Quality Through Collaboration The Future of Rural Health (2005) / Chapter Skim
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From page 249... ...
, Adoption of ICT in rural settings, 165 65, 89, 122, 229 168 American Osteopathic Association, 73 data standards for connectivity, 167 Amish settlements, 1 federal leadership, 166 Applicants from rural areas, attracting finance, 168 qualified, 10, 112 information network components, Area Health Education Centers, 8, 88, 110 165166 Asian Americans, 9192 patient privacy laws, 166167 Assessment of availability and quality of Advanced Learning Institute, 52 mental health and substance Adverse event rates, 33 abuse services, in rural areas, African American communities, 1, 17, 1213, 142 38, 9192, 205, 211 249
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From page 250... ...
, 7, 11, 16, 66 rural areas, 1213, 142 72, 75, 104, 121n, 122, 136, 141, 174, 225 Centers of Excellence program, 8, 110 B Certification programs, 7273 Challenges facing rural providers, 123 Balanced Budget Act of 1997, 130, 133 124 Beale, Calvin, 194 Changes Behavioral Risk Factors Surveillance fundamental, in existing payment System surveys, 131 programs for physicians, 95 Behaviors. See Health behaviors and in the health care system, 12, 109 health threats in rural in rural populations, 204207 communities; Social behaviors Children's Health Insurance Program, Benefits Improvement and Protection provider payments under, 12, Act of 2000, 130131, 134 141 "Bottom-up" approach to health system Choices, zero-sum, 43 reform, 5, 177 Chronic disease management, 20, 72, Bridges to Excellence program, 121 152153 Broadband networks, 14 role of residents in, 107 expanding federal efforts to extend Clinical knowledge and associated tools, into rural areas, 15, 172 63 Burdick Program.
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From page 251... ...
INDEX 251 Communities Comprehensive quality improvement hub role in standardized program performance measures, 64 clinical knowledge and associated with nonfederal physician specialty tools, 63 services, 223 key components of, 6166 Community Access Program, 37 knowledge of the science of quality Community-based efforts, 20 and safety improvement, 6162 toward a comprehensive health performance measurement and data system, 5 feedback capabilities, 65 Community-based technical assistance, quality improvement processes and with measuring and improving resources, 6566 personal and population health standardized performance care programs in rural areas, 7, measures, 6365 75 Computerized decision support, 60 Community-centeredness, of improving Congress, 20 population health and personal recommendations to, 1415, 54 health care, 4546 Connecting for Health initiative, 159 Community Facilities Program, 138 Consistency, of regulatory and payment Community health centers, 125126, policies, 172173 225, 237 Consolidated Health Informatics (CHI) regional conferences for, 7 initiative, 167 Community health systems, 61 Continuing education, 106 Community ICT applications, 151153 requirements in medical education, 89 communicating with the health Core competencies for health system, 151152 professionals, 2, 8, 8187, 101 enabling access to health applying quality improvement, 8, information, 151 8587 managing chronic conditions, 152 employing evidence-based practice, 153 8, 8485 Community level, personal and formal education programs for population health needs at, 3 public health professionals, 101 Community resources providing patient-centered care, 8, culture and society, 107108 8182 education system, 107 reforms to improve quality in, 8187 health system, 107 utilizing informatics, 8, 87 options for mobilizing, 106109 working in interdisciplinary teams, Community Tracking Study Physician 8, 8384 Survey, 129 Core health services Community-wide measurement and access to, 2 monitoring systems, 6465 emergency medical services, 3 Commuting, to jobs in urban areas, 1 hospital care, 3 Comprehensive health system long-term care, 3 community-based efforts toward, 5 mental health and substance abuse demonstrations towards reform of, services, 3 5, 5456 oral health care, 3 primary care in the community, 3 public health services, 3
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From page 252... ...
Health System for the 21st Community Facilities Program, 138 Century, ixxi, 2, 23, 30, 33 Economic Research Service, 200 Cultural competency, of health care Rural Utilities Service, 170 professionals, 108 Department of Commerce, 163, 170, 200 Culture and society, as community Department of Education, 910, 111, resources, 20, 107108 113 Current status National Science Education of funding for mental health and Standards, 91 substance abuse services in Department of Health and Human rural areas, 13, 142 Services (DHHS) , 23, 54, 68, of health care, cost-effectiveness of, 74, 123, 133, 136, 166 43 comprehensive health system of ICT in health care, 159165 reform demonstrations funded of quality improvement efforts in by, 5, 5456 rural areas, 6673 meeting the needs of rural communities, 6 Public Health Functions Working D Group, 242 Rural Task Force, 14, 169170 Data exchange Department of Housing and Urban establishing secure platforms for, 27 Development (HUD)
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From page 253... ...
, 17, in improving population health and 200201, 208 personal health care, 47, 5051 Education system of physician payments, 12 as a community resource, 107 in quality of care in rural in rural populations, 213216 communities, 3738 Educational attainment Ethnicity, population growth rates in by race, 215 rural populations by, 210 in rural populations, 20 European descendants, 1 Effectiveness Evaluation of current funding mental of improving population health and health and substance abuse personal health care, 4344 services in rural areas, 13, 142 of quality of care in rural Evidence-based practice, health communities, 3435 professionals employing, 2, 8, Efficiency 8485 of improving population health and Evidence-based Practice Center, 120 personal health care, 47, 49 Exercise, physical, lack of in rural of quality of care in rural communities, 39 communities, 3637 Experientially-based workforce training Electronic health records (EHRs) , 13, programs, expanding in rural 6063, 149, 160162 areas, 89, 87, 89, 109110 assisting rural providers in Experimentation, rapid-cycle, 5 converting to, 1516, 27, 173 175
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From page 254... ...
254 QUALITY THROUGH COLLABORATION F Flex Program, 230 Flexibility, needed by rural communities, 6 Faculty, recruiting more from rural Formal education programs for practice, 10, 112 physicians, 9396 Federal allocations to states, for domestic making fundamental changes in preparedness, 228 existing payment programs, 95 Federal Communications Commission, making incremental changes in 171 existing payment programs, 95 Federal leadership, in adopting ICT in Formal education programs for public rural settings, 166 health professionals, 101102 Federally-funded financial incentives, for core skills, 101 residency training programs, discipline-specific skills, 101 10, 112 function-specific skills, 101 Federation of American Hospitals, 122 subject-specific skills, 102 Finance, 119146 workplace basics, 102 in adopting ICT in rural settings, 168 Formal education programs for the rural pay-for-performance, 120126, 140 health professions workforce, 141 92102 public, 27 for dentists, 9899 recommendations regarding, 140 for emergency care professionals, 142 9798 for rural health care institutions, ix, for health administrators, 100101 27 for mental and behavioral health See also Funding of rural health care care professionals, 99100 Financial assistance for EHRs, 27, 173175 for nurses, 96 Financial resources, 1113 for pharmacists, 99 recommendations for providing for physician assistants, 9697 adequate and targeted, 1113, Fostering Rapid Advances in Health Care: 140142 Learning from System Financial stability of rural health care Demonstrations, 5, 2324, 40, providers 177178 analyzing, 12, 141142 Frontier areas, 1, 17, 204 need for, 3, 40, 139 population change in, 207 Findings Function-specific skills, for public health regarding human resources, 910, professionals, 101 110111 Funding of rural health care, 126139, regarding information and 141142 communications technology, access to capital for rural hospitals, 15, 173 137138 regarding personal and population funding rural emergency medical health needs, 45, 54, 56 services, 134135 First-contact roles, standardized Medicare and Medicaid payments performance measures of, 64 to primary care physicians, First responders, 226 129130 1st Annual Crossing the Quality Chasm Medicare and Medicaid support for Summit: A Focus on nursing homes and home Communities, 2324 health services, 132134
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From page 255... ...
changes in, 12 programs, 9495 communicating with, 151152 Grand rounds, 84 as a community resource, 107 Grigsby, Jim, 195196 infrastructure for, 20 providing leadership training to H rural communities engaged in redesigning, 5, 56 Handicapped people, social support for, 25 in the U.S., calling for fundamental Hartley, David, 196 reform, 2 Health, United States, 2001 with Urban Health Careers Opportunity Program, 8, and Rural Chartbook, 38 110 Health administrators, formal education Health Disparities Collaboratives: programs for, 100101 Changing Practice, Changing Health Alert Networks, 159 Lives, 124 Health and health care in rural Health Education and Training Centers, communities 8, 110 an integrated approach to Health information technology (HIT) , improving, 3059 176177 range of interventions available to enabling access to, 151 improve, 45, 54 storage and retrieval of, 156
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From page 256... ...
256 QUALITY THROUGH COLLABORATION Health Information Technology Hispanic communities, 1, 17, 38, 9192, Program, 16, 177 211 Health insurance HIV infection, 36 costs reimbursed by, 25 Home Health Compare, 69 in rural populations, 217218 Home ICT applications, 151153 See also Uninsurance rates in rural communicating with the health areas system, 151152 Health Insurance Portability and enabling access to health Accountability Act of 1996, 72, information, 151 166167 managing chronic conditions, 152 Administrative Simplification 153 provisions of, 167 Hospital care in rural health care Health literacy in rural populations, 107 delivery, 229230 108, 213216 full-time hospital-based registered levels of, 1011 nurses in rural counties, 232 measuring, 113 Hospital Compare, 69 Health policy, rural, 2022, 45 Hospital Mortgage Insurance Program, Health Professions Education: A Bridge to 138 Quality, 8 Hospitals in rural areas, 229 Health-related Internet applications critical access, 21, 231 ensuring that rural communities can Medicare-dependent, 21 access and use, 1415, 170172 operating margins of, 12 transferring messages by sole community, 2021 telecommunications access Hullett, Sandral, 196 networks, 15, 172 Human resources, 3, 711, 78118 Health Resources and Services enhancing the rural health Administration (HRSA) , 412, professions workforce, 3, 89 21, 55, 7174, 88, 110, 137, 106 142, 169, 174175, 225 findings, 910, 110111 Area Health Education Centers, 88, formal education programs for, 92 110 102 Centers of Excellence program, 8, fundamental reforms to improve 110 quality, 8089 Office of Rural Health Policy, 74 options for mobilizing community recruitment programs from, 93, 103 resources, 80, 106109 Health Sciences and Technology recommendations for strengthening, Academy, 91 811, 109113 Health system reform, 45 "bottoms up" approach to, 5 Healthy Communities Access Program, I 37 Immunization campaigns, 25 Healthy lifestyles, 25 Improvements in population health and Heterogeneity, of rural communities, 1, personal health care, 3952 20 effectiveness of, 4344 High Plains Rural Health Network, 152 efficiency of, 47, 49 High-speed access to the Internet, 170172 equity in, 47, 5051 Hill-Burton Program, 138
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From page 257... ...
, xi, 2, 22 1317, 6162, 147153, 158 23, 25, 3031, 37, 136, 162 160, 165 Institute of Medicine's Quality Chasm accelerating the adoption of, 165 series, 2224 168 Crossing the Quality Chasm: A New collaborations and demonstrations Health System for the 21st in, 175178 Century, ixxi, 2, 23, 30, 33 current status of, 159165 Fostering Rapid Advances in Health electronic health records, 161162 Care: Learning from System expanding developmental programs Demonstrations, 5, 2324, 40, for, 16, 175178 177178 findings, 15, 173 Priority Areas for National Action: in health care settings, 153158 Transforming Health Care at home and in the community, 151 Quality, 24 153 Insurance. See Uninsurance rates in rural Internet connections, 160161 areas personal health records, 162163 Integrated approach to improving health in population health, 158159 and health care in rural recommendations for better communities, 3059 utilizing, 1417, 169180 health behaviors and health threats strengthening, 40 in rural communities, 3839 technical requirements, 164165 improving population health and telemedicine, 163164 personal health care, 3952
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From page 258... ...
, 33, 73, 75, 121n, 173 Long-term care, in rural health care delivery, 20, 230234 K Kaiser Commission on Medicaid and the M Uninsured, 217 MacKinney, A Clinton, 196197 Kellogg Foundation, 5, 21, 52 Mansfield University, Master's Program Knowledge support, 84, 154156 in Community Psychology, 104 web-based, 84 Markle Foundation, Connecting for Health initiative, 159 L Master's Program in Community Psychology, 104 Leadership Mayo Clinic website, 151 in improving population health and Measurement systems, community-wide, personal health care, 5152 6465 needed within health care Measures, of pay-for-performance, 124 institutions, 51 126 school, 41 Medicaid, provider payments under, 12, Leadership for Community Change 141 Program, 5, 52, 56 Medical Compare, 69
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From page 259... ...
See Office of the Medicare Health Plan Compare, 69 National Coordinator for Medicare Modernization Act of 2003, Health Information Technology 104, 119, 125, 128, 130, 134, National Council for Healthcare 138139 Leadership (NCHL) , 5, 52, 56 pay-for-performance program National data standards, 160 mandated in, 123 National Disparities Report, 6869 Medicare Personal Plan Finder, 69n National Domestic Preparedness Medicare Prescription Drug Improvement Consortium, 228 and Modernization Act of National Health Account data, 135 2003, 21 National Health Information Medicare Rural Hospital Flexibility Infrastructure (NHII)
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From page 260... ...
, communities in implementing 17, 155, 180 new technologies, 17, 180 Medline Plus, 151 Ongoing educational assistance, 178180 Partners in Information Access for Ongoing pay-for-performance studies, the Public Health Workforce, 121123 159 Online information sources, providing National Network of Libraries of access to, 17, 180 Medicine, 17, 155, 180 Open EHR Pilot Project, 174 National Quality Forum (NQF) , 33, 69, Operating margins, 6, 12 75, 121n Oral health care, in rural health care National quality movement, 21, 53 delivery, 238240 National Rural Health Association, 89 Oral Health in America, 238 National Rural Recruitment and Retention Network, 102 National Voluntary Hospital Reporting P Initiative, 65, 122 Paper-based information, 87 Native Americans, 1, 17, 38, 92, 236 Parks, availability of, 45 Networking, among rural providers, 179 Partners in Information Access for the Nonfederal physician specialty services, Public Health Workforce, 159 communities with, 223 Patient-centered care, 8 Nurse practitioners, providing primary health professionals providing, 8182 care, 83, 224 in improving population health and Nurses personal health care, 4546 cross-training of, 95, 99 and the quality of care in rural formal education programs for, 96 communities, 35 full-time hospital-based, in rural Patient-level safety improvement counties, 232 strategies, 43 recommendations for strengthening Patient monitoring, distance training programs for, 10, 112 consultations and, 156157 Nursing Home Compare, 69 Patient privacy laws, in adopting ICT in rural settings, 166167 O Patient safety practices, 33 Patients, traveling long distances to Obesity among women, self-reported in provider sites, 47 rural communities, 3, 39 Pay-for-performance programs, 11, 70, Office of Management and Budget 120126, 140141 (OMB)
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From page 261... ...
, 93 delivery, 225226 Physicians Priority Areas for National Action: communities with nonfederal Transforming Health Care physician specialty services, 223 Quality, 24 cross-training of, 100 Professional associations, 9 equity of payments to, 12 Professionals formal education programs for, 93 finding qualified health care, 3 96 in rural communities, 1, 7 J-1 waiver, 103 Programs to provide core competencies providing primary care, 222224 for health professionals, 8789 specialist, 222223 Prospective Payment System, 69, 72, Pilot projects, 11 126127, 130131, 133 Pipeline, for the rural workforce, 80, 90 Public and private programs providing Population change in rural populations, support for mental health and 204207 substance abuse services in growth rates by race and ethnicity, rural areas, 13, 142 210 Public financing, 27
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From page 262... ...
, 6668, 71, 75, 86, 89 Medicare, 66 Qualified applicants, attracting from Quality Interagency Coordinating rural areas, 10, 112 Committee, 75 Qualified health care professionals, Quality movement, national, 21, 53 shortages of, 3 Quality of care in rural communities, 31 Qualis Health, 67 38 Quality challenge in a rural context, 23, defining, 4, 2223 85 effectiveness of, 3435 Quality Chasm series, xixii, 2, 56, 22 efficiency of, 3637 24, 3033, 38, 41, 51, 55, 80 equity in, 3738 82, 119120, 125, 142, 147 patient-centeredness of, 35 Quality improvement activities in rural safety of, 3234 areas, 8, 6077 shortcomings in, 80 accreditation and certification timeliness of, 3536 programs, 7273 Quality of mental health and substance applying to core competencies for abuse services in rural areas, health professionals, 8, 8587 1213, 142
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From page 263... ...
INDEX 263 Quentin Burdick Rural Program for Reforms to improve quality of rural Interdisciplinary Training, 8, health care, 8089 88, 110 basing services available on the population health needs of the local community, 26 R core competencies for health professionals, 8187 Race ensuring that a core set of health educational attainment by, 215 care services is available, 2526 population growth rates in rural establishing links to services in populations by, 210 other locales that cannot be Racial and ethnic trends, in rural delivered locally, 26 populations, 68, 210211 explicitly addressing the special RAND Corporation, 32 circumstances of rural areas in Rapid-cycle experimentation, 5 health care financing, 27 Recommendations focusing on rural communities in for an integrated approach to developing local and national improving health and health health information technology care in rural communities, 52 infrastructures, 27 for better utilizing information and guiding principles for, 2527 communications technology, improving population health in 1417, 169180 addition to meeting personal for financing, 140142 health care needs, 25 for human resources, 109113 programs to provide the core for personal and population health competencies, 8789 needs, 5, 5456 shaping and guiding rural health care for providing adequate and targeted services by local community financial resources, 1113, and rural organizations and 140142 institutions, 26 for quality improvement activities in teams of well-trained health care rural areas, 7375 clinicians, managers, and for quality improvement support leaders working together, 2627 structure, 67, 7475 Regenstrief Institute, 175 for rural health care in the digital Regional information and age, 168181 communications technology/ for strengthening human resources, telehealth resource centers, 17, 811, 109112 178180 Recreational facilities, availability of, 45 Registered Nurse-Bachelor of Science in Recruitment of the rural health Nursing Satellite Program, 96 professions workforce, 102 Registered nurses in rural counties, full 103 time hospital-based, 232 Redesign of health systems, providing Remote language, and cultural leadership training to rural interpretation, 154 communities engaged in, 5, 56 Remoteness from urban areas, 1, 20 Reform demonstrations, toward a Residency training programs, federally comprehensive health system, funded financial incentives for, 5, 5456 10, 112
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From page 264... ...
264 QUALITY THROUGH COLLABORATION Residents, role in chronic disease establishing relationships with management, 107 health care providers and Resource centers, for regional institutions in urban settings, 26 information and flexibility and assistance needed by, communications technology/ 6 telehealth, 17, 178180 health care organizations in, 1 Resource context, standardized heterogeneity of, 1, 20, 26 performance measures in professionals in, 1 scarcer and more diverse, 64 siting portions of the educational Response times by emergency medical experience in, 10, 112 personnel, 35, 47 Rural communities accessing and using Retention of the rural health professions the Internet for health-related workforce, 104106 applications, 1415, 170172 Retrieval, of diagnostic and health Rural disparities, 68 information, 156 Rural emergency medical services, 226 Rewarding Results program, 121122 229 Robert Wood Johnson Foundation, 52, funding, 134135 121 Rural EMS Initiative, 97 Partnerships for Training Program, Rural focus, incorporating into NHII 97 planning and developmental Practice Sites Program, 104 activities, 14, 169170 Turning Point: Collaborating for a Rural health care New Century of Public Health funding of, 126139, 141142 Initiatives, 158 greater use of midlevel ROME (Rural Opportunities in Medical professionals, 83 Education) , 94 renaissance in, 21 Rosenblatt, Roger, 197198 Rural health care delivery systems, 27, Rural America, defining, xixii, 13, 19, 220248 200204 hospital care, 229230 Rural Americans, deserving access to full improving, 23 spectrum of high-quality, long-term care, 230234 appropriate health care, 25 mental health and substance abuse Rural areas care, 234238 population change in, 207 oral health care, 238240 quality improvement activities in, persistence of underresourced 6077 infrastructure in, 3 Rural Assistance Center, 89 primary care clinicians, 221225 Rural Broadband Loan and Loan primary care settings, 225226 Guarantee Program, 170, 201 public health care, 241242 Rural Clearinghouse for Lifelong Rural health care in the digital age, 147 Learning and Development, 215 190 Rural communities accelerating the adoption of ICT in Department of Health and Human rural settings, 165168 Services meeting the needs of, 6 consistent regulatory and payment engaged in health system redesign, policies, 172173 providing leadership training current status of ICT in health care, to, 5, 56 159165
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From page 265... ...
INDEX 265 financial assistance for EHRs, 173 Rural Medical Education Program, 94 175 Rural mental health and substance abuse high-speed access to the Internet, services, funding of, 139140, 170172 142 ICT applications in rural settings, Rural Physician Program, 94 150159 Rural populations, 200219 ICT collaborations and age distribution, 3, 208210 demonstrations in rural areas, defining rural America, 200204 175178 the digital divide, 216217 ongoing educational assistance, education and literacy, 213216 178180 educational attainment by race, 215 recommendations, 168181 health insurance, 217218 rural focus in the NHII plan, 169 higher rates of limitations among, 3 170 income and employment, 212213 Rural health care institutions, capital and population change, 204207 financial support for, 27 population growth rates by race and Rural Health Care Program, 15 ethnicity, 210 expanding to include all rural racial and ethnic trends, 210211 providers, 15, 172 rural older Americans, 209 Rural health clinics, 125, 225226 Rural Quality Advisory Panel, 67, 7475 regional conferences for, 7 Rural Quality Initiative, 6, 7475 "Rural health network," 179n applying evidence to practice, 7, 75 Rural health policy, 2022, 45 community-based technical Rural health professions workforce, 89 assistance, 7, 75 106 data repository, 7, 75 attracting rural students to health establishing to measure and careers, 9192 improve personal and enhancing, 40 population health care formal education programs, 92102 programs in rural areas, 67, recruitment, 102103 17, 7475 retention, 104106 public reporting, 7, 75 the rural workforce pipeline, 80, 90 standardizing measure set for rural skill set of, 80 communities, 7, 75 Rural health providers Rural referral centers, 20 challenges facing, 6, 123124 Rural Research Center, 137 historical underpayment of, 12 Rural resources for dental care, 131132 mentoring program for, 9 Rural Task Force, 14, 169170 Rural health providers converting to Rural training tracks and fellowships, electronic health records, 15 developing, 10, 112 16, 173175 Rural/Underserved Opportunities Rural Health Research Center, 137 program, 94 Rural Health Support Mechanism, 171 Rural-urban continuum code 172 classifications, 206 Rural Healthy People 2010 report, 239 Rural Utilities Service, 170 Rural Hospital Flexibility Grant Program, 71, 86
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From page 266... ...
formula, in, 64 130 Smoking increased likelihood of in rural communities, 3, 3839 T public policies regarding, 45 Social behaviors, influence on the health of Targeted rural quality programs, 7172 individuals and populations, 4 targeting workforce training programs Social infrastructures, 20 more effectively, 9, 110111 Social Security Act, 176 Technical requirements of health care, Titles VII and VIII, 8, 110 164165 Social support, for the disadvantaged providing assistance with, 17, 180 and handicapped, 25 Technology/telehealth resource centers, Sole community hospitals, 2021 establishing regional Southern Rural Access Program, 102, 138 information and Specialist physicians, 222223 communications, 17, 178180
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From page 267... ...
K Kellogg Foundation, 5, 21 Transfer of health messages across Leadership for Community Change telecommunications access Program, 5, 52, 56 networks, prohibiting Wakefield, Mary, ixx, 193 surcharges for, 15, 172 Walsh Center for Rural Health Analysis, Transfer services, 6 137 Traveling long distances to provider sites, Watson, Linda, 198199 47 Web-based communication, 6062, 84 Trends, racial and ethnic, in rural WiMax technologies, 171 populations, 210211 Women, self-reported obesity among, in Turning Point: Collaborating for a New rural communities, 39 Century of Public Health Workforce training programs Initiatives, 158 expanding experientially based in rural areas, 89, 109110 targeting more effectively, 9, 110111 U Working in interdisciplinary teams, by health professionals, 8384 Underpayment of rural health providers, Workplace basics, for public health historical, 12 professionals, 102 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 37 Z Uninsurance rates in rural areas, 20, 27, 211, 217 Zero-sum choices, 43
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