When Hurricane Katrina blew through the Gulf Coast last fall, it devastated many Mississippi seaside cities and towns. Included in the destruction was the Coastal Family Health Center, whose facility in Biloxi was so badly damaged that it was condemned.

At one point following the storm, the clinic was operating out of a tent. That situation improved when an Islamic relief organization donated a double-wide trailer outfitted with exam tables and medical and dental equipment, but it had only one room to see patients.

Those resources formed the nucleus of the health center’s operations until designers and contractors from Extreme Makeover arrived. The health center had another asset, however, a parcel of land donated by the City of Biloxi before the storm. Besides the donated trailer, the land had only one other structure on it – an old house that was in sorry shape after the hurricane.

Before Katrina hit, Coastal intended to use the house as a construction office for a new, permanent facility the health center planned to build on the donated land. Extreme Makeover saw the damaged house and offered instead to convert it into a small clinic.

On Saturday, Feb. 18, some 500 volunteers descended on the site to begin renovations; teams worked around the clock for four days. When the dust settled the following Wednesday, Feb. 22, Coastal Family Health had a new, state-of-the-art clinical facility complete with three exam rooms and an upstairs administrative office. And that wasn’t all. Workers from the show added plasma screen monitors in each room to access an electronic medical records system. They even installed nice artwork and a waterfall.

When Coastal CEO Joe Dawsey first saw the result of their work, he was amazed. “They did a great job, since they didn’t have much to start with,” he said. “They essentially had to start from scratch.”

Dawsey and Coastal’s staff, led by Dr. Scott Russell, whom the episode featured, were greatly moved by Extreme Makeover’s efforts. Dawsey said Coastal will likely use part of the new space as an infectious disease clinic. He said the health center also plans to work with Atlanta’s Morehouse University to develop a telemedicine network that will link the clinic to psychiatric services provided by Tulane University of New Orleans.

And with help from the pharmaceutical company Pfizer, Coastal plans to install more plasma monitors for electronic medical records when they build a new main facility, which they hope to do later this year. That would restore the 21 exam rooms Coastal had before the storm.

In fact, employees who work in program areas impacted by recent budget cuts participated in a Job Fair on March 27 where they learned more about agency vacancies and met potential supervisors.

To help all employees better navigate the upcoming changes, HRSA also sponsored four training sessions during March 28-29 on the topic, “Who Moved My Cheese?” The sessions, based on a best-selling book of the same name, focused on creating effective models for handling change.

Speaking at one of these sessions, HRSA Administrator Betty Duke urged employees to see themselves as more than what they do on their jobs.

“Changing jobs is not easy,” Dr. Duke said. “But the opportunity to grow is there. Change happens, but life goes on.”

Dr. Duke continues to work on the reassignment process with a high-level team headed by Becky Spitzgo. The team works in close cooperation with senior staff, union representatives and human resources to ensure a positive transition.

During Phase I of the reassignment process, bureaus and offices with vacancies are set to notify selected employees by April 10, with reassignments becoming effective on April 30. During Phase II, vacancies will be announced via Quick Hire from April 13-26. Staff selected to fill those vacancies will be notified the week of May 8, with reassignments effective May 28.

Efforts by HRSA to improve access to care there involve the creation of more health centers and oversight of a demonstration project to test the value of the Frontier Extended Stay Clinic, or FESC.

Expansion of the health center system is dramatically increasing access to care. The number of health center grantees in Alaska grew from six in 2001 to 20 by the end of 2004, and the number of patients served at these centers over the same period rose from 26,000 to almost 69,000.

In 2004, health center grantees served about 11 percent of the population of Alaska; health centers’ uninsured patients that year represented 26 percent of the uninsured population in Alaska.

In the most remote parts of the state, obstacles to accessing health care led policymakers to consider new options.

Marcia Brand, associate administrator for rural health policy, remembered the difficulties health care providers face in recalling a flight from Anchorage – Alaska’s biggest city – to Bethel, a town near the Bering Sea in remote and virtually unpopulated western Alaska. From Bethel, she traveled to Napaskiak, a village of about 300 just seven miles away.

“There are no roads,” Brand said. “In summertime, you get to Napaskiak by boat up the Kuskokwim River. If you don’t have a boat, you fly. In the wintertime when it’s frozen you can drive up and the state clears the ice like it’s a road.”

When she visited Napaskiak, the frozen ground was beginning to break up. “Boards had been laid down between buildings so pedestrians could cross from one to the other, over mud and water from the thaw,” Brand said. “There was a ‘washeteria,’ the one place in town you can wash clothes and take a shower. Things are unbelievably expensive since the only way to get anything there is to fly or boat it in. A carton of milk might be $7 and a tin of crackers $6.”

Residents and Alaska officials offered some ideas on how the Federal government could improve medical conditions.

“One thing folks kept telling us was that rural clinics in remote areas often have to ‘weather-hold’ someone,” she said. “That means someone’s been injured or is ill and needs to go to the next level of care, but you can’t fly the individual out because it’s blowing snow or it’s dark and the runway doesn’t have lights. You have to hold the person, but you can’t get reimbursed since you can only bill for outpatient services.”

Together with colleagues in other states’ Offices of Rural Health, Primary Care Offices and Primary Care Associations, Alaska officials explored ways to permit reimbursement of “extended stay” services by Medicare, Medicaid or other third-party payers. Those discussions eventually led to the development of the FESC.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) authorized the Centers for Medicare and Medicaid Services to conduct a demonstration program to treat FESCs as Medicare providers. Under MMA, FESCs must be located in communities at least 75 miles away from the closest hospital or inaccessible by public road. They must also accommodate patients who can’t be transferred due to adverse weather conditions or who need monitoring for a limited time.

An additional $1.5 million FESC demonstration program administered by HRSA was established by the Consolidated Appropriations Act of 2004. Brand believes the developing FESC model of care can be useful in serving rural residents in “the lower 48” as well.

As a tribute to Alaskan resourcefulness in confronting the many challenges of life there, Brand offers a rule of thumb: “If anybody in Alaska offers you a fleece, bug spray, life vest, boots or something whose use you’re not sure of, just take it. They know something you don’t.”

“We want to give citizens what they need,” HRSA Administrator Betty Duke said in tasking OIT with the Web renovation. “They should be able to come through the ‘door’ and get to an answer.”

To make sure that a redesigned hrsa.gov would offer an easy path to answers, OIT asked Web site users to complete a customer satisfaction survey and sort HRSA Web content into categories. OIT also used HHS’ Web site usability lab to track users’ mouse movements and even videotaped users’ faces as they navigated through prototype Web sites. OIT then analyzed users’ searches and paths across the sites to assess their information needs.

HRSA launched its re-engineered Web site on Feb. 24. Early indications are that the agency has achieved its goal of making its most useful information more easily accessible to anyone with an Internet connection and a Web browser.

Information that had been buried a half-dozen mouse-clicks from the home page is now available in one or two clicks. Find Help, which pulls together HRSA programs that provide direct service to citizens, was the third most-visited page on hrsa.gov two days after the launch.

New content was also developed to fill needs uncovered through usability research. Users asked for a simple way to find current grantees in a given program. The result: granteefind.hrsa.gov. Others requested quick access to HRSA investments by major program and by state. The answer: stateprofiles.hrsa.gov.

Everyone wanted a single point-of-entry for related information and no one wanted to wade through the organizational structure. That translated to the consolidation of information from hrsa.gov and its sub-sites into six second-level pages:

• Grants (to help users apply for, manage and report on their grants);
• Find Help;
• Service Delivery (resources and tools for clinicians and health care administrators);
• Health System Concerns (information on health care issues affecting the entire U.S. health care system);
• About HRSA; and
• Data, which will be rolled out with a new release of the HRSA Geospatial Data Warehouse in early April.

Donor registry databases have several important functions. They give organ procurement organizations (OPOs) and medical personnel around-the-clock access to vital information regarding a person’s decision on donation. Registries also can provide ready access to donation sign-up data by county or township; such knowledge can help states improve their targeting of pro-donation public education efforts and gauge their effectiveness.

Americans who want to donate organs and tissues after death are encouraged to share this desire with their families, indicate their wishes on their driver’s license, and add their names to state registries, where available. The precise mechanisms for registries vary by state, explained Mary Ganikos, chief of DoT’s Public and Professional Education Branch. Ganikos and her staff will oversee the new HRSA grants.

Practical reasons encourage the close relationship between donation and DMVs. Because people regularly visit DMVs to obtain driver’s licenses and vehicle registrations, these agencies have for years helped increase pledges to donate by simply asking people if they would like to become an organ donor. The decision to donate is then indicated on the person’s license.

“Many people seem willing to say yes to donation, but won’t necessarily go out of their way to record their decision to donate,” said Ganikos. “DMVs work well to increase donor sign-up.”

If the only evidence of the donation decision resides on a license or a donor card, however, that decision may not be available to medical staff in the critical moments when a donor’s organs are viable and the decision to donate or not must be made.

Registry databases overcome those deficiencies. Many of these databases are already linked to DMV lists; some databases offer online access to names. In Utah, this link has had a significant impact on donation.

Intermountain Organ Recovery System, based in Salt Lake City, received a grant from HRSA in 2002. The OPO used the grant to improve organ and tissue donation through a comprehensive donor registry and statewide outreach campaign. Part of their program included a research component that aimed to gauge the impact of a comprehensive donor registry on donation rates, and whether it could increase the consent rate of organ and tissue donation.

To launch the project, the state of Utah passed legislation that transferred the records on people who agreed to be organ donors from Utah’s Drivers’ License Division (DLD) to the Yes! Utah Donor Registry database (www.yesutah.org). The site also was configured to allow people to sign-up for donation independently of the DLD and get basic information on donation.

An initial mass mailing went to individuals whose DLD records were entered into the new registry. The letters informed them of the existence of the new database and assured them that the purpose of the registry database was to honor the wishes of the deceased. The state launched a pro-donation media campaign aimed at Utahns between 16 and 74, and training on the new registry was provided to hospital, OPO, and tissue bank staff.

The project ran a little over two years. Here’s part of what Intermountain learned during the project period:

• Signing up for the registry made a decisive impact on donation rates. Of all medically eligible deaths during this study period, 97 percent of people on the registry became donors compared to 61 percent of those not on the registry.
  
  
• The registry helped boost Utah’s already high donor registry participation rate. During the period of the study, the percentage of Utah’s population between 16 and 74 registered to donate rose from 58.4 percent to 63 percent. That 4.6 percentage point increase translated into a net increase of 70,224 committed organ and tissue donors.
  
  
• Families and hospital personnel were almost universally positive about the value of having information readily available from the registry at the time of the donation decision.
  
  
• The project also highlighted the importance of the Utah registry’s link with the DLD: 99 percent of the individuals who joined the registry came from this source, but very few took the opportunity to sign-up online.

That experience has been echoed in other states with online registry components. In Virginia, approximately 10,000 to 15,000 individuals are entered each month in that state’s donor registry from DMV records, while only 60 to 100 individuals signed up online during that same period.

For more information on what your state offers to help you express your decision to donate, go to http://www.donatelife.net/.

Although registries aren’t the only issue facing states regarding the individual decision to donate, they do help to ensure that this information is readily available when vital decisions need to be made. HRSA’s grant program will aid this effort and help assure individuals that their decisions about donation are honored.

For more information on organ donation, go to www.organdonor.gov.

Just over half of those grant dollars, funded under Title I of the CARE Act, are awarded through a formula based on the estimated number of people living with AIDS in each metro area. Another 40 percent of Title I dollars, called “supplemental” funds, are awarded competitively among the areas based on demonstration of severe need and other criteria. Remaining Title I dollars support the Minority AIDS Initiative to target care and services to minority populations.

The rest of the $2.1 billion annual CARE Act appropriation is directed to states and community-based and nonprofit organizations through three other major Titles. FY 2006 funding totals for the other Titles are known at this time, but the amounts that will be distributed to individual grantees have not been released.

Most CARE Act funds – almost $1.1 billion of the total – are allocated through Title II, which distributes grants to all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and five U.S. Pacific Territories and Associated Jurisdictions. States may use the funds to pay for direct HIV/AIDS health care, outreach and other support services, and early intervention activities. The biggest chunk of Title II dollars – $780 million of the $1.1 billion – pays for life-saving pharmaceutical drugs made available through the AIDS Drug Assistance Program (ADAP).

Title III grants, which total $194 million in FY 2006, are awarded on a competitive basis to community-based, public and private nonprofit primary care providers that serve people living with HIV/AIDS. Ninety-eight percent of Title III funds provide early intervention services such as counseling, testing, drug therapy, case management and mental health services. The remaining 2 percent supports capacity building to help organizations provide more efficient care and services.

The final major CARE Act title, Title IV, awards competitive grants to public and private nonprofit organizations to support care, services, access to clinical trials and research for HIV-positive women, infants, children and youth and the family members and others who care for them. Title IV also supports efforts to identify and ensure access to care for HIV-positive pregnant women so that they do not transmit the virus to their newborns. The FY 2006 appropriation is $71.8 million.

Additionally, the CARE Act funds several smaller programs, including:

• AIDS Education and Training Centers, a national network of 11 regional centers and 130 local sites that conduct multidisciplinary training and education programs for health care providers who treat patients with HIV/AIDS;
  
  
• Special Projects of National Significance, which support the development and repli-cation of innovative models of HIV/AIDS care and service delivery; and the
  
  
• HIV/AIDS Dental Reimbursement Program, which improves access to oral health care for HIV-positive individuals by reimbursing dental education programs for costs incurred in providing such care.

President Bush has asked for almost $2.2 billion for CARE Act activities in his FY 2007 budget request, an increase of $95 million over FY 2006.

Of the additional funds, $70 million would go to resolve state waiting list backlogs for ADAP medications and to provide care and drugs to those newly diagnosed as HIV-positive.

The remaining $25 million would be used to expand outreach efforts by providing new HIV community action grants to intermediaries – including faith and community-based organizations – and to provide technical assistance and sub-awards to grassroots organizations.

The President’s budget request also includes a new authority to increase program flexibility by allowing the HHS Secretary to transfer up to 5 percent of funding provided for each title of the CARE Act to any other title.

For more information on CARE Act programs and services, visit http://hab.hrsa.gov/.

But the report found room for improvement in preventive oral health care among young children (ages 1 to 5) and children of families with lower incomes.

Key findings state that:

• 72 percent of children, according to surveyed parents, had a preventive dental visit in the past year.
  
  
• 93 percent of children received all necessary dental care in the past year, parents said.
  
  
• 90.5 percent of children have teeth in excellent, very good or good condition – 68.5 percent with teeth in excellent or very good condition and 21.9 percent in good condition. Seventy-seven percent of young children (ages 1 to 5 years) have teeth reported to be in excellent or very good condition compared to only 61.8 percent of 6- to 11-year-olds and 67.5 percent of 12- to 17-year-olds.

Other findings indicate that:

• Younger children are less likely to receive preventive dental care than school-aged children. Only 10.1 percent of 1-year-olds and fewer than a quarter (23.8) of 2-year-olds received a preventive dental visit in the past year, despite the recommendation that all children see a dentist by age 1.
  
  
• Parents of 88.9 percent of children who did not see a dentist in the past year did not believe that their children needed a preventive dental visit, indicating a need for oral health education among parents.
  
  
• Dental care rises steadily with increased income. Only 58.1 percent of children with family incomes below 100 percent of the federal poverty level (FPL) received care in the past year, compared to 82.4 percent of children in families with incomes of 400 percent FPL and above.

Oral health is vital to the overall health and well-being of children. Left untreated, pain and infection caused by tooth decay can lead to problems in eating, speaking and learning. Tooth decay or dental caries, the most common chronic childhood disease, is five times more common than asthma and seven times more common than hay fever in U.S. children.

The Oral Health of Children, second in a series of overviews based on the National Survey of Children’s Health, examines national and state-level data and includes breakdowns by ethnic and racial group. Parents of 102,353 children ages 0-17 participated in the 2003-04 survey, supported by HRSA’s Maternal and Child Health Bureau and conducted by CDC’s National Center for Health Statistics.

Eloquent yet simple, the Women and HIV/AIDS Quilt was created by members of the HRSA Women’s Health Coordinating Committee (WHCC) to recognize the increasing impact of HIV/AIDS in the lives of women, their families and their communities.

Volunteers from the WHCC, HAB, HRSA’s Office on Women’s Health (OWH), and the National Institute of Health’s Office of AIDS Research came together to design the handmade quilt, which features 12 individual panels with distinct motivational themes for women living with HIV/AIDS.

Panels are linked by red ribbons, the international symbol of AIDS awareness, to emphasize the need for people everywhere to join together in the struggle against HIV/AIDS. From inspiration to faith and spirit to hope, the panels represent positive concepts that help to bring balance and strength to the lives of women living with HIV/AIDS. The quilt was presented on Feb. 15 to Deborah Parham Hopson, HRSA’s associate administrator for HIV/AIDS, and Peter van Dyck, HRSA’s associate administrator for maternal and child health, by Sabrina Matoff Stepp, OWH director, as a sign of the continuing collaboration on HIV/AIDS issues among the three HRSA entities. To view the Women and HIV/AIDS Quilt, call Marsha Lewellyn at (301) 443-1993.