IMPROVEMENT IMPR VEMENT MEASURES MEASURES(SHIP) (SHIP) AS AS - - PowerPoint PPT Presentation

MAR MARYLA YLAND ND ST STATE HEAL TE HEALTH TH IMPR IMPROVEMENT VEMENT MEASURES MEASURES(SHIP) (SHIP) AS AS REL RELATED TED TO O ACTIVITI CTIVITIES IN ES IN RURAL URAL COMMUNI COMMUNITIES TIES AND AND WORKF ORKFORCE ORCE DEVE DEVELOPMENT LOPMENT

B Y R O X A N N E H A L E , M H A , C M P E , F A C H E D I R E C T O R , O F F I C E O F P R I M A R Y C A R E A C C E S S

1

MAP OF RURAL MARYLAND

MARYLAND RURAL HEALTHCARE FACILITIES

There re are 50 hospi pitals als in Maryland nd The state has zero hospi pitals ls identified ed as C Critical l Ac Access s Hospital als s

• A

A Critical Ac Access Hospital al (CAH) H) is a h hospital l certified under a set et o

• f Medicare

Conditions ns of Pa Participat pation

• n (CoP),

), requ quire rements nts for CAH certifica cation

• n includ

ude e having ng no more than 25 inp npatient ent beds; maintaini ning an annual al average length of stay of no more than 96 hours for acute inp npatient ent care; offering ng 24-hour

• ur,

, 7-day-a-week ek emergency cy care; and being located in a r rural area, at l least 35 miles drive awa way from any ot

• ther hospi

pital al There re are zero Rural Health Clinics cs in Maryland nd

• A Rural Health Clinic

c is a f federally y qu qualified d health clinic c certified to receive special l Medicare re and Medicaid reimbursem ement ent There re 16 Federally y Qualified Health Centers provide services at 141 sites in the state

• FQHCs

s must serve an underser erved ed area or popu pulati ation, n, offer a s sliding ng fee scale, provid vide e compr prehen ehensive services, , have an ongoi

• ing

ng qu quality y assurance nce program, am, and have a g governi ning ng board of directors

RURAL HEALTHCARE FACILITIES

SELECTED SOCIAL DETERMINANTS OF HEALTH FOR RURAL MARYLAND

• 10.0% of Maryland

nd residents dents lack health insura surance nce

• Ac

According ding to the Economic c Res Research h Service ce, , the average per-ca capi pita ta income for Maryland nd rural reside dent nts s wa was $46,013 3 per capita ta; ; and $53,826 26 for all of Maryland nd

• Poverty rate of 15.1% exists

sts in rural Maryland, nd, comp mpared ed to 10.1% % in urban areas

• f the state

e

• Based

d on 2009-20 2013 data, , 14.2% of the rural populati tion

• n has not
• t comp

mplet eted ed high h school

• l;

; comp mpared d to 11. 1.2% of urban populati tions ns

• Unemplo

mploym yment ent rate in rural Maryland nd is 6.7%, and in urban Maryland, nd, it is 5.8%

MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP) Go Goal

To

• provi

vide de a framewor

• rk

k for accountability ty, , local action, , and public c engagement nt in order to adva vance ce the health h of Maryland nd reside dents nts.

Me Measureme surements nts

Aligne ned d with h He Healthy People 2020 objectives s establi lishe hed d by t the Department nt of He Health h and Human n Services.

• es. State

e and county ty level data on criti tical al health h measures res is also provi vide ded d throug

• ugh

h the SHIP.

6

MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP) Re Result sult

SHIP P has s encour

• uraged

aged the developme elopment t of Local al Health h Imp mproveme ement t Coalition litions. s. These ese are each led by local health th officer cers and provide de a forum m for county ty health th departm tment ents, s, nonpr nprof

• fit

it hospit itals, s, and commun munity ty based ed organiza izati tion

• ns

s to analyze ze and prioriti tize ze commun munity ty health th need eds. s.

7

MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP)

Avail ailab ability Concerns s of local al jurisd sdict ictio ions s are e addre dress ssed ed by the exten ensiv sive e list of tools s and resou sources s ava vaila ilable ble to:

The general public Health planne ners Clinici cians ans Measur Measures es Maryland’s State Health Improvement Process (SHIP) provides a framework for continual progr gres ess s towa ward a h healthier er Maryland nd. . The SHIP include des s 39 measures es in five focus s areas that represent nt what it means for Maryland and to be healthy.

8

SHIP - HEALTHY BEGINNINGS

• Infant

fant Death Rate

• Babies

es with h Low B Birth th Weight

• Sudden

den Unexpect ected d Infa fant nt Death Rate (SUIDS)

• Teen Birth

th Rate

• Early

y Prenatal Care

• Stude

udents nts Enterin ring Kinderg ergarten n Rea Ready To Learn

• High

h School Graduation ation Rate

• Childr

dren n Rec Receivi ving ng Blood Lead Screeni ning ng

SHIP - HEALTHY LIVING

• Ad

Adults ts Who Have a H Healthy Weight ht

• Childr

dren n and Ad Adolesce cents nts That Are Obese

• Ad

Adults ts Who Current ntly Smoke

• Ad

Adolesce scents nts Who Use Tobacco Products cts

• HIV Incidenc

dence Rate

• Life Expecta

tancy ncy

• Incre

rease se Physica cal Ac Activity vity

SHIP – HEALTHY COMMUNITIES

• Child

d Maltre reatme tment nt Rate

• Suici

cide de Rate

• Domesti

stic c Violence

• Childr

dren n With h Eleva vated d Blood Lead Levels

• Fall-Rel

elat ated d Death Rate

• Pedestr

trian n Injury y Rate On Public Ro Roads

• Afforda

dable e Housing

SHIP – ACCESS TO HEALTHCARE

• Ad

Adolesce scents nts Who Rec Received d A Wellness ess Checkup up In The Last Year

• Childr

dren n Rec Receivi ving ng Dental Care In The Last Year

• Persons
• ns With

h A U Usual Primary y Care Provide der

• Unins

nsured ured ED Visits ts

SHIP – QUALITY PREVENTATIVE CARE

• Age-Adjust

usted Mortality y Rate From Cancer

• Emergency

ncy Department nt Visit Rate Due To Diabet etes

• Emergency

ncy Department nt Visit Rate Due To Hypertensi nsion

• n
• Drug-ind

nduce uced d Death Rate

• Emergency

ncy Department nt Visits Related To Mental l Health Conditions

• ns
• Hospitalization Rate Related To Alzheimer’s Or Other Dementias
• Childre

ren n (19-35 35 months s ole) Who Receive Recommende nded Vaccines nes

• Annu

nual al Season n Influe uenza nza Vaccina nations

• ns
• Emergency

ncy Deparment ent Visit Rate Due To Ashtma

• Emergency

ncy Department nt Visits From Health Disease

• Emergency

ncy Department nt Visits For Ad Addictions

• ns-Rela

lated Conditions ns

• Emergency

ncy Department nt Visit Rate For Dental Care

MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP)

The The health health con

• ncer

erns ns of

• f loc

local jur al jurisd isdic iction tions s are ad are addre dress ssed ed by y the the exten extensi sive e list list of

• f too

tools ls and and reso resour urces a es availa ailable le to to the the gen eneral eral pub public lic, h hea ealth lth pla plann nners ers, an and d clinic linician ians. In In orde

• rder to

r to dis dissemina seminate te the the most most impor importan tant t an and d de devas astat tating ing charac haracter teristic istics of s of the the health health of

• f Ma

Maryland ylanders o ers overall, erall, the the SH SHIP IP pub publishes lishes a w a weekl eekly y ne news wslette letter r an and d po posts sts pub public lic health health ne news ws on

• n

soc social m ial media edia platfor platforms, inc inclu luding ding twitter twitter and and fac aceb ebook

• ok.

15

Comparison: Age-adjusted mortality rate from cancer Map

CENTER FOR C CENTER FOR CANCER CONTR ANCER CONTROL OL AND AND PREVENTION PREVENTION

DHMH DHMH CCCP adm dmin inis isters: Breast, , cervic ical al, , and/ d/or colorect

• rectal

l cancer r screen enin ing programs ms statewid ide Includi uding g each county ty in in rural Western/Southe

• uthern

rn Maryland d and t d the Eastern Shore via ia sub- contrac tracts ts (programs) ms) Each h pr progr gram m is is al also to pa partic icip ipate in in a c cancer coali liti tion

• n aim

imed t d to redu duce the burde den of cancer r in in that ju juris isdi dict ction ion

COMPARISON: ADULTS WHO SMOKE

17

Map

18

Comparison: Adolescents Who Use Tobacco Products

Map

CENT CENTER ER FO FOR R TOBACCO CCO PREV REVENT ENTION N AND AND CO CONTR NTROL

Maryland nd has seen an incre rease se in smokel eless ess tobacco cco use among undera rage ge youth in Maryland

• To address this dangerous trend:
• Ads have been placed to increase awareness about the dangers of smokeless

tobacco

• Radio stations on the Eastern Shore and Western Maryland Counties were

targeted

• Information was placed on transit mediums in Queen Anne’s, Somerset,

Wicomico, and Worcester Counties

• Ads placed in USA Today Sports section, an Orioles addition, and the Maryland

Hunting and Fishing Publication

CENTER CENTER FO FOR R TOB OBACCO CCO PREVE PREVENTIO NTION AND N AND CONTR CONTROL OL

Pregnan ancy cy and Tobacco cco Cessati sation

• n Help (PATCH

CH) ) helps to:

• Mobilize existing resources at the local level to address smoking

cessation, tobacco use screening, education, prevention, and treatment

• ffered and made available to pregnant women and women in child

bearing age

• In FY 15, PATCH funded 12 rural jurisdictions – Allegany, Calvert, Caroline,

Carroll, Cecil, Dorchester, Garrett, Kent, Somerset, St. Mary’s, Washington, and Wicomico Counties

• Federally Qualified Health Centers (FQHCs) in Allegany, Caroline,

Dorchester, Garrett, Somerset, Washington, and Worcester are PATCH partners

CENT CENTER ER FO FOR R TOBACCO CCO PREV REVENT ENTION N AND AND CO CONTR NTROL CTPC works rks closely sely with local health th departm tment ents: s:

• Cecil County collaborated with Triangle Health Alliance and West

Cecil Health Center to integrate electronic referrals into the electronic medical record system to assure appropriate care and follow up (referral forms generated to Cecil LHD for tobacco cessation services)

• Carroll County Catholic Charities/Head Start program added

tobacco assessment to enrollment process to identify, educate, and refer families to tobacco cessation

• Caroline County Board of Education Family Support Center

incorporated PATCH education in the “Parents As Teachers” and home visiting program

22

Comparison: Age-Adjusted Mortality Rate From Heart Disease

Map

CENTE TER R FOR CHRONI NIC DISEASE SE PREVENTI TION ON AND CONTR TROL OL

School

• l and Child

d Care Wellness ss Policie ies

• LHDs in Calvert, Carroll, Cecil, and Dorchester are collaborating with partner

school systems and county-level child care organizations to provide training and technical assistance to establish and implement wellness policies in schools and child care centers Compreh prehensiv ensive e School Physical cal Ac Activit ity y Programs s (CSPAP) AP)

• Trained 257 teachers across 211 schools in Caroline, Cecil, Charles,

Frederick, Garrett, Harford, Kent, Somerset, Wicomico, and Worcester counties

• 3 trained schools systems (Harford, Kent, and Wicomico) are receiving

additional funding to implement CSPAP activities

CE CENTER NTER FOR CH FOR CHRONIC D ONIC DISEASE ISEASE PREVENTION PREVENTION AND AND CONTR CONTROL OL

Worksit sites es He Health thie iest st Maryland d Busine ness sses es (HM HMB)

• HMB recruits employers to make a commitment to worksite wellness by

completing the Worksite Health Score Card

• Employers receive guidance and resources to implement policy and systems

changes to improve the health of their workforce

• HMB Regional Coordinators in LHDs in Charles, Frederick, Howard, Kent,

Washington, and Wicomico counties provide outreach and technical assistance to employers statewide

• Of the 403 businesses currently participating in HMB, there are 226 businesses -

with a total of 68,326 employees - in rural areas

• Engaging businesses to improve nutrition and physical activity in in 1422

communities (Allegany/Garrett, Washington, Dorchester/Caroline and Wicomico/Somerset/Worcester)

CENTER CENTER FOR CH OR CHRONIC ONIC DISEASE DISEASE PREVENTION REVENTION AND C AND CONTR ONTROL OL

Health h Systems ms - Ad Addressing essing Chroni nic c Diseases ases in Health Systems ms

• LHDs in Calvert, Cecil, Charles, Frederick, and St. Mary's County implementing

quality improvement strategies in health systems to prevent and control diabetes and hypertension

• Strategies include increasing EHR adoption and the use of HIT to improve

performance, increasing the monitoring of quality measures for hypertension and diabetes control, implementing team-based care approaches, and increasing referrals to evidence-based community programs

• Establishing system changes to address undiagnosed hypertension and

prediabetes and increase referrals in 1422 communities (Allegany/Garrett, Washington, Dorchester/Caroline and Wicomico/Somerset/Worcester)

CENTER CENTER FOR FOR CHR CHRONI ONIC DISEASE C DISEASE PR PREVENTIO EVENTION N AND CONTR AND CONTROL OL

Commu mmuni niti ties es Diabe betes es Pre revent ntion

• n Progra

ram (DPP)

• 3 master trainers, located in Kent, Washington, and Worcester counties, increase

capacity to implement the National DPP in Maryland by providing lifestyle coach trainings

• 5 YMCAs, including 4 in rural areas, will begin offering the DPP
• National DPP scaling in 1422 communities (Allegany/Garrett, Washington,

Dorchester/Caroline and Wicomico/Somerset/Worcester) Health thy y Pa Parks, Healthy People

• Project involves educating health care providers to prescribe outdoor activities for

patients to encourage them to utilize Maryland state parks

• Target parks include Rocky Gap in Allegany County as well as parks in Central and

Southern Maryland and the Eastern Shore

27

Comparison: Children receiving dental care in the last year

Map

WORKFORCE DEVELOPMENT PROGRAMS

Maryland nd Health Work rkfor

• rce Programs

ms

J1 Visa Waiver Program

National Health Services Corp

State Loan Repayment Program (SLRP) Maryland Loan Assistance Repayment Program (MLARP)

NATIONAL HEALTH SERVICE CORPS (NHSC)

NHSC is a federal loan repayment program for the following practitioner types:

• Primary Care Physician (MD or DO)
• Dentist (DDS or DMD)
• Primary Care Certified Nurse Practitioner (NP)
• Certified Nurse-Midwife (CNM)
• Primary Care Physician Assistant (PA)
• Registered Dental Hygienist (RDH)
• Health Service Psychologist (HSP)
• Licensed Clinical Social Worker (LCSW)
• Psychiatric Nurse Specialist (PNS)
• Marriage and Family Therapist (MFT)
• Licensed Professional Counselor (LPC)
• Practitioners must be working in

a Health Professional Shortage Area at an NHSC approved site

• DHMH only processes site

applications and not individual applications

J-1 VISA WAIVER PROGRAM

• The Office of Primary Care Access reviews applications and makes

recommendations to the United State Citizens and Immigration Services (USCIS) for foreign-born physicians requesting waivers for their J-1 Visa, which requires them to return to their home country for two years at the end of their medical training; the waiver is granted in exchange for the physician's agreement to work in an underserved area for three years

• Maryland is granted 30 waiver slots per federal fiscal year for primary

care and specialty physicians

• 20 slots are for physicians in federally designated shortage areas, the
• ther 10 slots are FLEX spots and can be in non-designated areas as long

as a specific need is being filled

STATE LOAN REPAYMENT PROGRAM (SLRP)

The State Loan Repayment Program is a federal program that offers educational loan repayment to primary care providers who agree to work in a Health Professional Shortage Area. This program requires a 1:1 federal to state match OPCA administers state loan repayment program for;

• Physicians (MDs or DOs specializing in pediatrics, geriatrics, psychiatry, family or internal medicine, and obstetrics

and gynecology)

• Physician assistants (primary care or specializing in adult, family, geriatric, pediatric, psychiatry/mental health,

women’s health)

Practitioner must be working for a non-profit organization Site must be in a Health Professional Shortage Area (HPSA) Two year obligation period with up to $50,000 loan repayment award

MARYLAND LOAN ASSISTANCE REPAYMENT PROGRAM (MLARP)

The Maryland Loan Assistance Repayment Program is a state program that

• ffers educational loan repayment to physicians, physician assistants and

medical residents and provides the 1:1 state match to the SLRP program OPCA administers state loan repayment program for:

• Physicians (MDs or DOs specializing in pediatrics, geriatrics, psychiatry, family medicine, internal medicine,
• bstetrics and gynecology, emergency medicine and women’s health)
• Physician assistants (primary care or specializing in adult, family, geriatric, pediatric, psychiatry/mental health,

women’s health)

• Medical Residents (in final year) specializing in Primary Care

Many of the guidelines are identical to the SLRP with the exception of for profit eligibility along with DHMH designated shortage area rather than a HPSA requirement

Two year obligation period with up to $50,000 loan repayment award per year

MARYLAND HIGHER EDUCATION COMMISSION – JANET

• L. HOFFMAN

Lawyers Nurses (degree- or diploma-holding registered nurses) Licensed Clinical Counselors Physical and Occupational Therapists Social Workers (either a bachelor’s or master’s degree in social work) Speech Pathologists Teachers at any level or subject field who teach in schools designated as Federal Title I or Schools Identified for Improvement by the Maryland State Department of Education (MSDE) The Nancy Grasmick Teacher Award – Science, Technology, Engineering and Math

CONCLUSION

• Work

k closely

• sely with

h rural al stakeho eholders lders such ch as LHDs Ds, hospi pital tals, s, FQHCs, Cs, LHICs, Cs, RMC, C, MRHA A to gain n a work rking ng knowledge wledge of program rams, measurem surements ents,

• utcom

tcomes, es, et

• etc. – Be Proacti

ctive

• Log onto the SHIP measures

sures and d navi vigat gate e to bet etter er under derstand stand where e your targe rgeti ting ng effor

• rts

ts will ll be most t advant vanteg egeous eous

• Work

k closely

• sely with

h your local al Area Healt lth h Education ation Counci cils s – ESAHEC, HEC, AHEC-W, MAHEC, C, BCAHEC HEC

• They provide educational outreach either through literature or via

continuing education (CEUs), delivery of care and can be an instrument to help address and resolve issues

• Un

Underst erstand and that there e are workf rkfor

• rce

e develo elopm pment ent programs rams in state e and point nt students ents towar ard them J1/SLR LRP/ P/ML MLARP ARP ret etention ntion rates es by conduct ucting ng site e visits sits of bot

• th the empl

ployer er and the physici cian an

• OPCA

A is conduct ducting ng a needs ds asses essm sment ent to det determ ermine ne which ch areas as need d which ch types s of physici cians ans can be paired red to shortage tage areas as

• SORH

RH (Temi Oshi hiyoye, e, MPH) ) is avai vailabl able e for fa face-to to-face ace engagem gement ents s with h LHDs Ds, partic ticipat pate e in LHICs Cs, and ot

• ther

er local al meeti etings ngs to tie inform

• rmation

ation gather hered ed back k to the needs s assessment essment 34