11/2/2012 Community APGAR Project: Comparing Results from the National Database David Schmitz, MD, FAAFP Associate Director of Rural Family Medicine Family Medicine Residency of Idaho Ed Baker, PhD Professor and Director/Center for Health Policy Boise State University Presented to: Office of Rural Health Policy State Offices of Rural Health Region B Grantee Meeting Date: July 31, 2012 Top 10 Advantages - CAH Idaho Wyoming North Dakota Wisconsin Alaska (2012) (2011) (2011) (2012) (2012) •Recreational •Employment status •Internet access •Recreational •Moving allowance opportunities opportunities •Community • Perception of •Income guarantee •Internet access need/physician quality •Employment status •Emergency medical support •Community need/ •Transfer •Income guarantee services physician support •Loan repayment arrangements •Nursing workforce •Recreational •Loan repayment opportunities •Income guarantee •Recreational •Religious/cultural •Community opportunities opportunities •Inpatient care •Loan repayment volunteer •Income guarantee •Community •Community •Community opportunities need/physician volunteer volunteer • Ancillary staff •Income guarantee support opportunities opportunities workforce • Ancillary staff • Ancillary staff •Community • Perception of •Revenue flow workforce workforce need/physician quality support •Transfer •Hospital leadership • Perception of •Competition arrangements quality •Payor mix •Schools • Ancillary staff •Start-up/marketing •Transfer • Perception of •Start-up/marketing workforce costs arrangements quality costs (tie for 10 th ) •Mid-level provider •Perception of •Employment status •Moving allowance •Recreational workforce community opportunities (tie for 10th) •Community need/physician •Part-time support (tie for 10 th ) opportunities (tie for 10th) •Moving allowance (tie for 10 th ) Top 10 Challenges - CAH Idaho Wyoming North Dakota Wisconsin Alaska (2012) (2011) (2011) (2012) (2012) •Shopping/other •Spousal •Spousal •Spousal • Climate services satisfaction satisfaction satisfaction •Spousal •Spousal •Shopping/other •Shopping/other •Televideo support satisfaction satisfaction services services •Shopping/other • Access to larger •Inpatient care • Mental health • Climate services community •Shopping/other •Schools •C-section • Mental health services • Mental health • Access to larger • Access to larger • Access to larger • Social networking • Social networking community community community •Electronic •Allied mental •Allied mental •Part-time •Allied mental medical records health workforce health workforce health workforce opportunities •C-section • Mental health •Endoscopy, •Emergency room • Climate coverage surgery •Electronic • Climate •Religious/cultural medical records •Employment opportunities • Social networking status •C-section •Obstetrics •Electronic •Demographic/pati •Electronic •Religious/cultural medical records ent mix •Obstetrics medical records opportunities •Call/practice •Nursing home • Social networking coverage (tie for 10 th ) •Electronic medical records (tie for 10 th ) 1
11/2/2012 Top 10 Importance - CAH Idaho Wyoming North Dakota Wisconsin Alaska (2011) (2012) (2011) (2012) (2012) •Spousal •Spousal •Revenue flow •Spousal •Schools satisfaction satisfaction satisfaction •Spousal •Employment • Loan repayment • Physician •Perception of satisfaction status quality workforce stability • Income •Perception of guarantee •Competition •Call/practice •Call/practice quality coverage coverage •Call/practice • Income •Physical coverage guarantee • Physician •Schools plant/equipment workforce stability •Recreational • Physician •Perception of •Spousal opportunities workforce stability quality • Loan repayment satisfaction •Revenue flow •Call/practice • Loan repayment •Physical •Revenue flow coverage •Schools plant/equipment •Moving allowance •Perception of • Physician •Perception of •Recreational •Transfer quality workforce stability quality arrangement opportunities •C-section •C-section •Emergency room •Obstetrics •Nursing coverage workforce •Obstetrics •Employment •Emergency room status •Employment coverage • Income status guarantee • Loan repayment •Call/practice (tie for 10 th ) • Income coverage guarantee •Obstetrics (tie for 10 th ) Top 10 Apgar Factors - CAH Alaska Idaho Wyoming North Dakota Wisconsin (2012) (2011) (2011) (2012) (2012) • Recreational • Perception of • Employment status •Moving allowance • Employment status opportunities Quality • Recreational • Recreational opportunities opportunities •Loan repayment •Transfer •Internet access arrangements • Perception of •Income guarantee •Income guarantee • Community need/ quality •Emergency medical •Internet access physician support • Community •Income guarantee services •Loan repayment need/physician •Loan repayment •Nursing workforce •Inpatient care support •Income guarantee •Religious/cultural • Community •Income guarantee • Recreational opportunities need/physician • Community opportunities support • Perception of need/physician •Physician quality workforce stability • Perception of support •Revenue flow quality •Transfer •Competition •Ancillary staff arrangement •Community •Competition workforce •Stability of volunteer •Ancillary staff physician workforce •Ancillary staff • Employment status opportunities workforce workforce • Employment status •Physical plant and •Moving allowance •Community equipment •Transfer volunteer •Call/ practice arrangements •Schools opportunities (tie •Welcome and coverage for 10 th ) recruitment (tie for •Moving allowance 10th) •Revenue flow (tie for 10 th ) •Perception of community (tie for 10th) Bottom 10 Apgar Factors - CAH Idaho Wyoming North Dakota Wisconsin Alaska (2012) (2011) (2011) (2012) (2012) •Spousal •Spousal •Spousal •Spousal • Climate satisfaction satisfaction satisfaction satisfaction •Spousal •Shopping/other •Shopping/other •Shopping/other •Televideo support satisfaction services services services •Shopping/other •Inpatient care •Schools • Access to larger • Climate services community •Shopping/other • Access to larger • Mental health • Mental health services community • Mental health •Allied mental • Access to larger • Mental health •Part-time health workforce • Social networking community opportunities • Social networking •C-section •Allied mental •Emergency room •C-section • Climate • Access to larger health workforce coverage •Endoscopy, community •Religious/cultural •Demographic/pati •Electronic medical surgery records •Electronic medical opportunities ent mix •Employment records •Perception of status • Climate • Social networking community •Obstetrics •Electronic medical •Electronic medical •Allied mental •Religious/ Cultural •Mid-level records records health workforce supervision opportunities • Social networking •Electronic medical •Nursing home records 2
11/2/2012 Cumulative CAH Community Apgar Score by Hospital – Across Five States Cumulative CAH Community Apgar Score by Hospital - Across Five States Top 10 Advantages - CHC Idaho Maine (2010) (2012) •Recreational opportunities •Recreational opportunities •Loan repayment •Loan repayment •Retirement package •Community need/physician support •Perception of quality •Inpatient care •Mid-level provider workforce •Obstetrics: deliveries, C-section •Perceived fiscal stability •Obstetrics: prenatal care •CME benefit •Mid-level provider workforce •Minor trauma (casting/suturing) •CHC leadership •Community need/physician support •Perception of quality •Schools (tie for 10 th ) •Call/practice coverage (tie for 10 th ) •Teaching (tie for 10 th ) •Physical plant and equipment (tie for 10 th ) •Ancillary staff workforce (tie for 10 th ) •Office GYN procedures (tie for 10 th ) 3
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