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

Visual, Motor and Attentional Influences on Proprioceptive Contributions to Perception of Hand Path Rectilinearity during Reaching

We examined how proprioceptive contributions to perception of hand path straightness are influenced by visual, motor and attentional sources of performance variability during horizontal planar reaching. Subjects held the handle of a robot that constrained goal-directed movements of the hand to the paths of controlled curvature. Subjects attempted to detect the presence of hand path curvature during both active (subject driven) and passive (robot driven) movements that either required active muscle force production or not. Subjects were less able to discriminate curved from straight paths when actively reaching for a target versus when the robot moved their hand through the same curved paths. This effect was especially evident during robot-driven movements requiring concurrent activation of lengthening but not shortening muscles. Subjects were less likely to report curvature and were more variable in reporting when movements appeared straight in a novel “visual channel” condition previously shown to block adaptive updating of motor commands in response to deviations from a straight-line hand path. Similarly, compromised performance was obtained when subjects simultaneously performed a distracting secondary task (key pressing with the contralateral hand). The effects compounded when these last two treatments were combined. It is concluded that environmental, intrinsic and attentional factors all impact the ability to detect deviations from a rectilinear hand path during goal-directed movement by decreasing proprioceptive contributions to limb state estimation. In contrast, response variability increased only in experimental conditions thought to impose additional attentional demands on the observer. Implications of these results for perception and other sensorimotor behaviors are discussed

Exploring the Community Impact of CAHs (Briefing Paper #14)

This publication presents the findings of a project to understand the community involvement and impact of CAHs and the Flex Program. It provides greater depth and discussion than the associated policy brief, which is designed to summarize key findings and identify important trends. For state-level CAH community impact data, browse State Profiles. Key Findings: CAHs are expanding services that positively impact their communities. Strategies to meet community need include: 1) Growth/expansion strategies for services that contribute to CAH’s longterm viability, and 2) services that address specific unmet community needs and are subsidized by the hospital. CAHs are not consistently reporting on the ways in which they benefit and impact their communities. More formal performance measures capturing CAH community impact are needed

The Community Impact of CAHs (Policy Brief #2)

This publication presents the findings of a project to understand the community involvement and impact of CAHs and the Flex Program. A briefing paper presents these results in greater detail. For state-level CAH community impact data, browse State Profiles. Key Findings: CAHs are expanding services that positively impact their communities. Strategies to meet community need include: 1) Growth/expansion strategies for services that contribute to CAH’s longterm viability, and 2) services that address specific unmet community needs and are subsidized by the hospital. CAHs are not consistently reporting on the ways in which they benefit and impact their communities. More formal performance measures capturing CAH community impact are needed