Promoting Active Living in Rural Communities

This brief summarizes current research on elements of the rural built environment that may be related to obesity or physical activity. Much of this research is qualitative in nature, including evidence and conclusions drawn from rural focus groups, PhotoVoice studies, policy statements, observations from the field, and lessons learned from rural active living interventions

Summary Report of the MaineCare Listening Sessions

In September of 2010, the Muskie School of Public Service conducted four Listening Sessions with MaineCare members to gather in-depth information about their experiences on MaineCare, their likes and dislikes, and suggestions, needs and wants for improving the program. The overall goal of these sessions was to provide rich information to help inform DHHS in their design of a new managed care initiative. Funding for this project was provided by the Maine Health Access Foundation (MeHAF)

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

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

Mental Health Services in Rural Jails [Policy Brief]

Based on interviews with state and local corrections and mental health informants in four rural states (Minnesota, Montana, Texas, and Vermont), the researchers sought to learn more about hte challenges that rural jails face along with promising practices being used to meet the needs of inmates with mental health concerns

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

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

Active Living for Rural Youth [Policy Brief]

Childhood obesity and inactivity are significant and growing problems in many rural areas where the prevalence of obesity and overweight has been shown to be 25 percent higher than urban rates, even after controlling for income, race, physical activity and other known risk factors. While rural areas are often viewed as an ideal setting for an active childhood, kids face a variety of obstacles to incorporating physical activity in their daily lives. Active living research to date has focused largely on urban and suburban environments. This study investigates the complex web of determinants that support or undermine physical activity in rural youth. We visited three very different small Maine towns (Waldoboro, Dover-Foxcroft and Houlton), where we led youth focus groups and interviewed key informants including rural town planners, school personnel, recreation directors and parents. We also conducted townscape surveys of the physical characteristics of each community. Obesity and inactivity have roots in many aspects of rural life, from the physical environment, to social, policy and programmatic factors

Mental Health Problems Have Considerable Impact on Rural Children and Their Families

The majority of children with mental health problems go untreated, and the gap between need and service use is assumed to be wider in rural than in urban areas, particularly for children with more severe needs.1-2 It is also assumed that rural families of children with mental health problems experience a greater financial and emotional burden than urban families. These assumptions reflect the lower availability of mental health specialty care and support services in rural areas. Lower income and more limited economic opportunities may further hamper the ability of rural families to care for children with mental health problems. The current research literature does not describe how well the needs of children with mental health problems are being met in rural areas. Although there are reasons to believe the burden these needs place on families is higher in rural areas, evidence to support this assumption is limited. Using the 2005-06 National Survey of Children with Special Health Care Needs, we examine the prevalence, access to services, problem severity, and family impact of children’s mental health in rural and urban areas. These data are linked to the Rural-Urban Continuum Codes to examine populations living in urban areas, rural areas adjacent to urban areas, and rural areas not adjacent to urban areas