Quality Through Collaboration The Future of Rural Health (2005) / Chapter Skim
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2 An Integrated Approach to Improving Health and Health Care in Rural Communities
2 An Integrated Approach to Improving Health and Health Care in Rural Communities
Pages 30-59
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From page 30... ...
Many community-level actions extend beyond the traditional health care sector, thus necessitating greater collaboration between that sector and others, such as education, transportation, and social services. By making explicit the full range of options available to rural communities for improving health, the integrated framework set forth in this chapter is intended to lead closer to a more optimal allocation of scarce financial resources between personal health care and population health initiatives.
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From page 31... ...
This chapter presents an integrated approach to addressing both personal health care and population health needs that builds on the six quality aims of the Quality Chasm report. The approach is intended to be most useful at the community level in facilitating prioritization of a community's health needs and identification of the most promising interventions.
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From page 32... ...
The discussion is organized according to the six quality aims set forth in Chapter 2 of the Quality Chasm report. Safety Patient safety is the prevention of harm to patients (IOM, 2004)
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From page 33... ...
. On the other hand, a study of rural health clinics documented a wide range of medication errors, including errors in dosage, errors in agent selection, and failure to recognize potential drug interactions and contraindications (Williamson et al., 1991)
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From page 34... ...
. A study of elderly diabetic patients found that patients in large remote rural communities (i.e., ones that could support both generalist and specialist physicians)
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From page 35... ...
. Timeliness Timeliness in access to care is a critical factor influencing the quality of rural health care.
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From page 36... ...
. Handoffs between clinicians at each point along the response continuum have a significant impact on the outcome of rural patients because of the overall fragmentation of emergency medical services and the rural health system in general, and the greater geographic distances that must be traveled to reach the local emergency room or nearby trauma center.
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From page 37... ...
. It is also important to recognize that rural and urban health care delivery systems have different advantages and disadvantages when delivering care.
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From page 38... ...
HEALTH BEHAVIORS AND HEALTH THREATS IN RURAL COMMUNITIES A comprehensive review of the Quality Chasm six aims is beyond the scope of this report; however, this section highlights some of the more salient differences between rural and urban communities in terms of health behaviors and environmental threats -- the two areas most amenable to intervention in the short run. Appendix B speaks to differences in the racial and ethnic compositions of rural and urban communities (which influence genetic predispositions to a great extent)
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From page 39... ...
Moreover, important differences are likely to exist within rural communities in terms of priorities for action, necessitating community- or state-based action plans. IMPROVING POPULATION HEALTH AND PERSONAL HEALTH CARE Rural America has struggled for many decades with shortages of health professionals; constrained access to specialty services; and financial, geographic, and other barriers to health care access (see Appendix C)
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From page 40... ...
Bolstering the personal health care delivery system is important, but the committee also believes a better balance must be struck between investments in personal health care and community health improvement strategies. As pointed out in the IOM report Fostering Rapid Advances in Health Care: Learning from System Demonstrations: The health care system of the 21st century should maximize the health and functioning of both individual patients and communities.
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From page 41... ...
To guide its work, the committee developed a framework designed to facilitate a more integrated approach to decision making regarding personal and community health programs and needs. As noted earlier, the Quality Chasm report focuses largely on health care quality within the personal health care delivery system.
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From page 42... ...
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From page 43... ...
A variety of community planning strategies exists for improving community-level safety, ranging from remediation of environmental hazards to enhancement of traffic safety. Effectiveness Rural health systems of the twenty-first century must be designed to promote not only evidence-based patient care services, but also community health improvement interventions that have been demonstrated to improve quality and health outcomes.
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From page 44... ...
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From page 45... ...
Health professions training programs are also critical to the production of clinicians who understand and can apply the skills needed to address this goal. Timeliness At the level of the personal health care delivery system, timeliness refers to the reduction of waits and harmful delays in accessing health care and in
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From page 46... ...
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From page 47... ...
Examples of interventions that might improve timeliness are the expansion of health insurance coverage and safety net programs to improve access to preventive and primary care services, and communitywide educational programs aimed at parents of young children to encourage proper diet and exercise at the earliest possible age. Table 2-4 lists some illustrative strategies for improving timeliness.
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From page 48... ...
System times Community-Level Personal Care Measures receipt patients wait routine elective Response emergency and the System e to of Health delay Car early or and vention Health Population Focus Ensure inter prevent onset progression disease Definition Personal those care and harmful and Health both give 2-4 waits for who receive TABLE Personal Focus Reduce sometimes delays who those xxx
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From page 49... ...
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From page 50... ...
raise environmental that disproportionate impact of ventions Equity Inter for of health Health competency for System professionals Examples Personal Care Sponsoring cultural training care to use code and Illustrative lead race, Level health zip and areas of by exposure (e.g., ,and of ventions: access Community Measures care across subpopulations geographic Rates environmental hazards poisoning) ethnicity Inter Measures to , of stratified other the ceptions in different Health of ethnic and provided per ethnicity subgroups of acceptability System vices, and Community-Level the ser race, vices Personal Care Patient of of by religion, relevant Measures differences appropriateness ser patients racial backgrounds and System high- health e Health residents to needs that residents Car rural care all environment population- health access an smoke-free promotes Health Population Focus Provide community with quality meets based Provide community with that (e.g., public establishments)
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From page 51... ...
and the professional community to redesign the care delivery system to achieve the six aims set forth in the Quality Chasm report (IOM, 2001) (see Chapter 1)
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From page 52... ...
. Committed leadership of senior clinicians and administrators is key to the institutional and environment changes necessary to achieve improved quality of care and patient safety -- a task that may at the same time be more difficult in rural areas because of personal connections that amplify feelings of blame for errors and easier because of the fewer layers of bureaucracy in rural health care delivery (Wakefield, 2002)
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From page 53... ...
The human and technological infrastructures of rural health care are generally inadequate to support the quality improvement ambitions of rural communities and health care systems (see Chapters 4 and 6, respectively)
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From page 54... ...
These strategies and approaches need to be modified to fit the realities of the rural health care environment, and rural-derived quality innovation needs to be strengthened and supported. The committee believes not only that rural communities must participate in such demonstrations, but also that, because of their smaller scale, more cohesive community structures, and other unique characteristics, rural areas and health systems offer an excellent opportunity to undertake and evaluate significant health system reform initiatives.
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From page 55... ...
Residents of rural America are diverse, but one thing they generally do have in common is a strong sense of attachment to their community. This community orientation, combined with the smaller scale of rural health, human services, and community systems, may afford rural communities an opportunity to demonstrate more rapidly the vision of balancing and integrating the needs of personal health care with broader communitywide initiatives that target the entire population (IOM, 2003b)
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From page 56... ...
Rural communities engaged in health system redesign would likely benefit from leadership training programs. Such training pro grams could be provided by the Agency for Healthcare Research and Qual ity and the Office of Rural Health Policy working collaboratively with private- and public-sector organizations involved in leadership develop ment, such as the National Council for Healthcare Leadership and the W
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From page 57... ...
2002. Rural healthy people 2010: Identifying rural health priorities and models for practice.
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From page 58... ...
1996. Why patients bypass rural health care centers.
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From page 59... ...
2002. Patient safety and medical errors: Implications for rural health care.
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