Rural Opioid Prevention and Treatment Strategies: The Experience in Four States [Working Paper]

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, North Carolina, Vermont, and Washington State, this qualitative study explores promising state and community strategies to tackle the opioid crisis in rural communities and identifies rural challenges to the provision of OUD prevention, treatment, and recovery services

Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program

Since the first full year of Flex Program funding, the number and range of EMS improvement activities proposed by participating facilities has increased substantially. This report describes the EMS-related projects that states proposed to conduct in fiscal year 2004-2005

Models for Quality Improvement in CAHs: The Role of State Flex Programs (Briefing Paper #25)

A central goal of the Flex Program, as defined in the original and reauthorizing legislation, is to help Critical Access Hospitals (CAHs) develop and sustain effective quality improvement (QI) programs. This study examined the range of multi-CAH QI and performance measurement reporting initiatives supported by the Flex Program in nine states, assessed the role of State Flex Programs in developing and supporting these initiatives, and explored their impact on the QI programs of CAHs. Key Findings: State Flex Program funding was frequently the primary, if not sole, source of funding to support these efforts. Collaboration and shared learning are common Flex Program strategies underlying state QI initiatives. Quality measurement and reporting is a challenge due to a lack of agreement on common measures across state QI and benchmarking systems and a common belief that Hospital Compare measures are not “rurally relevant” (i.e., specific to the needs of CAHs). Administrative, clinical, and board leadership and buy-in were consistently identified as crucial to the success and sustainability of CAH-level QI initiatives. States reported that the scope of their QI has to be scaled to the available resources and capacity of CAHs to avoid QI fatigue among CAH staff. There is limited hard evidence on the impact of the QI initiatives adopted by State Flex Programs; much of the “evidence” supporting these initiatives is anecdotal or based on postconference or webinar evaluations

The Role of State Flex Programs in Supporting Quality Improvement in CAHs (Policy Brief #16)

This study examined QI activities supported by the Flex Program in nine states, assessed the role of the State Flex Programs in developing and supporting QI activities, and explored the effect of these initiatives on CAH QI efforts. Key Findings: The Flex Program has been instrumental in funding and providing leadership for the development of CAH quality improvement initiatives. Collaborative shared learning strategies have been central to the success of Flex Program QI programs. Scaling QI program activities to the capacity and resources of CAHs is critical to success. Administrative, clinical, and board leadership and buy-in are also critical to the success of CAH QI initiatives. Despite widespread support for these QI initiatives, there is limited hard evidence on their impact. Overlap between the quality measures in Hospital Compare and those used by state and multi-state QI reporting and benchmarking programs offers the opportunity for developing a common set of “rural relevant” hospital quality measures

Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey

Previous studies have investigated the rural provision of mental health services by FQHCs and CMHCs (Wagenfeld, 1994; Hartley et al., 2002). However, there is little documentation of the extent to which ERs provide mental health services in rural communities. This paper provides new information about the role of rural ER’s in the provision of mental health services, gathered from a structured telephone survey of ER managers in a nationally representative sample of Critical Access Hospitals, and from service logs completed by ER staff. Specifically, we have sought to determine 1) what proportion of ER encounters involve mental health pathology; 2) what kinds of mental health problems are most commonly seen in these encounters, and; 3) what resources are available to CAHs to address the problems they encounter

Pilot testing a Rural Health Clinic quality measurement reporting system

More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities, and are therefore an important source of primary care and other essential health services for rural residents. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data on the financial, operational, and quality performance of participating clinics. In light of the significant expansion of quality performance reporting and growing use of performance-based payment approaches, it is critically important that RHCs be able to compete in this changing healthcare market. To this end, we piloted the reporting and use of a small set of primary care-relevant quality measures by a geographically diverse sample of RHCs. This policy brief reports on the results of this pilot with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs

A Formative Evaluation of the Family Strengthening Program in the Treasure Valley

Family Advocates, a nonprofit organization serving families in the Treasure Valley in Idaho, offers the Family Strengthening Program. This is a 20-week program providing weekly meetings for families who need to develop strong family cohesion, resilience, and parenting skills to maintain healthy families. The program uses the Strengthening Families’ approach with an emphasis on the protective factors framework and provides incentives to participants for participation. A third-party evaluation team from a local university conducted a formative evaluation of the program to help improve its quality. The evaluation team used both goal-based and goal-free, needs-based evaluation approaches, and analyzed quantitative and qualitative data. This included survey data from past weekly sessions, Facebook alumni group communications, and group interviews and surveys with participants, graduates, volunteers, and staff. The triangulated data indicated that program participants were highly satisfied with the program and felt the program helped improve their protective factors. The data also revealed the parents’ perceptions regarding program incentives as well as their preference for learning in socialized contexts. Based on the formative evaluation results and considering the participants’ perceptions and experiences, the program amended their curriculum and incentive plans to better accommodate the participants’ needs

Making GDPR Usable: A Model to Support Usability Evaluations of Privacy

We introduce a new model for evaluating privacy that builds on the criteria proposed by the EuroPriSe certification scheme by adding usability criteria. Our model is visually represented through a cube, called Usable Privacy Cube (or UP Cube), where each of its three axes of variability captures, respectively: rights of the data subjects, privacy principles, and usable privacy criteria. We slightly reorganize the criteria of EuroPriSe to fit with the UP Cube model, i.e., we show how EuroPriSe can be viewed as a combination of only rights and principles, forming the two axes at the basis of our UP Cube. In this way we also want to bring out two perspectives on privacy: that of the data subjects and, respectively, that of the controllers/processors. We define usable privacy criteria based on usability goals that we have extracted from the whole text of the General Data Protection Regulation. The criteria are designed to produce measurements of the level of usability with which the goals are reached. Precisely, we measure effectiveness, efficiency, and satisfaction, considering both the objective and the perceived usability outcomes, producing measures of accuracy and completeness, of resource utilization (e.g., time, effort, financial), and measures resulting from satisfaction scales. In the long run, the UP Cube is meant to be the model behind a new certification methodology capable of evaluating the usability of privacy, to the benefit of common users. For industries, considering also the usability of privacy would allow for greater business differentiation, beyond GDPR compliance.Comment: 41 pages, 2 figures, 1 table, and appendixe

Telemental Health in Today\u27s Rural Health System

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of telemental health programs

Black Holes in Modified Gravity (MOG)

The field equations for Scalar-Tensor-Vector-Gravity (STVG) or modified gravity (MOG) have a static, spherically symmetric black hole solution determined by the mass $M$ with two horizons. The strength of the gravitational constant is $G=G_N(1+\alpha)$ where $\alpha$ is a parameter. A regular singularity-free MOG solution is derived using a nonlinear field dynamics for the repulsive gravitational field component and a reasonable physical energy-momentum tensor. The Kruskal-Szekeres completion of the MOG black hole solution is obtained. The Kerr-MOG black hole solution is determined by the mass $M$, the parameter $\alpha$ and the spin angular momentum $J=Ma$. The equations of motion and the stability condition of a test particle orbiting the MOG black hole are derived, and the radius of the black hole photosphere and the shadows cast by the Schwarzschild-MOG and Kerr-MOG black holes are calculated. A traversable wormhole solution is constructed with a throat stabilized by the repulsive component of the gravitational field.Comment: 14 pages, 3 figures. Upgraded version of paper to match published version in European Physics Journal