Natalie Ryan, Montana Office of Rural Health Kami Norland, Rural Health Resource Center

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Natalie Ryan, Montana Office of Rural HealthKami
Norland, Rural Health Resource Center

• Six Frontier Hospitals and Their Communities
• 2008 Champions for Quality/ Community Crossroads

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• Montana Office of Rural Health (MORH) is located
  at Montana State University and is affiliated
  with the WWAMI Medical Program
• MORH has managed the Community Health Services
  Development (CHSD) process in Montana over the
  past 20 years

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Community Health Services Development (CHSD)
Facts

• When did it begin?
• MORH collaborated with the University of
  Washington School of Medicine in 1987 evolved
  from other foundation funded projects
• What did they do?
• Developed a survey focus group process that
  identifies utilization perception of local
  health care services
• Why?
• To engage communities in strengthening the local
  healthcare system
• How is this funded?
• Flex Grant money from the Montana Hospital
  Association

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Six Frontier Critical Access Hospitals (CAH)
Objectives for CHSD Participation

• Identify address community health needs
• Measure the perception of local quality of care
• Involve health professionals in the community
• Engage community members in the future of their
  health systems

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Outcome of CHSD

• Community engagement
• Community health goals
• Strengthened healthcare services
• Community investment in the future of the health
  system

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The Current CHSD Project

• 31 communities in MT have used the CHSD process
  over the past 20 years
• In 2007 funds were available to support the CHSD
  project with 6 or more hospitals
• In 2008, 6 more hospitals are participating

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CHSD Communities

• 2007
• Anaconda
• Forsyth
• Hardin
• Philipsburg
• Plains
• Terry

• 2008
• Chester
• Conrad
• Culbertson
• Fort Benton
• Red Lodge
• Roundup

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2007 CHSD/ CAH Communities
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Issues Affecting Rural Health

• Reimbursement
• Workforce shortages
• Technology electronic health records
• EMS/ preparedness
• Aging population
• Cost of health care insurance/ access issues
• Quality performance improvement

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Community Health Planning

• Update on health care issues current trends
• Review of Economic Impact study county health
  information
• Determine vision for the local health care
  system
• Identify prioritize critical issues,
  solutions, opportunities for health care
• Develop action strategies to address critical
  issues a timeline

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Steps in the CHSD Process

• Create a steering committee to advise the project
• Review economic health information
• Conduct a community survey
• Interview key people in the community
• Analyze the information
• Hold a community forum

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Step 1 Steering Committee

• Community leaders
• Health care providers
• Business owners
• Clergy
• Ethnic diversity leaders
• Seniors
• Youth
• Media

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Questions Addressed by the Steering Committee

• What are the major health issues in your
  community County?
• How does the community compare to the rest of the
  state?
• What health status indicators could improve?
• Does the community have resources to address the
  issues?

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Step 2
Economic Impact Analysis Profile

• The source of the economic impact data is Brad
  Eldredge, the state economist. In his report, he
  writes
• A quality healthcare system gives communities
  advantages when competing for new businessand
  can provide an opportunity for young people to
  stay in the community.

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Economic Impact- Terry MT Example

• Demographics 1,140 residents in Prairie County
  a higher of people over 45, and a lower of
  people under 45 than the state
• Median age of 48.9 the oldest county in the
  state
• Older people use more healthcare services

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More economic indicators

• Each job at the Prairie Community Health Center
  generates another .14 jobs
• Every 1.00 in hospital wages benefits paid to
  employees generates another .07 in wages for
  other people in the community
• If Prairie Community Health Center suddenly went
  away, about 54,883 in additional annual wages
  would be lost from other jobs in the county

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Step 3 Community Survey

• Methodology
• 6 page survey mailed to 700 random households
  based on population inpatient admissions
• Half female/ half male adults over 18 years of
  age
• 33 response rate 1,273 out of 3,845 mailed
• Comparable survey design

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Questions

• Use of Health Services
• Use and location of Hospital, primary specialty
  care services
• Delay in receiving health care services and why
• Perception of care
• Types of services used and location
• Participation in health education programs

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Questions

• Health Insurance
• Type medical and dental
• Quality
• Why uninsured
• Demographics
• Age
• Zip code
• Length of residence

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Questions

• Community Health Issues
• Is the community a healthy place to live?
• What is important for a healthy community?
• What are the most important health issues?
• Interest in health and wellness initiatives

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Step 4 Focus Groups

• Qualitative data to provide context for survey
  results
• Questions varied by community
• Participants identified based on demographical
  information

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Step 5 Analyze the data
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Demographics

• Gender
• 63.5 Female
• 33.3 Male
• 3.2 No answer
• Ethnicity
• 96.7 White
• 2.2 Native American
• 1.1 Other

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Demographics - Employment
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Demographics - Respondent Age
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Demographics - Length of Residence
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• Needed Health Services

? In the past 3 years, was there a time when you
or a member of your household thought they needed
health care services but did NOT get it or
delayed getting it?
? If yes, why did you NOT get or delay getting
health services?
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• Hospitalization

Received Hospital Care
How Hospital was Selected (top responses)
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• Primary Care

Primary Care Received
How Primary Care Provider was Selected (top
responses)
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• Specialty Care

Specialty Care Received
Type of Specialist Seen (top responses)
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• Dental Care- Service Utilization

? When was the last time you or a household
member went to the dentist?
? If you have NOT received needed dental care,
WHY?
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• Public Health Issues- Top community health
  concerns

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• Public Health Issues- Components of a Healthy
  Community

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• Knowledge of Health Services

Learn about Services Available
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• Attendance of Health Education
• Classes/ Programs

Low participation in classes/ programs offered,
as well as how respondents learn about health
information indicate a preference for informal
communication systems
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• How would you rate your community as a Healthy
  Community to be living in?

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• Health Insurance

How well Health Insurance Covers Costs by Type
of Insurance Coverage (in percent)
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Step 6 Community Meetings

• Accuracy check Does it resonate?
• Community discussion of results
• Newsletter handout of results
• Opportunity to discuss future programs/
  specialists/ goals of hospital

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After the information gathering

• Identify the strategic issues and opportunities
• Develop healthcare delivery goals
• Address health disparities
• Contact the Rural Health Resource Center for
  technical assistance with the Culture of Wellness
  initiative

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• Technical Assistance Services Center
• Performance Improvement
• Rural HIT Coalition
• MN Recruitment Retention
• Workforce Resources
• Network Assistance
• Community Development

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Culture of Wellness

• Serves 8 states in Northwestern
  USA

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Culture of Wellness
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Community Health Strategy Map Vision Create a
Culture of Wellness

Healthy Economy
What economic benefits will we see as result of a
Culture of Wellness?


Healthy People
As residents of the community what do you want,
need or expect from a Culture of Wellness?


Community Services
What services and partnerships are needed for a
Culture of Wellness?
Community Assets
What type of skilled workforce, facilities
technology are needed to support a Culture of
Wellness?
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Community Health Score Card
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Culture of Wellness Visions

• Wellness resource center
• Lifestyle enhancements
• Senior services
• Transportation/ access to health care services

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Lessons from six MontanaCritical Access
Hospitals

• Provide quality care
• Identify address community health needs
• Involve health professionals in the community
• Engage community members in the future of their
  health systems

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Contact Information

• Natalie Ryan, MPH- Project Director
• Montana Office of Rural Health
• Montana State University
• Bozeman, Montana 59715
• 406-994-6003
• natalie.ryan_at_montana.edu
• www.healthinfo.montana.edu

Kami Norland, MA, ATR Community Specialist
Rural Health Resource Center 600 East Superior
Street Suite 404 Duluth, Minnesota
55802 218-727-9390 ext. 223 knorland_at_ruralcenter.o
rg www.ruralcenter.org