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Linda Jones, M.S.P.H. Director, State Office of Rural Health Texas Department of Rural Affairs
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177 of 254 counties in Texas are rural counties (70%) 89 of these have a population of less than 10,000 15% of state’s total population is rural
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Population of Texas 2010 census
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Population % Change, 2000 to 2010
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Coleman County
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Projected Population Among Older Texans Source: Texas State Data Center, 2000-2004 Projection Scenario
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Percent of Persons Aged 65 Years and Older in Texas Counties, 2000 Census and 2040 Projected 20002040
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◦ Population growth ◦ Urbanization ◦ Increased racial and ethnic diversity ◦ Increasing longevity ◦ More uninsured ◦ Higher obesity rates ◦ More diabetes ◦ More people with self- care limitations ◦ More persons needing access and transportation to health care
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Texas State Office of Rural Health Currently located in the Texas Department of Rural Affairs The only state agency dedicated to rural Texas
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Vision - Strategic allocation of resources to provide and support services, and to develop, and implement programs that build on previous efforts and proven models Mission - To strengthen local healthcare infrastructure and systems of care to better meet the needs, challenges and priorities of rural Texas
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Recruitment and Retention - ~ $1.2 million Rural Hospital Support – ~ $3 million State Office of Rural Health - ~ $1.3 million
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Outstanding Rural Scholar Recognition Program (ORSRP) Rural Communities Healthcare Investment Program (RCHIP)
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Physicians per 100,000 by Metro & Border Status for Counties, 2009 Sources: Census 2009 Estimates Department of State Health Services, Health Professions Resource Center Database
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$584,782 – GR (matched by communities) Provides matching funds to scholar studying to become a healthcare professional who agrees to serve in a rural community after graduation
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$112,000 – Tobacco Fund Provides stipend or loan repayment assistance to non-physician healthcare professionals who agree to practice in medically underserved areas.
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TDRA supported 51 in 2009 and 67 in 2010.
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Rural Health Facility Capital Improvement Loan Fund Small Rural Hospital Improvement Program Medicare Rural Hospital Flexibility Program
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$1,935,150 from GR – Tobacco Fund Provides grants to rural hospitals for capital improvement, purchase of equipment, construction of new health facilities TDRA makes ~40 awards per year @$50,000 Applications submitted in January, then scored, awards in February, contracts in March
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Capital Improvement Loan Fund $19 million awarded to rural hospitals 2002-2010 Examples of Equipment Purchased Autoclaves CT Scanners Hospital beds Nurse call systems
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$971,685 from Health Resources and Services Administration (HRSA) Grants to hospitals with 49 beds or less in rural areas for quality improvement and other hospital-specific needs Last year TDRA awarded 117 grants @ $8,305 TDRA receives proposals which are included in HRSA application; funds received and distributed in September
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$635,413 from HRSA Provides support for Critical Access Hospitals (CAHs)in 4 areas: 1. Quality improvement 2. Operational and financial improvement 3. Health system development and community engagement 4. Conversion to CAH status
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Patient care and safety – 20 hospitals use the Health Data Integration (HDI) tool to report data which is then reported to CMS’s Hospital Compare Nurse quality and patient safety collaborative – 10 hospitals participate Continuing education through TTUHSC – 440 online courses accessed 35,000 times Remote Pharmacy Pilot Project
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Estimated 98,000 preventable deaths Despite landmark 1999 study, not much improvement 1 in 3 patients admitted into a hospital suffer a medical error or adverse event (Health Affairs, April 2011) 1 in 7 Medicare beneficiaries is harmed in care process, costing ~$4.4 billion/year 1 in 5 Medicare patients discharged from the hospital is readmitted within 30 days – ~ 2.6 million seniors at a cost of $26+ billion/year
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Cost the economy ~ $2 billion each year Harm >1.5 million people every year 400,000 in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics 7,000 estimated deaths each year
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Omission error Improper dose/quantity Extra dose Unauthorized drug Wrong time Prescribing error Drug prepared incorrectly Mislabeling Wrong dosage form Wrong patient Wrong route Wrong administration technique
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All errors Errors that may or may not (“near miss”) have reached the patient Errors that reached the patient Errors that reached the patient and caused harm/death
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Pharmacist review of orders within 24 hours Double check of transcription to record before initial dose Independent double check of medication within pharmacy before administration Verification of 5 rights of medication administration by nurse at bedside
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1.Right patient 2.Right drug 3.Right dose 4.Right route 5.Right time
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CAH summer conference with TORCH Board of Trustee education – 52 CAHs and 153 trustees over past 3 years
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Comprehensive Advanced Life Support (CALS) training for rural trauma teams Support of training for EMS providers and designation of CAHs as Level IV trauma facilities Purchase of EMS equipment
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Data Source: http://soupfin.tdh.state.tx.us/death10.htm
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Provision of technical assistance Support for feasibility studies
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ICD 10 Project Rural Community Economic Impact Assessments Nursing Peer Review Program Patient Safety Organization Assistance Nursing Skills Enhancement Program
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Community connectivity grant Regional Health Information Organization Chambers County generator Sutton County CAT scan
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Increase visibility Build and strengthen partnerships Support for health information technology and meaningful use Complete rural health work plan Investigate foundation funding
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Print Share Email << View Previous CartoonView Previous Cartoon March 10, 2011
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State Office of Rural Health P.O. Box 12877 Austin, TX 78711 Headquarters: 512-936-6701 FAX: 512-936-6776 www.tdra.texas.gov
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