical efficiency and outcomes; facilitate and ensure corporate compliance (HIPAA and Medicare) by all network members; develop an organizational performance benchmarking capability; and enable a joint contracting capability for medical specialty services and business consulting services. The six founding CAHs anticipate that other CAHs in eastern Washington will join the network in the future.

Eastern Washington is a dry, sparsely populated region characterized by small, remote communities and extreme variations in climate. This intensely rural area relies on resource based industries made possible by Federal dams and land reclamation projects. The network area's total population of 44,701 has a disproportionately large and growing percentage of seniors aged 65 and older (17 percent versus 11.5 percent statewide), a significant Native American population (6 percent), and a significant Hispanic population, which is projected to grow by 48 percent between 2001 and 2006. At least one of the counties in the network is a designated frontier county. Most of eastern Washington is characterized by economic distress. In the network's service area, per capita income runs from 29 to 38 percent lower than statewide per capita income. Aside from the network member organizations, the nearest available significant hospital and health care services for most residents in the service area are in Spokane-up to 100 miles away. The region's highways are typically icy in winter, and portions are frequently closed because of blowing snow or whiteout conditions.