State Offices of Rural Health Grant Program (SORH)

The goal of the State Offices of Rural Health (SORH) grant program is to assist States in strengthening rural health care delivery systems by creating a focal point for rural health within each State. The program provides an institutional framework that links small rural communities with State and Federal resources to help develop long term solutions to rural health problems. The SORH grant program features a single grantee from each of the 50 United States. The program is a Federal-State partnership that requires a State funding match of $3 for each $1 of Federal funding.
SORH Award Amount (FY06): $150,000 `

Major Accomplishments in FY 2006 (October 1, 2005 – September 30, 2006):
Mid-Valley Hospital
Helped initiate a Latino Health Education Project in rural Okanogan County: “La Futura Mamá y Su Salud” (The Future Mother and Her Health). The three-pronged approach included Spanish radio health education; Spanish childbirth classes; and cultural competency training for providers. The sponsoring hospital recognized that sizeable gaps existed in patient knowledge of the childbirth process, the level of understanding of Latino culture among hospital staff and providers in the community.

Mattawa Community Medical Clinic
We supported, with federal and state funds, a Rural Health Clinic in Grant County in creating a community outreach program designed to increase awareness of the availability of and access to local health services. To research options, provide counseling (individual and public) and direct assistance with filling out Medicaid, Basic Health Plan, Private Insurance, Medicare, Sliding Fee applications and Patient Assistance Programs for medications. By promoting outreach services the clinic increased the number of rural residents that actually received primary health care and related services.

Whidbey General Hospital
The SORH assisted in the creation of a previously non-existent chronic pain management program for residents of Whidbey Island, located in the middle of Puget Sound and having a population of 77,200. Without this local program residents were faced with having to use ferry transport across Puget Sound to Seattle for treatment. The sheer inconvenience of the limited transportation options created a barrier that many people in need of help were unable to overcome. The program requirements include screening criteria to ensure participants are well motivated, use of an interdisciplinary team, and an effective marketing strategy. The program is also innovative in that it relies heavily on holistic methods of treatment.

Shoalwater Bay Wellness Center
We supported the development of a community-based primary care integrated behavioral health program for one of the state’s Indian tribes. A multidisciplinary team was developed to treat patients holistically by integrating their primary care with behavioral health services to address more fully the spectrum of problems that patients bring to primary medical care. The program is capable of assessment and treatment of complex patients with multi-system problems.

All of these programs and others were written up and published in the August 2006 issue of the Washington Rural Health Association newsletter. The newsletter’s distribution list of over five hundred includes three hundred fifty associations and legislators.

SORH Contact Information:
Office: Office of Rural Health
Address: P.O. Box 47834
Phone: 360-236-2819
Fax: 360-664-9273
Email: john.hanson@doh.wa.gov
:
Director: Kris Sparks

2) Medicare Rural Hospital Flexibility Grant Program (Flex)

The Flex Program helps sustain access to high quality health care services in rural America. It facilitates the development and support of community-based collaborative rural delivery systems in all grantee States through conversion of hospitals to critical access status, development of rural healthcare networks and integration of EMS.
Flex Award (FY06): $ 640,699

Program Highlights:

• Number of Critical Access Hospitals (CAHs) supported: 39
• Number of Critical Access-eligible Hospitals supported: 3
• Number of Rural Health Networks developed: 4
• Number of Emergency Medical Services (EMS) assisted: 30
• Number of Rural Communities assisted: 39

Major Accomplishments:

1. RHQN – AMI Outcome Improvements – The Rural Health Quality Network in Washington State is funded by both Flex and Ship grants. Through training directed to both leadership and quality improvement staff, the RHQN has been able to produce a steady improvement over their 2004 baseline in all four of the Medicare Acute Myocardial Infarction (AMI) quality improvement measures that are reported to “Medicare Compare”, as reflected in the table below.

Note: In addition, the RHQN membership, comprised of all 39 Washington State Critical Access Hospitals has just agreed to a 40% dues increase. This reflects recognition of the importance of quality improvement and the value of the RHQN to their efforts, as well as the need to establish a sustainable organization. The Washington Flex & SHIP grant programs have been the primary RHQN start-up funding sources to-date. A grant program goal from inception has been to see the RHQN become self supporting, and with this recent decision a major step in that direction has been taken.

2. Distance Learning – A Flex grant provided to Ferry County Memorial Hospital in Republic last year has resulted in identifying a potential partnership between the Health Workforce Institute at the State Hospital Association and Lower Columbia Community College in Longview, Washington. This partnership has already generated $115,000 of additional (non-Flex/SHIP) grant funding to develop a curriculum for a distance learning nursing degree program. The partnership has a goal of admitting it’s first cohort of students by January of 2009.

3. Benchmarking – For the last two grant cycles the State Office has provided Flex grant funds to the Association of Washington Public Hospital Districts to develop a financial benchmarking program for the 36 Critical Access Hospitals in Washington State that are operated as Hospital Districts. This program provides department level volume, cost, and productivity comparisons. These comparisons are provided annually, with each facility fully identified to all 36 participants. Hospital leaders are therefore able to communicate with those who are achieving the best outcomes and learn from each other. This program has been seen as so valuable that hospitals are self funding the effort now that they are in maintenance mode and through the effort of start-up.

4. Health Information Technology/ TeleHealth – The Association of Washington Public Hospital Districts which has received small ($15,000 to $20,000) Flex HIT grants over the past two years, has just received notice of a Federal Communications Commission (FCC) grant totaling $700,000 to continue this work. Jeff Mero, Association Director, indicates the State Office Flex grants were “vital to the process of identifying the need and pursuing FCC support.” The State Office of Rural Health also coordinated with the Western Washington Critical Access Hospital Quality Network in its successful application and award of $1.4m Federal Office of Rural Health Policy Health Information Technology grant. This grant will be used to develop a system for electronically transmitting emergency department patient medical record information between these rural hospitals and Harborview Medical Center, in Seattle.

3) Small Rural Hospital Performance Improvement Grant Program (SHIP)

The goal of SHIP is to assist small (less than 50 beds) rural hospitals pay for any or all of the following: 1) costs related to implementation of prospective payment systems, (2) compliance with provisions of HIPAA and 3) reduction of medical errors and quality improvement. State Offices of Rural Health (SORH) help eligible rural hospitals to participate in SHIP. Eligible hospitals submit an application to their SORH; the SORH prepares and submits a single grant application to HRSA on behalf of all hospital applicants in the State. There are approximately 1600 eligible hospitals nationwide and each usually receives approximately $9,000.
SHIP Award (FY06): $410,964

Program Highlights:

• Hospitals receiving funding: 45
• Hospitals in consortiums, networks or systems: 41
• Hospitals using funds for QI and /or reduction of medical errors: 45
• Hospitals using grant funds for Health Information Technology: 24+

Major Accomplishments:

Population Groups Served: During this grant cycle thirty-nine (39) Critical Access Hospitals, and five (6) rural hospitals served the rural population of Washington State, spanning 31 counties and totaling approximately 1.82 million residents.

Quality improvement: All of the 45 SHIP hospitals spent most and usually all of this grant cycle's funding (94.5%) for medication error reduction and quality improvement work to:

• Utilize an external Rural Health Quality Network physician to provide peer review to their medical staff.
• Participate in the Quality Improvement Indicator tracking with the Rural Health Quality Network.
• Provide clinical staff training focused on medication delivery and safety improvement, surgery site infections, and medication reconciliation.
• Orient staff to a bedside computer charting system which will provide patient safety control and monitoring. Of priority will be meds management and data entry prompting which requires the entry of any information pertinent to the patient’s physical and mental status.
• Investigate and implement a radiology “nighthawk” interpretation service, expanding access to emergency film interpretation.
• Plan and implement a new Tele-pharmacy project. This will included onsite assessments, training of hospital staff and project management.

Total HRSA Funding (FY06): $1,201,663