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« Previous: Appendix C The Rural Health Care Delivery System
Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
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Index

A

Access

to capital for rural hospitals, 137–138

to health information, enabling, 151

Accidents, 41

Accreditation programs, 72–73

Acute myocardial infarction (AMI) patients, 6

interventions for, 34

Administrative Simplification provisions, 167

Adoption of ICT in rural settings, 165–168

data standards for connectivity, 167

federal leadership, 166

finance, 168

information network components, 165–166

patient privacy laws, 166–167

Advanced Learning Institute, 52

Adverse event rates, 33

African American communities, 1, 17, 38, 91–92, 205, 211

Age distribution, in rural populations, 208–210

Agency for Healthcare Research and Quality (AHRQ), 4–5, 7, 12, 16–17, 21, 33, 55–56, 68, 71, 75, 84, 89, 120, 141, 164, 177

Health Information Technology Program, 16, 177

America, rural, defining, 1–3, 200–204

American Academy of Family Physicians (AAFP), 161, 174

American Health Quality Association, 67

American Hospital Association (AHA), 65, 89, 122, 229

American Osteopathic Association, 73

Amish settlements, 1

Applicants from rural areas, attracting qualified, 10, 112

Area Health Education Centers, 8, 88, 110

Asian Americans, 91–92

Assessment of availability and quality of mental health and substance abuse services, in rural areas, 12–13, 142

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Assistance, needed by rural communities, 6

Association of American Medical Colleges, 122

Attracting rural students to health careers, 91–92

Availability, of parks and recreational facilities, 45

Availability of mental health and substance abuse services in rural areas, 12–13, 142

B

Balanced Budget Act of 1997, 130, 133

Beale, Calvin, 194

Behavioral Risk Factors Surveillance System surveys, 131

Behaviors. See Health behaviors and health threats in rural communities;

Social behaviors

Benefits Improvement and Protection Act of 2000, 130–131, 134

“Bottom-up” approach to health system reform, 5, 177

Bridges to Excellence program, 121

Broadband networks, 14

expanding federal efforts to extend into rural areas, 15, 172

Burdick Program. See Quentin Burdick Rural Program for Interdisciplinary Training

Bureau of Economic Analysis, 212

Bureau of Health Professions, 9, 111

Bureau of Indian Affairs, 9, 111

Bureau of Primary Health Care, 124, 140, 238

Bureau of the Census, 17, 200–201

Bush, George W., 159

C

California HealthCare Foundation, 121

Capital support, for rural health care institutions, 27

Cardiac care link, in Bridges to Excellence, 121

Caucasian Americans, 91

Center for Tracking Health System Change, 129

Centers for Disease Control and Prevention (CDC), 4, 101

Health Alert Networks, 159

Centers for Medicare and Medicaid Services (CMS), 7, 11, 16, 66– 72, 75, 104, 121n, 122, 136, 141, 174, 225

Centers of Excellence program, 8, 110

Certification programs, 72–73

Challenges facing rural providers, 123– 124

Changes

fundamental, in existing payment programs for physicians, 95

in the health care system, 12, 109

in rural populations, 204–207

Children’s Health Insurance Program, provider payments under, 12, 141

Choices, zero-sum, 43

Chronic disease management, 20, 72, 152–153

role of residents in, 107

Clinical knowledge and associated tools, 63

Coburn, Andrew, 194

Cochrane Collaboratives, 84

Code classifications, for the rural-urban continuum, 206

Collaboration

in improving population health and personal health care, 51–52

propensity toward, 20

Committee on the Future of Rural Health Care, 2, 22, 25, 89, 193–199

Committee on the Quality of Health Care in America, 159

Communications technologies in information networks, 166

resource centers for, 17, 178–180

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Communities

hub role in standardized performance measures, 64

with nonfederal physician specialty services, 223

Community Access Program, 37

Community-based efforts, 20

toward a comprehensive health system, 5

Community-based technical assistance, with measuring and improving personal and population health care programs in rural areas, 7, 75

Community-centeredness, of improving population health and personal health care, 45–46

Community Facilities Program, 138

Community health centers, 125–126, 225, 237

regional conferences for, 7

Community health systems, 61

Community ICT applications, 151–153

communicating with the health system, 151–152

enabling access to health information, 151

managing chronic conditions, 152–153

Community level, personal and population health needs at, 3

Community resources

culture and society, 107–108

education system, 107

health system, 107

options for mobilizing, 106–109

Community Tracking Study Physician Survey, 129

Community-wide measurement and monitoring systems, 64–65

Commuting, to jobs in urban areas, 1

Comprehensive health system

community-based efforts toward, 5

demonstrations towards reform of, 5, 54–56

Comprehensive quality improvement program

clinical knowledge and associated tools, 63

key components of, 61–66

knowledge of the science of quality and safety improvement, 61–62

performance measurement and data feedback capabilities, 65

quality improvement processes and resources, 65–66

standardized performance measures, 63–65

Computerized decision support, 60

Congress, 20

recommendations to, 14–15, 54

Connecting for Health initiative, 159

Consistency, of regulatory and payment policies, 172–173

Consolidated Health Informatics (CHI) initiative, 167

Continuing education, 106

requirements in medical education, 89

Core competencies for health professionals, 2, 8, 81–87, 101

applying quality improvement, 8, 85–87

employing evidence-based practice, 8, 84–85

formal education programs for public health professionals, 101

providing patient-centered care, 8, 81–82

reforms to improve quality in, 81–87

utilizing informatics, 8, 87

working in interdisciplinary teams, 8, 83–84

Core health services

access to, 2

emergency medical services, 3

hospital care, 3

long-term care, 3

mental health and substance abuse services, 3

oral health care, 3

primary care in the community, 3

public health services, 3

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Coronary angioplasty procedures, 35

Cost-based payment, 20

Cost-effectiveness, of current patterns of health care, 43

Costs reimbursed by health insurance, 25

Critical access hospitals (CAHs), 21, 123, 126, 230

locations of, 231

regional conferences for, 7

Cross-training

of nurses, 95, 99

of pediatricians, 95, 99

of physicians, 100

Crossing the Quality Chasm: A New Health System for the 21st Century, ix–xi, 2, 23, 30, 33

Cultural competency, of health care professionals, 108

Culture and society, as community resources, 20, 107–108

Current status

of funding for mental health and substance abuse services in rural areas, 13, 142

of health care, cost-effectiveness of, 43

of ICT in health care, 159–165

of quality improvement efforts in rural areas, 66–73

D

Data exchange

establishing secure platforms for, 27

expense of, 14

Data feedback capabilities, 65

Data repositories

in information networks, 166

in measuring and improving personal and population health care programs in rural areas, 7, 75

Data standards

for connectivity in adopting ICT in rural settings, 167

in information networks, 166

Decision support, 53, 154–156

computerized, 60

Delivery systems. See Rural health care delivery systems

Demonstrations for comprehensive health system reform, 11

funded by the Department of Health and Human Services, 5, 54–56

Density. See Population density

Dental health training programs, 98–99

recommendations for strengthening, 10, 111–112

Department of Agriculture (USDA)

Community Facilities Program, 138

Economic Research Service, 200

Rural Utilities Service, 170

Department of Commerce, 163, 170, 200

Department of Education, 9–10, 111, 113

National Science Education Standards, 91

Department of Health and Human Services (DHHS), 23, 54, 68, 74, 123, 133, 136, 166

comprehensive health system reform demonstrations funded by, 5, 54–56

meeting the needs of rural communities, 6

Public Health Functions Working Group, 242

Rural Task Force, 14, 169–170

Department of Housing and Urban Development (HUD), Hospital Mortgage Insurance Program, 138

Detmer, Don E., 194–195

Diabetes, education program aimed at preventing, 55

Diabetes care link, in Bridges to Excellence, 121

Diagnostic information, storage and retrieval of, 156

Dialysis Facility Compare, 69

DICOM standard, 165

Digital age, rural health care in, 147–190

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Digital divide, in rural populations, 216–217

Disability-related conditions, 234–235

Disadvantaged people

loan repayment programs for students, 8

social support for, 25

Discipline-specific skills, for public health professionals, 101

Disparities, rural, 68

Distance consultations, and patient monitoring, 156–157

Distance learning programs, 89, 96

Diverse resource contexts, standardized performance measures in, 64

Doctors Office Quality Information Technology project, 174

Domestic preparedness, federal allocations to states for, 228

E

E-encounters, 149, 154

Economic Research Service (ERS), 17, 200–201, 208

Education system

as a community resource, 107

in rural populations, 213–216

Educational attainment

by race, 215

in rural populations, 20

Effectiveness

of improving population health and personal health care, 43–44

of quality of care in rural communities, 34–35

Efficiency

of improving population health and personal health care, 47, 49

of quality of care in rural communities, 36–37

Electronic health records (EHRs), 13, 60–63, 149, 160–162

assisting rural providers in converting to, 15–16, 27, 173–175

financial assistance for, 27, 173–175

investing in, 15

storing, 155

Emergency care professionals, formal education programs for, 97–98

Emergency medical services, 6, 157–158

federal allocations to states for domestic preparedness, 228

levels of training for emergency medical technicians, 226–227

response times by, 35, 47

in rural health care delivery, 98, 226–229

Emergency medical technicians (EMTs), 226–227

Emergency rooms, staffing, 227

Employment, in rural populations, 212–213

Environment

influence on the health of individuals and populations, 4

toxic exposure/risk, 43

Equity

defining, 47

in improving population health and personal health care, 47, 50–51

of physician payments, 12

in quality of care in rural communities, 37–38

Ethnicity, population growth rates in rural populations by, 210

European descendants, 1

Evaluation of current funding mental health and substance abuse services in rural areas, 13, 142

Evidence-based practice, health professionals employing, 2, 8, 84–85

Evidence-based Practice Center, 120

Exercise, physical, lack of in rural communities, 39

Experientially-based workforce training programs, expanding in rural areas, 8–9, 87, 89, 109–110

Experimentation, rapid-cycle, 5

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
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F

Faculty, recruiting more from rural practice, 10, 112

Federal allocations to states, for domestic preparedness, 228

Federal Communications Commission, 171

Federal leadership, in adopting ICT in rural settings, 166

Federally-funded financial incentives, for residency training programs, 10, 112

Federation of American Hospitals, 122

Finance, 119–146

in adopting ICT in rural settings, 168

pay-for-performance, 120–126, 140–141

public, 27

recommendations regarding, 140–142

for rural health care institutions, ix, 27

See also Funding of rural health care

Financial assistance for EHRs, 27, 173–175

Financial resources, 11–13

recommendations for providing adequate and targeted, 11–13, 140–142

Financial stability of rural health care providers

analyzing, 12, 141–142

need for, 3, 40, 139

Findings

regarding human resources, 9–10, 110–111

regarding information and communications technology, 15, 173

regarding personal and population health needs, 4–5, 54, 56

First-contact roles, standardized performance measures of, 64

First responders, 226

1st Annual Crossing the Quality Chasm Summit: A Focus on Communities, 23–24

Flex Program, 230

Flexibility, needed by rural communities, 6

Formal education programs for physicians, 93–96

making fundamental changes in existing payment programs, 95

making incremental changes in existing payment programs, 95

Formal education programs for public health professionals, 101–102

core skills, 101

discipline-specific skills, 101

function-specific skills, 101

subject-specific skills, 102

workplace basics, 102

Formal education programs for the rural health professions workforce, 92–102

for dentists, 98–99

for emergency care professionals, 97–98

for health administrators, 100–101

for mental and behavioral health care professionals, 99–100

for nurses, 96

for pharmacists, 99

for physician assistants, 96–97

Fostering Rapid Advances in Health Care: Learning from System Demonstrations, 5, 23–24, 40, 177–178

Frontier areas, 1, 17, 204

population change in, 207

Function-specific skills, for public health professionals, 101

Funding of rural health care, 126–139, 141–142

access to capital for rural hospitals, 137–138

funding rural emergency medical services, 134–135

Medicare and Medicaid payments to primary care physicians, 129–130

Medicare and Medicaid support for nursing homes and home health services, 132–134

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Medicare and Medicaid support for rural health clinics and community health centers, 131

Medicare hospital payments, 127– 129

need for financial stability in, 139

public health expenditures, 135–137

rural resources for dental care, 131–132

Funding of rural mental health and substance abuse services, 139– 140, 142

G

Geisinger Health System, 152

General Accountability Office (GAO), 130, 136

Genetic predispositions, influence on the health of individuals and populations, 4

Genomics, 158

Geriatric Education Centers, 8, 110

Global Patient Index, 176

Graduate medical education payments, under Medicare, 112

Graduate medical education (GME) programs, 94–95

Grand rounds, 84

Grigsby, Jim, 195–196

H

Handicapped people, social support for, 25

Hartley, David, 196

Health, United States, 2001 with Urban and Rural Chartbook, 38

Health administrators, formal education programs for, 100–101

Health Alert Networks, 159

Health and health care in rural communities

an integrated approach to improving, 30–59

range of interventions available to improve, 4–5, 54

Health behaviors and health threats in rural communities, 3, 20, 38–39

lack of regular physical exercise, 3, 39

likelihood of smoking, 38–39

self-reported obesity among women, 39

Health care leaders, 41

Health care professionals

cultural and linguistic competency of, 108

data needed on, 9

finding qualified, 3

lifelong educational programs for, 17, 180

Health care settings in rural communities, 1

distance consultations and patient monitoring, 156–157

e-encounters, 154

emergency care, 157–158

ICT applications in, 153–158

knowledge and decision support, 154–156

remote language and cultural interpretation, 154

storage and retrieval of diagnostic and health information, 156

Health care systems

changes in, 12

communicating with, 151–152

as a community resource, 107

infrastructure for, 20

providing leadership training to rural communities engaged in redesigning, 5, 56

in the U.S., calling for fundamental reform, 2

Health Careers Opportunity Program, 8, 110

Health Disparities Collaboratives: Changing Practice, Changing Lives, 124

Health Education and Training Centers, 8, 110

Health information technology (HIT), 176–177

enabling access to, 151

storage and retrieval of, 156

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Health Information Technology Program, 16, 177

Health insurance

costs reimbursed by, 25

in rural populations, 217–218

See also Uninsurance rates in rural areas

Health Insurance Portability and Accountability Act of 1996, 72, 166–167

Administrative Simplification provisions of, 167

Health literacy in rural populations, 107–108, 213–216

levels of, 10–11

measuring, 113

Health policy, rural, 20–22, 45

Health Professions Education: A Bridge to Quality, 8

Health-related Internet applications

ensuring that rural communities can access and use, 14–15, 170–172

transferring messages by telecommunications access networks, 15, 172

Health Resources and Services Administration (HRSA), 4–12, 21, 55, 71–74, 88, 110, 137, 142, 169, 174–175, 225

Area Health Education Centers, 88, 110

Centers of Excellence program, 8, 110

Office of Rural Health Policy, 74

recruitment programs from, 93, 103

Health Sciences and Technology Academy, 91

Health system reform, 45

“bottoms up” approach to, 5

Healthy Communities Access Program, 37

Healthy lifestyles, 25

Heterogeneity, of rural communities, 1, 20

High Plains Rural Health Network, 152

High-speed access to the Internet, 170–172

Hill-Burton Program, 138

Hispanic communities, 1, 17, 38, 91–92, 211

HIV infection, 36

Home Health Compare, 69

Home ICT applications, 151–153

communicating with the health system, 151–152

enabling access to health information, 151

managing chronic conditions, 152–153

Hospital care in rural health care delivery, 229–230

full-time hospital-based registered nurses in rural counties, 232

Hospital Compare, 69

Hospital Mortgage Insurance Program, 138

Hospitals in rural areas, 229

critical access, 21, 231

Medicare-dependent, 21

operating margins of, 12

sole community, 20–21

Hullett, Sandral, 196

Human resources, 3, 7–11, 78–118

enhancing the rural health professions workforce, 3, 89–106

findings, 9–10, 110–111

formal education programs for, 92–102

fundamental reforms to improve quality, 80–89

options for mobilizing community resources, 80, 106–109

recommendations for strengthening, 8–11, 109–113

I

Immunization campaigns, 25

Improvements in population health and personal health care, 39–52

effectiveness of, 43–44

efficiency of, 47, 49

equity in, 47, 50–51

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

leadership and collaboration in, 51–52

patient- or community-centeredness of, 45–46

safety of, 41–43

timeliness of, 45, 47–48

In-house presentations, 84

In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce, 93

Income, in rural populations, 20, 212–213

Incremental changes, in existing payment programs for physicians, 95

Indian Health Service (IHS), 9, 93, 111, 174–175, 225

expanding programs offered by, 8

planning for converting all paper health records to electronic, 16, 175

Indiana Network for Patient Care, 175–176

Informatics, 158

health professionals utilizing, 87

Information and communications technology (ICT) in rural areas, 13–17, 61–62, 147–153, 158–160, 165

accelerating the adoption of, 165–168

collaborations and demonstrations in, 175–178

current status of, 159–165

electronic health records, 161–162

expanding developmental programs for, 16, 175–178

findings, 15, 173

in health care settings, 153–158

at home and in the community, 151–153

Internet connections, 160–161

personal health records, 162–163

in population health, 158–159

recommendations for better utilizing, 14–17, 169–180

strengthening, 40

technical requirements, 164–165

telemedicine, 163–164

Information and communications technology (ICT) infrastructure, 2–3, 159–160

advances in, 79

EHRs, 160

information exchange networks, 160

investing in building, 3

national data standards, 160

PHRs, 160

Information network components, 165–166

in adopting ICT in rural settings, 165–166

appropriate regulatory oversight, 166

communications technologies, 166

data standards, 166

databases and medical knowledge sources, 166

“Information prescriptions,” 151

Injuries, 41

Inpatient margins, 127–129

Institute for Healthcare Improvement, 66, 89

Institute for Safe Medication Practices, 89

Institute of Medicine (IOM), xi, 2, 22–23, 25, 30–31, 37, 136, 162

Institute of Medicine’s Quality Chasm series, 22–24

Crossing the Quality Chasm: A New Health System for the 21st Century, ix–xi, 2, 23, 30, 33

Fostering Rapid Advances in Health Care: Learning from System Demonstrations, 5, 23–24, 40, 177–178

Priority Areas for National Action: Transforming Health Care Quality, 24

Insurance. See Uninsurance rates in rural areas

Integrated approach to improving health and health care in rural communities, 30–59

health behaviors and health threats in rural communities, 38–39

improving population health and personal health care, 39–52

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

quality of care in rural communities, 31–38

recommendations, 52

Interdisciplinary teams, health professionals working in, 8, 83–84

International medical graduates (IMGs), 103

Internet connections in health care, 84, 160–161

Internet penetration rates, 216–217

Interventions available to improve health and health care in rural America, range of, 4–5, 54

Investing in EHRs, 15

Iowa Health Professions Inventory, 102

Isolation, 3

J

J-1 waiver physicians, 103

Johnson Foundation. See Robert Wood Johnson Foundation

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 33, 73, 75, 121n, 173

K

Kaiser Commission on Medicaid and the Uninsured, 217

Kellogg Foundation, 5, 21, 52

Knowledge support, 84, 154–156

web-based, 84

L

Leadership

in improving population health and personal health care, 51–52

needed within health care institutions, 51

school, 41

Leadership for Community Change Program, 5, 52, 56

Leadership training, providing to rural communities engaged in health system redesign, 5, 56

Leapfrog Group, 33, 68–69

Letter Report on Key Functionalities of EHRs, 162

Levels of training for emergency medical technicians, 226–227

Lifelong educational programs, for health care professionals, 17, 180

Limitations, higher rates among rural populations, 3

Linguistic competency, of health care professionals, 108

Linking, in standardized performance measures, 64

Literacy. See Educational attainment;

Health literacy in rural populations

Loan repayment programs, for disadvantaged students, 8

Local area telecommunication access (LATA) networks, 14, 171

Local protocols, 63

Local public health agencies (LPHAs), 241

Long-term care, in rural health care delivery, 20, 230–234

M

MacKinney, A. Clinton, 196–197

Mansfield University, Master’s Program in Community Psychology, 104

Markle Foundation, Connecting for Health initiative, 159

Master’s Program in Community Psychology, 104

Mayo Clinic website, 151

Measurement systems, community-wide, 64–65

Measures, of pay-for-performance, 124–126

Medicaid, provider payments under, 12, 141

Medical Compare, 69

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Medical health training programs, recommendations for strengthening, 10, 111–112

Medical knowledge sources, in information networks, 166

Medical resources, 20

Medicare, 15

graduate medical education payments under, 112

historical underpayment of rural health providers under, 12

hospital payments from, 127–129

payment from, 20

Prospective Payment System, 72, 126–127, 130–131, 133

Medicare Advantage Data, 69n

Medicare and Medicaid, 27

graduate medical education programs through, 94–95

payments to primary care physicians, 129–130

providing financial incentives to providers who invest in electronic health records, 16, 175

support for nursing homes and home health services, 132–134

support for rural health clinics and community health centers, 131

Medicare-dependent hospitals, 21

Medicare Flex program, 71

Medicare Health Plan Compare, 69

Medicare Modernization Act of 2003, 104, 119, 125, 128, 130, 134, 138–139

pay-for-performance program mandated in, 123

Medicare Personal Plan Finder, 69n

Medicare Prescription Drug Improvement and Modernization Act of 2003, 21

Medicare Rural Hospital Flexibility Program, 230

Medication errors, 33

Medigap Data, 69n

Medline Plus, 151

MedPAC, 130, 133

Mental and behavioral health care professionals, formal education programs for, 99–100

Mental disorders, defined, 234n

Mental health and substance abuse services, in rural health care delivery, 12, 83, 234–238

Mental Health Parity Act, 139

Mental illness, defined, 234n

Mentoring program, for rural health providers, 9

Metropolitan areas, population change in, 207

Monitoring systems, community-wide, 64–65

Moscovice, Ira, 197

Multiethnicity, 17

N

National Adult Literacy Survey, 215n

National Advisory Committee on Rural Health and Human Services (NACRHHS), 67, 178

National Center on Vital and Health Statistics, 167

National Committee for Quality Assurance, 75, 121n, 173

National Committee on Vital and Health Statistics, 159

National Coordinator. See Office of the National Coordinator for Health Information Technology

National Council for Healthcare Leadership (NCHL), 5, 52, 56

National data standards, 160

National Disparities Report, 68–69

National Domestic Preparedness Consortium, 228

National Health Account data, 135

National Health Information Infrastructure (NHII), 13–16, 27–28, 108, 159, 165–170, 173, 175, 177

National Health Service Corps (NHSC), 102–103, 236n

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

National Healthcare Quality Report (NHQR), 68–69

National Library of Medicine (NLM), 17, 155, 180

Medline Plus, 151

Partners in Information Access for the Public Health Workforce, 159

National Network of Libraries of Medicine, 17, 155, 180

National Quality Forum (NQF), 33, 69, 75, 121n

National quality movement, 21, 53

National Rural Health Association, 89

National Rural Recruitment and Retention Network, 102

National Voluntary Hospital Reporting Initiative, 65, 122

Native Americans, 1, 17, 38, 92, 236

Networking, among rural providers, 179

Nonfederal physician specialty services, communities with, 223

Nurse practitioners, providing primary care, 83, 224

Nurses

cross-training of, 95, 99

formal education programs for, 96

full-time hospital-based, in rural counties, 232

recommendations for strengthening training programs for, 10, 112

Nursing Home Compare, 69

O

Obesity among women, self-reported in rural communities, 3, 39

Office of Management and Budget (OMB), 17, 167, 200–201

Office of Rural Health Policy (ORHP), 5–7, 9, 56, 74, 111, 169

designating to coordinate rural health input, 14, 170

Office of the National Coordinator for Health Information Technology, 13–15, 17, 166, 169–170, 173, 175, 180

Older Americans, rural, 20, 209

On-call resource center, providing to assist communities in implementing new technologies, 17, 180

Ongoing educational assistance, 178–180

Ongoing pay-for-performance studies, 121–123

Online information sources, providing access to, 17, 180

Open EHR Pilot Project, 174

Operating margins, 6, 12

Oral health care, in rural health care delivery, 238–240

Oral Health in America, 238

P

Paper-based information, 87

Parks, availability of, 45

Partners in Information Access for the Public Health Workforce, 159

Patient-centered care, 8

health professionals providing, 81–82

in improving population health and personal health care, 45–46

and the quality of care in rural communities, 35

Patient-level safety improvement strategies, 43

Patient monitoring, distance consultations and, 156–157

Patient privacy laws, in adopting ICT in rural settings, 166–167

Patient safety practices, 33

Patients, traveling long distances to provider sites, 47

Pay-for-performance programs, 11, 70, 120–126, 140–141

challenges facing rural providers, 123–124

establishing demonstration projects in rural communities, 11–12, 140–141

major ongoing pay-for-performance studies, 121–123

objectives, approaches, and measures, 124–126

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Payment policies, 2, 172–173

Pediatricians, cross-training of, 95, 99

Performance measures, standardized, 63–65

Personal health care programs in rural areas, establishing Rural Quality Initiatives to measure and improve, 6–7, 74–75

Personal health needs, 4–5

at the community level, 3

findings, 4–5, 54, 56

recommendations, 5, 54–56

Personal health records (PHRs), 152, 160, 162–163

Pew Internet and American Life Project, 161

Pharmacists

formal education programs for, 99

providing primary care, 83, 224–225

Physical exercise, lack of regular in rural communities, 3, 39

Physical infrastructures, 20

Physical therapy technicians, 83

Physician assistants

formal education programs for, 96–97

providing primary care, 224

Physician office link, in Bridges to Excellence, 121

Physician Shortage Area Program (PSAP), 93

Physicians

communities with nonfederal physician specialty services, 223

cross-training of, 100

equity of payments to, 12

formal education programs for, 93–96

J-1 waiver, 103

providing primary care, 222–224

specialist, 222–223

Pilot projects, 11

Pipeline, for the rural workforce, 80, 90

Population change in rural populations, 204–207

growth rates by race and ethnicity, 210

metropolitan, rural, and frontier areas, 207

rural-urban continuum code classifications, 206

Population density, xii, 20

Population health care programs in rural areas

establishing Rural Quality Initiatives to measure and improve, 6–7, 74–75

ICT applications in, 158–159

Population health needs, 4–5

at the community level, 3

findings, 4–5, 54, 56

recommendations, 5, 54–56

Practice guidelines, 63

Premier, Inc., a quality incentive demonstration project, 122–123

President’s Information Technology Advisory Committee, 159

Primary care clinicians in rural health care delivery, 221–225

broader scope of practice for, 83

communities with nonfederal physician specialty services, 223

nurse practitioners, 224

pharmacists, 224–225

physician assistants, 224

physicians, 222–224

Primary care settings in rural health care delivery, 225–226

Priority Areas for National Action: Transforming Health Care Quality, 24

Professional associations, 9

Professionals

finding qualified health care, 3

in rural communities, 1, 7

Programs to provide core competencies for health professionals, 87–89

Prospective Payment System, 69, 72, 126–127, 130–131, 133

Public and private programs providing support for mental health and substance abuse services in rural areas, 13, 142

Public financing, 27

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Public health capacity, 25

Public health care, in rural health care delivery, 241–242

Public health expenditures, 135–137

Public Health Functions Working Group, 242

Public health professionals, formal education programs for, 101–102

Public Health Security and Bioterrorism Preparedness and Response Act of 2002, 137

Public Health Service Act, 8, 88, 102, 225

Public Health Threats and Emergencies Act of 2000, 136

Public policies, regarding smoking, 45

Public reporting

concerns raised by, 70

in measuring and improving personal and population health care programs in rural areas, 7, 75

Public reporting programs, 68–70

Leapfrog Group, 69

Medical Compare, 69

National Healthcare Quality Report, 68–69

Public transportation, lack of, 47

Q

Qualified applicants, attracting from rural areas, 10, 112

Qualified health care professionals, shortages of, 3

Qualis Health, 67

Quality challenge in a rural context, 2–3, 85

Quality Chasm series, xi–xii, 2, 5–6, 22–24, 30–33, 38, 41, 51, 55, 80–82, 119–120, 125, 142, 147

Quality improvement activities in rural areas, 8, 60–77

accreditation and certification programs, 72–73

applying to core competencies for health professionals, 8, 85–87

clinical knowledge and associated tools, 63

current state of quality improvement efforts in rural areas, 6, 66–73

enhancing, 40

key components of a comprehensive quality improvement program, 61–66

knowledge of the science of quality and safety improvement, 61–62

performance measurement and data feedback capabilities, 65

processes and resources for, 65–66

public reporting programs, 68–70

quality improvement organizations, 66–68

quality improvement processes and resources, 65–66

recommendations for support structure, 6–7, 73–75

standardized performance measures, 63–65

support structures for, 3

targeted rural quality programs, 71–72

Quality Improvement Organization Support Center (QIOSCs), 7, 68, 75

Quality Improvement Organizations (QIOs), 66–68, 71, 75, 86, 89

Medicare, 66

Quality Interagency Coordinating Committee, 75

Quality movement, national, 21, 53

Quality of care in rural communities, 31–38

defining, 4, 22–23

effectiveness of, 34–35

efficiency of, 36–37

equity in, 37–38

patient-centeredness of, 35

safety of, 32–34

shortcomings in, 80

timeliness of, 35–36

Quality of mental health and substance abuse services in rural areas, 12–13, 142

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Quentin Burdick Rural Program for Interdisciplinary Training, 8, 88, 110

R

Race

educational attainment by, 215

population growth rates in rural populations by, 210

Racial and ethnic trends, in rural populations, 68, 210–211

RAND Corporation, 32

Rapid-cycle experimentation, 5

Recommendations

for an integrated approach to improving health and health care in rural communities, 52

for better utilizing information and communications technology, 14–17, 169–180

for financing, 140–142

for human resources, 109–113

for personal and population health needs, 5, 54–56

for providing adequate and targeted

financial resources, 11–13, 140–142

for quality improvement activities in rural areas, 73–75

for quality improvement support structure, 6–7, 74–75

for rural health care in the digital age, 168–181

for strengthening human resources, 8–11, 109–112

Recreational facilities, availability of, 45

Recruitment of the rural health professions workforce, 102–103

Redesign of health systems, providing leadership training to rural communities engaged in, 5, 56

Reform demonstrations, toward a comprehensive health system, 5, 54–56

Reforms to improve quality of rural health care, 80–89

basing services available on the population health needs of the local community, 26

core competencies for health professionals, 81–87

ensuring that a core set of health care services is available, 25–26

establishing links to services in other locales that cannot be delivered locally, 26

explicitly addressing the special circumstances of rural areas in health care financing, 27

focusing on rural communities in developing local and national health information technology infrastructures, 27

guiding principles for, 25–27

improving population health in addition to meeting personal health care needs, 25

programs to provide the core competencies, 87–89

shaping and guiding rural health care services by local community and rural organizations and institutions, 26

teams of well-trained health care clinicians, managers, and leaders working together, 26–27

Regenstrief Institute, 175

Regional information and communications technology/telehealth resource centers, 17, 178–180

Registered Nurse-Bachelor of Science in Nursing Satellite Program, 96

Registered nurses in rural counties, full-time hospital-based, 232

Remote language, and cultural interpretation, 154

Remoteness from urban areas, 1, 20

Residency training programs, federally-funded financial incentives for, 10, 112

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Residents, role in chronic disease management, 107

Resource centers, for regional information and communications technology/telehealth, 17, 178–180

Resource context, standardized performance measures in scarcer and more diverse, 64

Response times by emergency medical personnel, 35, 47

Retention of the rural health professions workforce, 104–106

Retrieval, of diagnostic and health information, 156

Rewarding Results program, 121–122

Robert Wood Johnson Foundation, 52, 121

Partnerships for Training Program, 97

Practice Sites Program, 104

Turning Point: Collaborating for a New Century of Public Health Initiatives, 158

ROME (Rural Opportunities in Medical Education), 94

Rosenblatt, Roger, 197–198

Rural America, defining, xi–xii, 1–3, 19, 200–20

Rural Americans, deserving access to full spectrum of high-quality, appropriate health care, 25

Rural areas

population change in, 207

quality improvement activities in, 60–77

Rural Assistance Center, 89

Rural Broadband Loan and Loan Guarantee Program, 170, 201

Rural Clearinghouse for Lifelong Learning and Development, 215

Rural communities

Department of Health and Human Services meeting the needs of, 6

engaged in health system redesign, providing leadership training to, 5, 56

establishing relationships with health care providers and institutions in urban settings, 26

flexibility and assistance needed by, 6

health care organizations in, 1

heterogeneity of, 1, 20, 26

professionals in, 1

siting portions of the educational experience in, 10, 112

Rural communities accessing and using the Internet for health-related applications, 14–15, 170–172

Rural disparities, 68

Rural emergency medical services, 226–229

funding, 134–135

Rural EMS Initiative, 97

Rural focus, incorporating into NHII planning and developmental activities, 14, 169–170

Rural health care

funding of, 126–139, 141–142

greater use of midlevel professionals, 83

renaissance in, 21

Rural health care delivery systems, 27, 220–248

hospital care, 229–230

improving, 23

long-term care, 230–234

mental health and substance abuse care, 234–238

oral health care, 238–240

persistence of underresourced infrastructure in, 3

primary care clinicians, 221–225

primary care settings, 225–226

public health care, 241–242

Rural health care in the digital age, 147–190

accelerating the adoption of ICT in rural settings, 165–168

consistent regulatory and payment policies, 172–173

current status of ICT in health care, 159–165

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

financial assistance for EHRs, 173–175

high-speed access to the Internet, 170–172

ICT applications in rural settings, 150–159

ICT collaborations and demonstrations in rural areas, 175–178

ongoing educational assistance, 178–180

recommendations, 168–181

rural focus in the NHII plan, 169–170

Rural health care institutions, capital and financial support for, 27

Rural Health Care Program, 15

expanding to include all rural providers, 15, 172

Rural health clinics, 125, 225–226

regional conferences for, 7

“Rural health network,” 179n

Rural health policy, 20–22, 45

Rural health professions workforce, 89–106

attracting rural students to health careers, 91–92

enhancing, 40

formal education programs, 92–102

recruitment, 102–103

retention, 104–106

the rural workforce pipeline, 80, 90

skill set of, 80

Rural health providers

challenges facing, 6, 123–124

historical underpayment of, 12

mentoring program for, 9

Rural health providers converting to electronic health records, 15–16, 173–175

Rural Health Research Center, 137

Rural Health Support Mechanism, 171–172

Rural Healthy People 2010 report, 239

Rural Hospital Flexibility Grant Program, 71, 86

Rural Medical Education Program, 94

Rural mental health and substance abuse services, funding of, 139–140, 142

Rural Physician Program, 94

Rural populations, 200–219

age distribution, 3, 208–210

defining rural America, 200–204

the digital divide, 216–217

education and literacy, 213–216

educational attainment by race, 215

health insurance, 217–218

higher rates of limitations among, 3

income and employment, 212–213

population change, 204–207

population growth rates by race and ethnicity, 210

racial and ethnic trends, 210–211

rural older Americans, 209

Rural Quality Advisory Panel, 6–7, 74–75

Rural Quality Initiative, 6, 74–75

applying evidence to practice, 7, 75

community-based technical assistance, 7, 75

data repository, 7, 75

establishing to measure and improve personal and population health care programs in rural areas, 6–7, 17, 74–75

public reporting, 7, 75

standardizing measure set for rural communities, 7, 75

Rural referral centers, 20

Rural Research Center, 137

Rural resources for dental care, 131–132

Rural Task Force, 14, 169–170

Rural training tracks and fellowships, developing, 10, 112

Rural/Underserved Opportunities program, 94

Rural-urban continuum code classifications, 206

Rural Utilities Service, 170

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

S

Safety

in improving population health and personal health care, 41–43

of quality of care in rural communities, 32–34

as a system priority, 85

Safety improvement, scientific knowledge of, 61–62

Scarce resource context, standardized performance measures in, 64

School-based health, 25

School leadership, outreach to, 41

Science of quality and safety improvement, knowledge of, 61–62

Section 242 Program. See Hospital Mortgage Insurance Program

Secure platforms for data exchange, establishing, 27

Self-Determination Act, 16, 175

Self-reported obesity, among women in rural communities, 39

Serious emotional disturbance, defined, 234n

Serious mental illness, defined, 234n

Sign language interpretation, 154

Size, Tim, 198

Small Hospital Improvement Program (SHIP), 71–72

Small rural provider settings, 6

standardized performance measures in, 64

Smoking

increased likelihood of in rural communities, 3, 38–39

public policies regarding, 45

Social behaviors, influence on the health of individuals and populations, 4

Social infrastructures, 20

Social Security Act, 176

Titles VII and VIII, 8, 110

Social support, for the disadvantaged and handicapped, 25

Sole community hospitals, 20–21

Southern Rural Access Program, 102, 138

Specialist physicians, 222–223

Stability, financial, of rural health care providers, 3, 12, 40, 141–142

Standardized performance measures for rural communities, 63–65

community hub role, 64

first-contact and linking roles, 64

measuring and improving personal and population health care programs, 7, 75

scarcer and more diverse resource context, 64

small rural provider settings, 64

State education agencies, 10

State financial conditions, worsening, 12

State Offices of Rural Health, 89

Storage, of diagnostic and health information, 156

Students, loan repayment programs for disadvantaged, 8

Studies, major ongoing pay-for-performance, 121–123

Subject-specific skills, for public health professionals, 102

Substance abuse

defined, 234n

See also Mental health and substance abuse services

Substance Abuse and Mental Health Services Administration (SAMHSA), 21, 142

Surgeon General, 238–239

Sustainable growth rate (SGR) formula, 130

T

Targeted rural quality programs, 71–72

targeting workforce training programs more effectively, 9, 110–111

Technical requirements of health care, 164–165

providing assistance with, 17, 180

Technology/telehealth resource centers, establishing regional information and communications, 17, 178–180

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
×

Telecommunications access networks, surcharges for transfer of health messages across, 15, 172

Telecommunications Act of 1996, 171

Telecommuting, to jobs in urban areas, 1

Teleconsultations, 156

Telehealth resource centers, 17, 178–180

Telehealth services, 149, 163–165

identifying barriers to, 15, 173

Telemedicine, 15, 153, 156, 163–164

Teleneurology diagnostics, 156

Telepsychiatry, 157

Tertiary centers, 63

Timeliness, 38

of improving population health and personal health care, 45, 47–48

of quality of care in rural communities, 35–36

Titles VII and VIII, 8, 88, 102, 110

To Err Is Human: Building a Safer Health System, xi, 31, 33

Training of emergency medical technicians, levels of, 226–227

Training programs, experientially based in rural areas, 8–9, 109–110

Transfer of health messages across telecommunications access networks, prohibiting surcharges for, 15, 172

Transfer services, 6

Traveling long distances to provider sites, 47

Trends, racial and ethnic, in rural populations, 210–211

Turning Point: Collaborating for a New Century of Public Health Initiatives, 158

U

Underpayment of rural health providers, historical, 12

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 37

Uninsurance rates in rural areas, 20, 27, 211, 217

Universal Service Administrative Company

E-rate Program, 172

Rural Health Support Mechanism, 171–172

Universal Service Fund, Rural Health Care Program, 15

Urban areas

commuting to jobs in, 1

remoteness from, 1, 20

U.S. health care system, calls for fundamental reform of, 2

Utilization of informatics, by health professionals, 87

V

Veterans Health Administration (VHA), 174, 225

Video-based telemedicine conferencing, 153

W

W. K. Kellogg Foundation, 5, 21

Leadership for Community Change Program, 5, 52, 56

Wakefield, Mary, ix–x, 193

Walsh Center for Rural Health Analysis, 137

Watson, Linda, 198–199

Web-based communication, 60–62, 84

WiMax technologies, 171

Women, self-reported obesity among, in rural communities, 39

Workforce training programs

expanding experientially based in rural areas, 8–9, 109–110

targeting more effectively, 9, 110–111

Working in interdisciplinary teams, by health professionals, 83–84

Workplace basics, for public health professionals, 102

Z

Zero-sum choices, 43

Suggested Citation:"Index." Institute of Medicine. 2005. Quality Through Collaboration: The Future of Rural Health. Washington, DC: The National Academies Press. doi: 10.17226/11140.
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Quality Through Collaboration: The Future of Rural Health Get This Book
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Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities.

Rural America is a vital, diverse component of the American community, representing nearly 20 % of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face.

Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends:

  • Adopting an integrated approach to addressing both personal and population health needs
  • Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals
  • Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care
  • Assuring that rural health care systems are financially stable
  • Investing in an information and communications technology infrastructure

    It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.

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