BENSON – Teresa Vincifora, chief nursing officer at Benson Hospital, received a second role in April overseeing quality assurance. That was after recruiting to replace a retiring employee came up empty.
“In rural hospitals, we wear many hats,” Vincifora said. “Jobs are really hard to fill.”
Then a program administered by the University of Arizona provided funds for her to attend a quality directors’ boot camp in Nashville.
“We don’t have the resources that large hospitals do, so that was just such an opportunity for me and so helpful,” she said. “There’s so much to learn. It got me fired up for the position.”
The Center for Rural Health, part of the Mel & Enid Zuckerman College of Public Health, has been helping hospitals in those kinds of ways for 25 years. Vincifora’s assistance came from the center’s Flexibility Program, called “Flex” for short, established by Congress in 1997 to address the disparity in Medicare reimbursement between urban and rural hospitals.
Dr. Graciela Silva, Assistant Professor in the College of Nursing, will be the Center for Rural Health’s inaugural Courtesy, Adjunct, and Affiliate Appointments Program member. Her research background, expertise, and interest in working on U.S.-Mexico Border issues will be a beneficial addition to the Center’s mission.
Dr. Silva first learned about the affiliate program shortly after joining the College of Nursing and thought of it as an opportunity to stay connected with public health research on the U.S. Mexico Border. “I was very excited to learn about this opportunity so I could continue collaborating with the College of Public Health,” she said.
Dr. Silva completed her bachelors in Guadalajara, Mexico and also at the University of Arizona, studying Medical Technology. She went on to obtain her Master of Public Health at the University of Arizona and eventually her PhD in Epidemiology as well.
As a doctoral student, Dr. Silva was awarded an NIH Minority Fellowship to research asthma and respiratory diseases, and she has also conducted post-doctoral research in sleep disorders. She has published numerous studies in these areas and has a depth of experience in working with longitudinal cohort data.
More recently, Dr. Silva worked on an evaluation of the Healthy Border 2010, a health promotion plan similar to Healthy People 2010, and focused primarily on the U.S. side of the U.S.-Mexico Border. Having lived in Nogales, Arizona, border health issues are very important to Dr. Silva. “The issue of border health is dear to my heart, and I wish to make some sort of impact in reducing morbidity in this area,” she said.
As a Center for Rural Health affiliate, Dr. Silva would like to continue her work in respiratory diseases, especially in drug-resistant tuberculosis along the Mexican border. She has a CDC fellowship in emerging infectious diseases and would like to find a way to integrate her research into her work with the Center for Rural Health.
The Arizona Strategic Enterprise Technology Office (ASET) is launching an Unconnected Providers’ grant program for the purpose of supporting Health Information Exchange (HIE) planning and implementation for health care organizations. The grant program is aimed at stimulating the adoption of HIE for healthcare providers who currently have not planned or implemented an information exchange solution.
Highlights of ASET Grant Program
Total amount of funding available for distribution is up to $1.1 million.
Estimated award amount for a single organization application is up to $25,000 for implementation planning, and up to $50,000 if implementing an HIE solution, with joint applications being eligible for up to $50,000 for implementation planning and up to $100,000 for implementing an HIE solution.
Period of performance of the grant is six (6) months – January 2013 to June 2013.
Matching requirements – cash or in-kind of at least 50% of the grant award.
Individual providers are not eligible for this grant award.
The target for this grant program is healthcare organizations and facilities.
Grant applications are due to ASET by Friday, November 16, 2012.
Healthcare coverage for low-income and sick patients in Arizona is extremely limited. One of the few relatively affordable options for the uninsured is the Pre-existing Condition Insurance Plan (PCIP). PCIP coverage is intended to serve as bridge for coverage until 2014 when health insurance exchanges become operational and the regulation ensuring people can no longer be denied coverage based on their health status is in place.
More than 70,000 people are now covered by PCIP since the program started in 2010. PCIP enrollment has not been as successful as it could be due in large part due to the lack of a marketing campaign. Grassroots efforts in Arizona and other states have helped increase PCIP enrollment, but they have had only limited success.
The Arizona Hospital and Healthcare Association, along with other healthcare partners, have produced commercials in English and Spanish to help generate public awareness of the program. The commercials are captivating, appeals to a wide audience and it has tremendous potential to grow PCIP enrollment at a faster pace.
These commercials are free for anyone to download and link to the YouTube versions. Here is the link to a background webpage with downloadable and online versions of the commercials:
We hope everyone – healthcare providers, community groups and the general public – will help promote the commercials so patients with pre-existing conditions will learn about PCIP and enroll in the program.
Please consider using the commercials in the following ways:
· Distribute this memo to all of your contacts;
· If you are a healthcare provider, show the commercials to patients in waiting areas in healthcare settings;
· Add the link to the YouTube version of the commercials on your web pages, Facebook, Blogs, etc.;
· Distribute the commercials through electronic media and encourage others to do the same;
· and, make a donation to air the commercials on television.
If you would like to brand the commercial with a logo, additional message or run it as a loop with other video, please contact Jim Manley, film producer at Manley Films at 602-312-2988.
According to the Arizona Rural Health Workforce Trend Analysis report, rural Arizona areas have proportionally less healthcare professionals per capita than urban areas in Arizona—for nearly all health professions analyzed in the report. This shortfall in workforce has huge implications for healthcare delivery and health status for rural populations since health workforce distribution directly influences access to care.
Moreover, the authors of the report suggest that the passage of the Patient Protection and Affordable Care Act of 2010 to rapidly increase the demand for patient services with resulting expanded coverage. The impending retirement of the ‘baby boomer’ generation is also expected to increase the demands on Arizona’s healthcare system. Arizona’s health workforce—especially in rural areas—will need to find strategies to meet this growing demand for health services.
A policy brief, prepared by Kimberly Ryan for the Center for Rural Health, summarizes the issues put forth by the Arizona Rural Health Workforce Trend Analysis report and offers several short-term and long-term strategies to address the expanding healthcare demands in rural Arizona. You can review the brief on our website, here.
The Southwest Rural Policy Network (SWRPN) has been awarded a grant from the Rural Policy Action Partnership to initiate a project in Rural Digital Advocacy. The grant provides support to rural advocacy groups like the SWRPN to leverage technology and social media tools to strengthen their rural policy work and campaigns.
The SWRPN has proposed to build an online “Rural Southwest Digital Community Center” as a platform to foster collaborative efforts between community-based projects in the rural Southwest. The website will replace their current site, and serve as a repository of shared resources for the rural communities in New Mexico and Arizona.
You can read more about the grant and the “Rural Southwest Digital Community Center” proposal here.
The Arizona AHCCCS has announced on their website that KidsCare II, a new children’s healthcare coverage program, will be available May 1, 2012 through December 31, 2013 for a limited number of eligible children.
KidsCare II has the same benefits and premium requirements as KidsCare, but with a lower income limit for eligibility. The income limit for KidsCare II is 175% of the Federal Poverty Level (FPL), based on family size.
Beginning June 25, 2012, all applications will be considered for eligibility in the KidsCare II program. Children will no longer need to be on the KidsCare waiting list.
Arizona’s Children's Health Insurance Program, known as KidsCare, operates as part of the AHCCCS program and is for children in households with incomes between 100%-200% of the federal poverty limit (FPL). Benefits and premium requirements for KidsCare II are the same as the regular KidsCare program.
The recent recession severely impacted Arizona's economy and led to a state budget shortfall, which required difficult decisions across all of state government. One of these decisions was to freeze enrollment into the KidsCare program on January 1, 2010. Since then, all KidsCare applicants have been placed on a waiting list in the event that enrollment could be re-opened.
KidsCare II is temporary and will end December 31, 2013. AHCCCS will assist children enrolled in KidsCare II to transition to the Health Insurance Exchange, which will be open for enrollment and coverage by that date.
The Pima County Women’s Health Review is the result of a collaborative effort among three groups: The Pima County/Tucson Women’s Commission, The University of Arizona Mel and Enid Zuckerman College of Public Health Center for Rural Health, and the University’s Southwest Institute for Research on Women.
The report was developed from information gathered at five structured discussion groups involving elderly women living in the Green Valley area, and economically disadvantaged women living in Tucson’s south side area. The aim was to find out if targeted groups of women experienced equal access to health care services, and also to discover information about their issues and challenges.
The report finds that the lack of access to health care services is devastating to both physical and mental health when a woman in Pima County cannot afford to pay for health care for herself or her minor dependents. When a person does not have the financial resources to pay for medical and/or diagnostic care, medications, dental or visual care, these problems and concerns do not go away. Instead, they usually worsen until serious problems develop and the individual then is forced to seek care in the emergency room, a far more expensive solution than if the problem had been dealt with in the first place. The report also addresses the seriousness of issues that face elderly women raising children. These are women whose struggle is enormous. In their so called “golden years” they find themselves raising grand children who they have adopted or are fostering in order to keep their families together.
To help to resolve some of the issues identified in the report, recommendations are made for action by Pima County Government, the Arizona Division of Aging and Adult Services, the Pima Council on Aging, the University of Arizona, the Kinship and Adoption Resource and Education (KARE) Family Center, the Tribal nations of Pascua-Yaqui and Tohono O-odham, and the Women’s Foundation of Southern Arizona. All recommendations are delineated in the report.
USDA Rural Utilities Service Community Connect Grant Program – Notice of Solicitation of Applications
The U.S. Department of Agriculture’s (USDA) Rural Utilities Service (RUS) announces its Community Connect Grant Program application window for Fiscal Year 2012. The Community Connect program provides grants to establish broadband transmission service in rural communities which are currently underserved. Funds may be used to build broadband infrastructure and establish a community center which offers free access to broadband services for community residents for two years.
Access to affordable and reliable broadband connectivity in rural communities improves the ability of rural health care providers to effectively utilize health information technology, achieve the meaningful use of electronic health records (EHR) and receive EHR Incentive payments. Broadband is particularly critical in rural areas, where advanced communications and utilization of health IT can shrink the distances that isolate remote communities.
Eligible entities for the Community Connect Grant program include state and local governments, incorporated organizations, tribal organizations or cooperative, private corporations or limited liability companies organized on a for-profit or not-for-profit basis. Eligible areas include a single community with a population less than 20,000 which does not have Broadband Transmission Service.
The application deadline is June 18, 2012. Please visit the Community Connect Grant Program website at http://www.rurdev.usda.gov see the attached Notice of Solicitation of Applications for the USDA RUS Community Connect Grant Program for additional information.
FOR IMMEDIATE RELEASE – April 30, 2012
Contact: Laura Oxley, ADHS Public Information: (602) 542-1094
In recognition of National Infant Immunization Week, the Centers for Disease Control and Prevention (CDC) and the CDC Foundation are honoring immunization advocates around the country with the first ever CDC Childhood Immunization Champion awards. These awards acknowledge people who have made immunization success possible in their community, including Leslie Maier from Tucson, Arizona.
Leslie lost her seventeen-year-old son, Chris, to bacterial meningitis in 2005. Chris Maier was a healthy, athletic high school senior and star soccer player when he suddenly became ill with meningitis and died within 18 hours of showing symptoms of illness. In the wake of her son’s death, Leslie joined the National Meningitis Associations’ (NMA) Moms on Meningitis program to teach other families about the dangers of meningococcal disease, and prevention methods, including immunization. She was elected as a NMA board member in 2006.
Leslie is an advocate for meningitis education, prevention and immunization. She was a driving force behind the addition of meningitis immunization requirement to Arizona’s school rules in 2008. Leslie collaborated with the Arizona Department of Health Services, the Centers for Disease Control and Prevention, and The Arizona Partnership for Immunization to develop meningitis education materials for parents, schools and health care providers in Arizona. She continues to honor Chris’ memory by speaking at national, regional and local meetings and conferences.
WHAT: Arizona’s CDC Childhood Immunization Champion Award Winner
WHEN: Wednesday, May 2nd 3:30 pm
WHERE: Arizona Department of Health Services, 150 N 18th Ave, Phoenix
WHY: Educate Arizonans about the importance of immunizations
WHO: Leslie Maier & ADHS Immunization Staff
Later that evening, Leslie will be recognized at The Arizona Partnership for Immunization’s 16th Annual Big Shots for Arizona Award Ceremony at the Phoenix Country Club.
National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and to celebrate the achievements of immunization programs in promoting healthy communities throughout the United States. This year, during NIIW, communities across the U.S. celebrate the CDC Childhood Immunization Champions.
“Vaccine-preventable diseases still circulate in the United States and elsewhere. Without the diligent efforts of our champions, these potentially deadly diseases would be an even greater threat to our nation’s children,” said Dr. Anne Schuchat, Director of the CDC’s National Center for Immunization and Respiratory Diseases. “Each of us has the potential to be a champion by protecting children’s health through immunization.”
KANSAS CITY, MO, April 30, 2012 – According to data released by the National Rural Health Association (NRHA), small, rural hospitals nationally have equal or better quality outcomes, and cost less per Medicare beneficiary than their urban counterparts. The intersection between cost and quality defines the value proposition that rural systems of care provide to the Medicare program. Despite the cost-effectiveness of rural hospitals, many may be forced to close if Congress does not reauthorize two rural hospitals programs set to expire on October 1.
(http://arizonasonoranewsservice.com) When people are injured or sick and need immediate medical attention, they usually find their way to the nearest physician or emergency hospital. In rural Arizona, that is easier said than done. Many people must travel 20 or more miles to reach the nearest doctor. This harsh reality has left those with low income and no transportation to struggle on their own.
Jill Bullock, the rural health services coordinator at The University of Arizona's Mel and Enid Zuckerman College of Public Health in Tucson, said that rural communities are suffering the most because there is no access to healthcare for patients, coupled with a lack of funding that has led to workforce issues when recruiting professionals. Read more
A new study in the Canadian Pharmacists Journal, looking at patient-related risk factors for medication errors, found that older women taking multiple medications are at greater risk than men for self-reported medication errors—errors reported by the patient.
Women were found to be 1.2 times more likely than men to experience a medication error. Furthermore, individuals 50-64 years old were nearly 1.5 times more likely than patients 18-24 to experience a medication error while those 65 years an older were nearly 1.8 times more likely.
“Prior studies that looked at the risk for inappropriate medication prescribing in elderly care also found women to be two times more likely than men to experience a medication error,” said Dr. Kim Sears, lead author on the paper. “I think the issue may be that women are living longer than men and they often have complex needs [and] are ordered more medications.”
The study also reported that the number of medications prescribed to a patient was significantly associated with the occurrence of an error. Patients taking 6-10 prescriptions were 1.6 times more likely to experience a medication error than patients taking 1-5. For those taking more than 10 prescriptions—the risk of error was 2.5 times higher. “Every time you increase the medication you increase the risk [for error],”said Sears. “You run into more risks for adverse drug interactions.”
The study also reviewed the difference in risk for community versus hospital settings and found that about 4 of every 5 errors reported occurred in a community setting. In fact—nearly every factor they considered was associated with higher risks for errors in community settings than in hospitals.
“Communications between providers in a community setting is a big factor in adverse [medication] outcomes. Hospitals already face challenges in communicating among in-house team members, but when you go out into the community setting—there are so many community providers involved in patient care and no central or national reporting system,” said Sears. “Patients may be seeing different providers and [the patients] aren’t always sure of what they’re taking.”
To compound the challenges, community providers are also treating increasingly more specialized conditions, and the need to communicate between providers is even more urgent. “The healthcare system is more complex than ever before,” said Sears. “You have patients going to community providers for things that would have been inpatient problems in the past.”
While increasing error reporting and communications between providers may help catch and rectify medication errors, there is little incentive for community providers to do so. In fact, even if there were a voluntary national reporting system, reporting errors would likely remain quite low.
While these communication gaps may exists between providers, Dr. Sears suggests that there are things patients can do to minimize those risks, like building relationships with their community providers and going to the same pharmacy to build a medication history. “One simple thing that patients could do is to keep a sheet or record of their medication history. Having a list of current medications they’re on, the reasons for taking them, and even medications they were taken off of and why.”
Medication errors are a persistent concern in all healthcare settings given their negative impact on population health as well as the financial burden they entail. One study has estimated that about 28% of all emergency room visits were drug related and more importantly—70% were preventable. In dollars and cents, $3.5 billion annually has been attributed to medication errors in the United States and up to C$11 billion in Canada.
A new study published in the BMJ Quality & Safety Journal, conducted in Nova Scotia with members from four community hospitals, found that reporter burden—the added work and difficulty in using reporting forms—may be a key barrier in medication error reporting.
“Extra time required in reporting, cumbersome report forms, hesitancy about “telling” on someone, and the perceived severity of the error,” were the four barriers to reporting most frequently identified by the focus group participants said Dr. Nicole Hartnell, the first author on the study.
On the other hand, “the most frequently mentioned incentive for reporting a medication error was to improve care and improve patient safety,” said Dr. Hartnell. “Reporting for protection or immunity was also mentioned at each of the study hospitals.”
Medication errors have an enormous impact on patient safety and care, but despite efforts to reduce these errors, it has been estimated that up to 20% of all medication doses administered are done in error. Even more worrisome—50-96% of errors are estimated to be underreported. These errors have been associated with increased hospital stays and wasted medical expenditures. In 2006, it was estimated that medication errors accounted for$3.5 billion in medical expenses. That figure rises to $177.4 billion when accounting for all drug related deaths and complications.
“In theory reporting compliance would translate into better practice because people could learn from the mistakes of others, thus hopefully preventing the same mistakes from happening time and time again,” said Dr. Hartnell.
The study also identified potential interventions to facilitate medication error reporting, suggesting a focus on reducing reporter burden—making the process easier and clearer—could increase reporter compliance. Dr. Hartnell suggested that “these facilitators could improve reporting because they were identified as such by the people doing the actual reporting. These were things that the front line health professionals thought would encourage them to report errors more often.”
In addition to increasing feedback, efforts to improve education around reporting—how to report, why to report and how reports were being used—was identified as an important factor to help providers feel more confident about reporting and to feel that they were helping to improve patient safety. Education is an important factor since many skeptics aren’t completely convinced that error reporting would improve patient safety.
“Improved communication and improved education were the two changes participants seemed to want the most,” Dr. Hartnell noted. “Better communication or organization specific feedback was requested by participants at each of the four study hospitals. Many participants voiced frustration over the feeling that they did not receive feedback about error reports that had been submitted.”
And of course, no one solution exists to improve error reporting.
“Error reporting is a multi-factorial and complex issue, and that band aid solutions are not available,” Dr. Hartnell said. “Each hospital will have unique factors at play that will influence the reporting environment within that organization. While vast improvements will not occur overnight, this study suggests that some small changes could make a positive difference in error reporting, and are worth considering.”