Arizona Rural Health Conference Agenda

Day 1: Tuesday, June 4

7:30-9:00 Continental Breakfast

Daniel Derksen, MD, Walter H. Pearce Endowed Chair & Director, Arizona Center for Rural Health, Professor of Public Health, Medicine & Nursing

University of Arizona Health Sciences Associate Vice President for Health Equity, Outreach & Interprofessional Activities. He is a tenured Professor of Public Health in the Mel and Enid Zuckerman College of Public Health with joint appointments in the College of Medicine and the College of Nursing. His current service, education and research activities include informing legislative, regulatory and program policy to improve access to health care and health insurance coverage; narrowing health disparities; developing, implementing and evaluating interprofessional service-learning sites; and working to assure a well-trained and distributed health workforce to meet the health needs of all Arizonans.

8_00-8_45 Dr.Derksen.pdf

Carlos Gonzales, MD, Assistant Dean Curricular Affairs and Associate Professor of FCM- UofA College of Medicine-Tucson. Carlos advises on Traditional Indian-Western Medicine Collaboration at the College.

Dr. Gonzales received his B.A. from Carleton College- Northfield, MN- 1977; M.D. from University of Arizona, College of Medicine- Tucson, AZ- 1981; a FM Residency at UNMH- Albuquerque, NM- 1984. Carlos is a sixth generation Tucsonan of Yaqui and Mexican descent. He participates in the Traditional Easter Ceremonies at the New Pascua Yaqui Pueblo. Also leads Yaqui-Inipi Way Sweat Lodge Ceremonies.

Dr. Dillon will share recent and ongoing federal government efforts to address health outcomes for birthing people and their babies in rural communities across the U.S. She’ll also address promising models and emerging practices that may provide paths forward for the nation, states, regions, and health care organizations.

8_45-9_30 Maternal Health - FORHP Slides 2024-06.pdf

Humphreys: Social Determinants of Health Track

Environment and Health in Rural Arizona: Initiatives and Opportunities

Human health and well-being are interconnected with the environment. Where we live, work, and play directly influences our quality of life, from the food we eat, to the air we breathe, to health risks from more extreme weather. Communities both rural and urban do not experience these health impacts from the environment in the same way. Rural communities face unique challenges in addressing such issues like drought, water security, and extreme heat. Presenters will showcase initiatives and opportunities and underscore the value of partnerships in building community resilience, capacity, and leadership. Examples will be broad, ranging from addressing extreme heat through cooling centers and heat risk prevention programs in rural health clinics to free technical support in finding and writing grants. In addition, this session will present opportunities for collaboration and engagement with the panelists and other organizations on how the environment impacts health and quality of life in rural communities across Arizona.

9_40- 10_25 Environment and Health in Rural Arizona.pdf

Doyle: Workforce Development Track

Developing a Culture of Teaching: Embedding Health Professions Education into the Fabric of a Community Health Center

Healthcare professionals are more likely to practice in rural and underserved communities if they trained in one, and academic programs are eager to expand these community-based training experiences. Unfortunately, many factors limit the teaching capacity of healthcare institutions, including both individual preceptor and institutional barriers. North Country HealthCare (NCHC) and its embedded Area Health Education Center (AHEC), the Colorado Plateau Center for Health Professions, led a three-year strategic initiative to systematically interweave teaching into the organization’s mission and develop a foundation to support teaching as a core activity. This presentation will discuss the history and elements of NCHC’s model, offer best practices and lessons learned from the strategic initiative, and provide examples of tools and resources other institutions can utilize to build their teaching culture.

9_40-10_25 Developing a Culture of Teaching.pdf

Abineau/Fremont: Addressing Health Disparities Track

Integrating Telehealth as a Social Determinant of Health: Implications for Healthcare Policy, Practice, Planning, and Research

9_40-10_25 Integrating TH into SDOH.pdf

Rees: Building Equitable Infrastructure Track

Many Shades of AZUL: Models and Measures for Mobile Programs

Project AZUL (Arizona Uniting Lives) is the rural outreach program of the Sahuarita Food Bank and Community Resource Center. We coordinate a broad range of programs and services in our 46ft mobile classroom for rural and underserved populations in Pima County. The U of A Primary Prevention Mobile Health Unit (MHU) provides free basic preventative screenings across underserved areas of Arizona. Beginning in October 2023, these two teams have collaboratively coordinated multiple free resource fairs in communities including Arivaca, Summit and South Tucson. Combining their mobile programs enhances each program’s capacity to educate community members on their own health issues, connect clients to workforce development programs and provide assistance during phases of acute hunger and financial crisis. By working together, Project AZUL and the Mobile Health Unit highlight and address the connection between food insecurity and health disparities while attempting to provide real time solutions to community members who often suffer in silence. Come learn about how we build relationships in rural areas, how we measure and celebrate our successes and challenges, and where we’d like to go next.

9_40-10_25 Project AZUL.pdf

Please visit with our Exhibitors:

Humphreys: Social Determinants of Health Track

Panel Discussion: Arizona AHEC Scholars Program Updates

Arizona AHEC Director Leila Barraza will facilitate a panel discussion about the Arizona AHEC Scholars Program. The AzAHEC Scholars Program (ASP) is a two-year interprofessional training program completed in partnership between the six AzAHEC Regional Centers and the nine AzAHEC-funded Rural Health Professions Program (RHPP). Arizona AHEC Scholars include nearly 200 students from the three public universities in Arizona in the UArizona COM-P and COM-Tucson (Medical Students), the UArizona College of Nursing (Nurse Practitioner Students), the College of Pharmacy (PharmD Students), and the College of Public Health (Master of Public Health Students); Northern Arizona University (NAU) (Physician Assistant, Physical Therapy, and Nurse Practitioner Students); and Arizona State University (ASU) (Nurse Practitioner Students).

Doyle: Workforce Development Track

Mastering Rural Medicine: A Roadmap Through Competency-Based Learning

A novel approach of UACOM-P curriculum, competency-based learning focuses on ensuring that students acquire the knowledge, skills, and attitudes necessary to practice medicine effectively. This approach emphasizes specific competencies, such as patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and system-based practice. Students are evaluated based on their ability to demonstrate these competencies, often through standardized assessments, clinical evaluations, and simulations. This method aims to produce graduates who are not only knowledgeable but also competent and capable of providing high-quality patient care in a variety of settings. This workshop discusses the why’s and how’s of Competency-based rural medical education in AZ

Abineau/Fremont: Addressing Health Disparities Track

Overview of Maternal Mental Health in Arizona

This session will provide a comprehensive update on the current state of maternal mental health in Arizona, shedding light on prevalent issues and recent trends. Introduction to Zurzave: Explore the latest developments in mental health medications, with a specific focus on Zurzave. Understanding the implications and applications of this new drug is crucial for rural healthcare providers in their care of expectant and new mothers

10_45- 11_30 Overview of Maternal Mental Health .pdf

Rees: Building Equitable Infrastructure Track

Lung Cancer Screening in Rural Arizona: Experiences and Lifesaving Opportunities

Researchers at KRMC recently conducted a study to evaluate the performance of Lung Cancer Screening with low-dose CT (LDCT) in a rural Arizona community. LDCT proved to be effective at diagnosing early-stage lung cancers, however, it was also found that an alarming number of patients were lost to follow-up and did not return for the additional imaging and testing they needed. KRMC has addressed this issue by forming a dedicated lung cancer screening program to manage patients through the screening process and address the various barriers to care for these patients. This has resulted in a more than 40% improvement in the rate of follow-up compliance in screening patients, a 62% year-over-year increase in the number of patients being screened for lung cancer, and a corresponding increase in the number of early-stage lung cancers being diagnosed. Arizona ranks near the bottom in rates of lung cancer screening, despite having smoking rates above the national average. Rural communities in particular stand to gain from improving lung cancer screening practices, and improved access to it. We would like to present research and experience from our institution and similar rural community-based ones about this opportunity and the steps that can be taken to address it in rural Arizona communities

10_45- 11_30 Lung Cancer Screening.pdf

Humpreys: Social Determinants of Health Track

Building a Better Future: Community Engagement for Collective Action

Community Engagement for Collective Action can move the needle on health in Arizona and reduce health disparities. The Collective Impact model can help to change health outcomes by organizing community actions. Many organizations are already involved in their communities and have connections to leadership. This framework emphasizes cross-sector collaboration and alignment among different stakeholders to achieve shared goals working towards mitigating the Social Determinants of Health. This approach moves towards policy, systems, and environmental changes to create sustainability of the efforts made. By simply working with the community members, organizations, and institutions that you are already a part of, you can achieve more. Successful examples include improvements in transportation in the rural area, food security, access to healthcare, and other successes. Learn more about Collective Impact, Community Engagement strategies, examples of success, tips, and more.

11_45-12_30 Building A Better Future.pdf

Doyle: Workforce Development Track

Ensuring our workforce is prepared - A facilitated activity to inform curriculum development for NAU’s Public and Allied Health Programs

This is an opportunity for rural health professionals to connect with Northern Arizona University Department of Health Sciences’ faculty to inform curriculum design towards the REAL workforce needs in rural Arizona. This facilitated session will elicit your perspectives and feedback on how our undergraduate curriculum can and should prepare new graduates for careers in your organizations/communities/fields. Your contributions will inform curriculum development in the Allied Health and Public Health programs. Together we will also identify new and enhanced ways to partner together towards improved health outcomes in rural Arizona.

Abineau/Fremont: Addressing Health Disparities Track

Rural Challenges in Suicide Prevention

Delve into the unique challenges that rural practitioners face in preventing suicide. Recognize the signs, explore risk assessment tools, and discuss strategies for intervention and postvention.

11_45-12_30 Rural Challenges In Suicide Prevention.pdf

Rees: Building Equitable Infrastructure Track

Providing Health Care Equity through a Mobile Integrated Health program

Gila River Health Care has pioneered a Mobile Integrated Health-Community Paramedic (MIH-CP) program. The program improves health equity and enhances the well-being of our rural native population through tangible health improvements. Our MIH-CP initiative involves dispatching a Community Paramedic and Community Health Representative directly to patients’ homes. We are eager to highlight how our collaboration with diverse community stakeholders during the needs assessment and data analysis phases has been instrumental in formulating program policies and standard operating procedures and with continued collaboration improved outcomes for our patients.

MIH-CP is adept at addressing the underlying causes of health disparities and overcoming numerous barriers related to social determinants of health by focusing on individual patient needs. By delving into issues such as housing, transportation, and food insecurity, alongside providing targeted interventions for complex health conditions, MIH-CP effectively mitigates common systemic inequities. The MIH-CP program consistently fosters community engagement and empowers patients to actively participate in shaping their health outcomes.

Employing state-of-the-art technology, point-of-care testing, and personalized interventions tailored to each patient’s unique requirements within their homes, MIH-CP has cultivated trust among our patient community and reshaped our healthcare delivery.

Humphreys: Social Determinants of Health Track

The Navajo Nation Niłch’ éí Bee Ííńá – Air is Life Act: The Passing of a Historic Commercial Tobacco Policy in the Navajo Nation

Background: Comprehensive commercial tobacco smoke-free laws are effective at protecting non-smokers and reducing tobacco use, yet they are not widely adopted by tribal governments. Methods: A series of tobacco smoke-free policy initiatives in the Navajo Nation, beginning in 2008 to 2021, were reviewed to identify key concerns, challenges, and triumph efforts by the Air is Life Coalition. Results: It has been essential that the proposed Navajo tobacco smokefree policies acknowledge the use of Nát’oh, a sacred and natural plant used for gift-giving, medicinal purposes, and traditional ceremonies, while simultaneously, in a “Hogan-level” approach, educating the Diné people and leaders about the harmful effects of exposure to secondhand smoke and the need to protect every person and worker on the Navajo Nation. Concerns on the Navajo economic impacts, especially Navajo Gaming Casinos, has been a major barrier to the broad implementation of a comprehensive commercial tobacco policy in the Navajo Nation. Conclusion: The Navajo Nation Niłch’ éí Bee Ííńá – Air is Life Act, recently passed by the Navajo Nation Council and signed into law by the Navajo Nation President, will protect non-smokers and prohibit commercial tobacco use within public places and workplaces in the Navajo Nation, including the Navajo Gaming facilities.

2_00-2_45 The Navajo Nation Niłch’ éí Bee Ííńá.pdf

Doyle: Workforce Development Track

Navigating Regulatory Risk in a Rapidly Changing Environment

The primary role of every compliance officer is risk management. Often times risk management is viewed as an Information Technology activity versus the overarching goal of risk tolerance and management. Compliance is more than recitation of regulations and following the rules. As organizations start to prepare for the plethora of regulatory changes coming, the role of risk management more important now than ever.

In 2024, we have eight regulatory changes/proposals that are on the federal unified agenda. These changes range from privacy to security to information blocking and span across HIPAA and 42 CFR Part 2. Understanding these regulatory changes and being able to navigate through the potential risks to your organization will be imperative to protecting the overall health of your operations and revenue.

In this presentation, we will review the upcoming proposed final rules and NPRMs. Participants will have a full understanding of what the proposed changes are as well as be able to identify potential risks to their organization as these new rules are published. We will discuss risk management tactics to implement in order to keep up with the changing regulatory environment while managing compliance risk.

Abineau/Fremont: Addressing Health Disparities Track

Innovating Access: Tackling Health Disparities in Rural Arizona with Denova Collaborative Health

Rural Arizona faces acute health disparities, particularly in maternal and behavioral health. These challenges are exacerbated by limited access to services and insurance barriers, disproportionately impacting vulnerable populations. Our presentation, led by Denova Collaborative Health’s CAO, Silvia Garcia, will share insights and strategies developed through our work in addressing these disparities. We will focus on the educational aspects of our data-driven programs and the role of cross-sector collaborations in fostering health equity.

Denova employs the Denova Based Symptom Assessment (DSBA), using self-reported surveys to customize care for depression, anxiety, and PTSD. This approach has significantly reduced symptoms, showcasing the impact of personalized interventions. By leveraging virtual care, we eliminate the barrier of accessible services regardless of location or insurance, accepting all Medicaid payors, Medicare, and commercial insurance in Arizona.

Attendees will gain insights into overcoming access barriers and the benefits of integrated care models. We aim to share actionable knowledge for replicating Denova’s successes, underscoring our commitment to health equity through patient-centered strategies. This session will equip health professionals with the tools to implement similar approaches in their communities, fostering a broader understanding of achieving health equity in rural settings.

2_00-2_45 Innovating Access.pdf

Rees: Building Equitable Infrastructure Track

Transforming Rural Health Through Virtual Care and Community Relationships

Over the past three years, Thriving Together NCW has dedicated its efforts to an initiative aimed at leveraging virtual care to enhance healthcare access and improve outcomes in rural North Central Washington.Through strategic partnerships and innovative approaches, Thriving Together NCW is leading the effort to build a sustainable virtual care ecosystem across four large rural counties. Utilizing data-driven insights, Thriving Together NCW, in collaboration with Ingenium and Laurel Health Advisors, is spearheading the development of scalable solutions to address the unique healthcare needs of our communities. In collaboration with clinical partners, social service providers, schools, libraries, and fire stations, this prototype initiative is revolutionizing rural healthcare delivery.

The presentation will highlight implementation strategies and ongoing efforts to establish a sustainable regional virtual care program. We will describe the initiative’s progress based on an independent evaluation assessing the effectiveness of interventions and their financial impacts on patients, providers, and the healthcare system. Emphasizing investments and activities replicable across other rural communities, this presentation aims to showcase the potential of virtual care in transforming rural health.

2_00-2_45 Transforming Rural Health Through Virtual Care and Community Relationships (1).pdf

Humphreys: Social Determinants of Health Track

Burning Questions: Using Community Feedback for Cannabis Education in Arizona

The AzCANN: Arizona Cannabis Education program is an ADHS funded program. We create balanced and factual resources for general and health professional audiences to empower Arizonans in making choices about responsible cannabis use.

This presentation examines two initiatives taken by AzCANN: an interprofessional training event presented to students at Arizona’s three state universities, as well as a series of feedback sessions with youth, adults, and professional stakeholders to reduce gaps and barriers to accessing reliable information on responsible cannabis use. We will 1) highlight our strategy for interprofessional messaging on cannabis, and provide an overview of participants knowledge, attitudes, and behaviors around cannabis trainings, 2) outline the outreach strategy used to ensure information gathered is responsive to rural and multiply marginalized communities and 3) a live demonstration of our “Ask AzCANN” survey, where participants will be able to ask their own questions about cannabis, and a snapshot of previous survey responses cannabis questions collected statewide and discussion of how feedback has influenced AzCANN materials and how health professionals, educators, and promotoras de salud can integrate insight into a variety of health environments.

3_00-3_45 Burning Questions.pdf

Doyle: Workforce Development Track

Transforming Medical Education: The Power of Longitudinal Integrated Curriculum (LIC)

A longitudinal integrated curriculum (LIC) is an educational approach that immerses health professional students in clinical learning experiences across multiple disciplines over an extended period, often spanning several months to years. Unlike traditional block rotations, LICs emphasize continuity of patient care, allowing students to follow patients over time, develop relationships, and understand the impact of social determinants of health. This model promotes deeper learning, holistic patient care perspectives, and professional identity formation, preparing students for the complexities of modern healthcare practice.

Abineau/Fremont: Addressing Health Disparities Track

Pediatric Mental Health: Front-Line Provider Essentials

Equip front-line providers with essential knowledge about pediatric mental health. This segment will cover early identification of mental health concerns, effective communication with young patients, and strategies for collaborative care with parents or guardians.

3_00-3_45 Pediatric Mental Health Frontline Provider Essentials.pdf

Rees: Building Equitable Infrastructure Track

Telehealth: Bridging Health Equity Gaps or Widening Disparities?

Telehealth serves as a powerful bridge in promoting health equity by addressing various barriers to healthcare access. It dismantles geographical constraints, ensuring underserved populations in rural, urban, and low-income areas can access essential healthcare services. Moreover, telehealth enhances convenience by eliminating transportation obstacles and offering flexible scheduling options, catering to the needs of diverse populations, including those with limited mobility or busy schedules. Additionally, telehealth fosters continuity of care by facilitating the management of chronic conditions and providing access to specialists, thus reducing disparities in healthcare outcomes.

However, this powerful tool also possesses the potential to widen the health equity gap. One significant concern lies in the unequal access to technology, where disparities in internet access and digital literacy could impede marginalized communities from utilizing telehealth services effectively. Furthermore, language and cultural barriers may hinder effective communication and understanding during telehealth interactions, potentially excluding non-English-speaking or culturally diverse populations. Additionally, differential adoption rates among demographic groups could further widen health disparities if certain communities are reluctant or unable to embrace telehealth solutions. Addressing these challenges is crucial to ensuring that telehealth contributes positively to health equity for all individuals, regardless of their socioeconomic status or background.

3_00-3_45 Telehealth & Health Equity.pdf

Research and Community Engagement Poster Session

Day 2: Wednesday, June 5

7:30-9:00 Continental Breakfast

Humphreys: Graduate Medical Education

Developing and supporting primary care residency programs in rural and underserved sites across Arizona has been the focus of a new 5 million dollar initiative funded by the State of Arizona (SB1727) through AZ AHEC. This presentation will provide an overview of rural and underserved primary care GME initiatives, now 6 months after implementation, and will include some goals of primary care GME development in Arizona.

Humphreys 8-8.45.pdf