1 PORH.psu.edu

2012-13 Annual Report

RURAL HEALTHP E N N S Y L V A N I A O F F I C E O F

2 2012-13 ANNUAL REPORT

WELcOmE TO THE 2012-13 ANNUAL REPORT

Pennsylvania is considered to be one of the most rural states in the nation. Anchored by the large metropolitan areas of Pittsburgh in the southwest and Philadelphia in the southeast, the state is home to more than 3.4 million residents living in areas that are designated as rural. Seventy-five percent of the state’s land area and twenty-eight percent of the state’s population live in areas that have been designated as rural according to state and federal definitions. Of the Commonwealth’s sixty-seven counties, forty-eight are considered to be rural.

EnhancingRural Pennsylvanians’Health

The natural resources, the communities, and the people make rural areas of the Keystone State the special places they are. However, the cultural, economic, and geographic differences between rural and urban areas are key factors that affect the delivery of health care services in rural Pennsylvania. These challenges include financially stressed health care delivery systems, shortages of primary and specialty health care provid-ers, hazardous road conditions during the winter months, and a lack of public transportation systems. Rural residents also have reduced access to health insurance options, health promotion and disease prevention programs, and services to address spe-cial health care needs. These issues are addressed through the efforts of advocacy and policy-making groups working in col-laboration with community-based agencies and organizations,

28% of the population lives in rural areas

3.4 million residents

48 counties are designated rural

75% of the land area

Rural Pennsylvania Counties

Rural Pennsylvania Residents

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state and federal governments, statewide and national associations, and others to address the health disparities and access issues that affect the health of the Commonwealth’s rural residents.

The Pennsylvania Office of Rural Health (PORH) is one of those advocates, promoting equity in and access to quality health care for the state’s rural residents and working to ensure that high quality health care is available to all Pennsylvanians, regardless of their geographic location.

OUR VisiON

The Pennsylvania Office of Rural Health will be recognized as the premier rural leadership and information organization across the Commonwealth of Pennsylvania and will strive to be one of the most effective state offices of rural health in the nation.

OUR missiON

The mission of the Pennsylvania Office of Rural Health is to enhance the health status of rural Pennsylvanians through

outreach, education, advocacy, applied research, and special projects focused on rural health care organizations and the communities they serve.

To fulfill its mission, PORH will be:

u recognized within the Commonwealth of Pennsylvania by statewide partners, local advocates, and health care providers as the resource for linking and disseminating rural health information, outreach and extension, and rural applied research;

u considered to be the clearinghouse in Pennsylvania for rural health-related information;

u viewed as a major provider of networking and coordina-tion among organizations and individuals dedicated to enhancing the health status of rural Pennsylvanians.

During its two decades of operation, PORH has established a reputation as one of the most trusted sources of information on rural health issues and topics in the state and nationally. PORH’s areas of expertise focus on rural health, agricultural safety and health, and community and economic development.

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PARTNERiNg fOR PENNsyLVANiA

PORH’s effectiveness is strengthened through collaborations with national, state, and local organizations and agencies, health care providers, academic institutions, and others that focus their efforts on rural health, agricultural health and safety, and community and economic development.

Located at Penn State, PORH is administratively housed in the Department of Health Policy and Administration in the College of Health and Human Development, and is affiliated with Penn State Outreach and Penn State Extension.

2012-13 fiscAL sUPPORT

sources of support

• Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services

• Pennsylvania Department of Health

• Pennsylvania Department of Agriculture

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RURAL HEALTH

Our Partners

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ExPENdiTUREs

PORH’s expenditures support its mission of service to the rural communities and citizens of the Commonwealth through outreach, education, and advocacy activities and through grants to eligible rural health care facilities to support enhanced services.

grants/contracts 35%

Personnel 50%

Operations 6%

Overhead 9%

Sources of Support Categories of Expenditures

federal 61%

state 25%

Other 2%

Penn state 13%

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AcTiViTiEs

Through activities centered on rural health, agricultural safety and health, and community and economic development, PORH strives to:

u advocate for rural Pennsylvanians;

u raise awareness of rural health issues;

u strengthen the existing network of rural providers and advocates by encouraging partnerships and identifying opportunities for collaboration;

u act as a liaison among academia, state and federal agen-cies, professional associations, and health care providers;

u provide information to policy makers, health care provid-ers, health educators, and health administrators; and

u conduct applied research about health care issues that affect rural Pennsylvanians.

AdVOcAcy

Rural health advocacy is one of the highest priorities of PORH. During 2012 and 2013, PORH staff members continued to advance the office’s impact by serving on health-related and rural economic development boards of directors, committees, task forces, and work groups at the national, state, and local levels to ensure that the rural voice was heard.

Accomplishments

PORH’s affiliations with the National Rural Health Association, the National Organization of State Offices of Rural Health, the Pennsylvania Rural Health Association, Pennsylvania Rural Partners, organizations addressing health information technology and insurance exchange in the state, and other community-based organizations, provide a strong voice for rural health advocacy.

PORH’s staff continued to co-chair the National Organization of State Offices of Rural Health’s Policy Committee where significant advocacy focused on national and state policy and legislation associated with the implementation of the Patient Protection and Affordable Care Act. Staff also chaired the Legislative Committee of the Pennsylvania Rural Health Association which advocated for rural representation in health information technology implementation, state Medicaid changes, and other issues that affect the delivery and payment of health care services in rural areas. PORH staff also chaired a coalition of organizations to offer a rural briefing for the Pennsylvania General Assembly and legislative staff.

PORH staff promoted rural health and safety by providing leadership to the advisory committees of the Pennsylvania Trauma Systems Foundation and Quality Insights of Pennsylvania, Inc. (the state’s quality improvement organi-zation), Penn State Hershey Children’s Hospital’s Center for Nutrition and Physical Activity, statewide pesticide advisory committees, and community-based health partnerships.

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PORH provided 662 technical assistance

encounters to 351 clients

PORH staff gave presentations reaching

more than 400 professionals, elected

officials, consumers, and students

TEcHNicAL AssisTANcE cONsULTATiONs

Providing technical assistance to rural communities and the health care delivery systems that serve rural areas is one of the core mandates of the State Office of Rural Health program. In 2012-13, PORH provided 662 technical assistance encounters to 351 clients in the state, including communities, state and local agencies, elected officials, rural health networks, hospi-tal and health care delivery systems, primary care providers, community-based clinics, community foundations, health care consultants, and consumers. These clients received valuable information on rural health issues, rural health and health care data, funding opportunities, project and grant reviews, best practices, referrals, tools, and more that helped strengthen the rural health care delivery system.

EdUcATiON ANd OUTREAcH

Rural Health continuing Education Programs

PORH coordinated statewide and regional continuing educa-tion events focused on issues and skills important to rural health providers and advocates, including grant writing, community health needs assessments, and meeting rural community health needs. In addition to continuing education programs coordinated by PORH, staff members gave presen-tations on rural health issues at conferences and academic settings, reaching over 400 professionals, elected officials, consumers, and students.

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The Power of Rural: celebrating National Rural Health day 2012

To highlight the health-related challenges that rural com-munities are facing on a regular basis–and to honor the community-minded spirit that prevails in rural America–the National Organization of State Offices of Rural Health (NOSORH) coordinated the second annual National Rural Health Day celebration on November 15. Events held that day across the United States showcased the efforts of rural health care providers; State Offices of Rural Health; and community, state, and national rural health advocates in addressing those challenges.

In Pennsylvania, rural stakeholders and rural health award winners gathered in State College, Pennsylvania, on November 15 for “The Rural Health Leadership Celebration” coordinated by PORH and co-sponsored by The Hospital and Healthsystem Association of Pennsylvania and St. Andrew Development, Inc. Dennis Berens (Ret.), former president of the National Rural Health Association and the National Organization of State Offices of Rural Health and director of the Nebraska Office of Rural Health, gave the keynote address on “Community Matters: New Paradigm Thinking in Rural and Rural Health” followed by the presentation of the 2012 Annual Rural Health Awards. Pennsylvania Governor Tom Corbett proclaimed the week of November 12-16, 2012 as “Rural Health Week in Pennsylvania.”

12th Annual Rural migrant and immigrant farm Worker Health conference

A close-knit group of migrant educators, health care providers, and advocates attended the 12th annual Rural Migrant and Immigrant Farm Worker Health Conference, held on March 13-14, 2013 in Grantville, Pennsylvania. The conference, the only one of its kind in Pennsylvania, brings together the health and agricultural communities to focus attention on migrant and immigrant farmworkers’ health care needs, barriers to care, and strategies to overcome those barriers.

This event was coordinated by PORH, and co-sponsored by the Pennsylvania Department of Agriculture, the Pennsylvania Department of Health, Penn State Outreach, and Penn State Extension.

The conference featured topics on community health worker models, identifying health needs, addressing language and cultural barriers, and access to care for documented and undocumented workers. A panel of outreach experts addressed strategies specifically geared to dairy workers.

A tour of Eaton Farms in Leesport, Pennsylvania, showcased wholesale trees, shrubs, and nursery stock. The owner spoke about the benefits and challenges of employing a migrant workforce.

Participants commented that they “look forward to the confer-ence every year,” “loved the variety of topics and speakers,” and also “enjoy networking with others from all over the state!”

The 2014 conference will be held in spring in central Pennsylvania and will focus on agricultural production in the area, including a tour of a local farm that employs a largely Hispanic workforce.

Dennis Berens (Ret.), former president of the National Rural Health Association and the National Organization of State Offices of Rural Health and director of the Nebraska Office of Rural Health, describes the future of rural health leadership.

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state grants Technical Assistance Workshop

The Community Primary Care Challenge Grant Program is an annual competitive grant program sponsored by the Pennsylvania Department of Health’s Bureau of Health Planning. These grants support access to primary medical and dental care for underserved populations by increasing the num-ber of primary practitioners and primary care medical and/or dental clinics through two tiers of funding.

To assist rural health care providers and advocates in pre-paring successful applications to this grant program, PORH coordinated the fourth annual technical assistance workshop, held in August 2012. Forty-four rural health program admin-istrators and advocates received an overview of the grant program and practical grant-writing tips and techniques. In response to the grant program’s Request for Application (RFA), forty-three applications were submitted and eleven projects were funded.

For more information about these grant programs and others, please see http://www.portal.state.pa.us/portal/server.pt/community/primary_care_resources/14194/community_challenge_grant_program/556930.

swimming Pool Pesticide Applicators certification Preparation and Recertification Training Program

Pennsylvania’s Pesticide Control Act requires that pesticides and chemicals used at commercial/public pools and swim-ming areas in the Commonwealth be applied only by a certified pool pesticide applicator. PORH, in collaboration with the Pennsylvania Department of Agriculture, coordinates cer-tification preparation and recertification training programs for swimming pool pesticide applicators. During the 2012-13 fiscal year, forty-eight applicators earned certification through PORH’s preparation programs and 136 applicators earned recertification credits through seven PORH programs.

44 rural health program administrators

and advocates received an overview

of the community Primary care

challenge grant Program

11 projects were funded

48 pool pesticide applicators earned

certification and 136 earned recertification

credits through 7 PORH programs

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Rural Health Program of the year

The Clearfield-Jefferson Community Mental Health Center (CJ- CMHC) was presented with the 2012 Rural Health Program of the Year Award. CJ-CMHC, an outpatient behav-ioral health organization providing care to the persistently mentally ill population in Clearfield and Jefferson counties, created an integrated physical/behavioral care program that is one of the first of its kind to be offered in rural Pennsylvania. Through this model, a primary care clinician from the DuBois Regional Medical Center and a pharmacist from Genoa Healthcare are housed in CJ-CMHC’s DuBois facility. As a result, these partners can provide better coordinated physical and behavioral health services that increase consumer lifespan and reduce health care costs.

state Rural Health Leader of the year

Michael Hecht, Ph.D., Penn State Distinguished Professor of Communication Arts and Sciences, received the 2012 State Rural Health Leader of the Year Award. Hecht leads a mul-ticultural drug prevention project, keepin’ it REAL (Refuse, Explain, Avoid, Leave), that aims to reduce alcohol, marijuana, and tobacco use among middle-school-aged youth. The pro-gram, recognized by the National Registry of Evidence-based Programs and Practices and available through Penn State and D.A.R.E. America, is a program “from kids, to kids, through kids” that has been proven to be effective in lowering levels of drug use. Under Hecht’s guidance, keepin’ it REAL has been adapted for use in rural settings and is the first program to emphasize culturally relevant themes for rural youth.

Rural Health Hero of the year

Penny Miles, DC, received the Rural Health Hero of the Year Award. Miles, a chiropractor practicing in Belleville, Pennsylvania (Mifflin County), was honored for her dedication to her patients and the communities in which she practices and lives. Miles goes the “extra yard” to organize her practice so

2012 ANNUAL PENNsyLVANiA RURAL HEALTH AWARds

A community health advocate, a community mental health center, a Penn State distinguished professor, a chiropractor, and a Critical Access Hospital were the recipients of the 2012 Pennsylvania Rural Health Awards. These awards are presented each year to recognize rural health programs and individuals who have made substantial contributions to rural health in Pennsylvania. This year’s award winners were honored at a luncheon ceremony during The Pennsylvania Rural Health Leadership Celebration on November 15.

Staff members from the Clearfield-Jefferson Community Mental Health Center pose with the Rural Health Program of the year award. Featured (l-r) are Wendy Pardee, chief financial officer (Fmr.); Christina Martz, director of adminis-tration; and Gwen Auman, development director(Fmr.).

Award winner Michael Hecht, Ph.D., Distinguished Professor of Communication Arts and Sciences at Penn State, and Morgan Sugg, administrative assistant at Penn State, pose with the State Rural Health Leader of the Year award.

Penny Miles, DC, poses with husband Dale Burkett after receiving the Rural Health Hero of the Year award.

that she can meet the health needs of her patients in the most accommodating way. She and her family, which includes two sons, are heavily involved in activities in their home commu-nity in rural Pennsylvania.

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community Rural Health Leader of the year

Sullivan County resident Joan Gruver received the 2012 Community Rural Health Leader of the Year Award. Gruver was part of a local team that established a volunteer dental clinic in the county and was responsible for founding the Sullivan County Health Partnership (which has since merged with Sullivan County Action). She also started the Sullivan County Health Fair, which is heavily attended each year by residents from Sullivan and surrounding counties. Gruver was lauded for being a “mover and shaker [who] has been a true gem in this rural Pennsylvania county.”

Rural Legislator of the year

The Honorable Matt Baker (R-68th District) received the Rural Legislator the Year Award. Baker, who represents Tioga and parts of Bradford and Potter counties (some of the most rural counties in the state), has been a strong advocate for rural health and has supported activities that advance the under-standing of the issues that impact the delivery of health care services in rural area. He serves as the Republican Chair of the House Health Committee and is a member of the Human Services Committee. His office has been instrumental in supporting and coordinating annual rural legislative brief-ings in Pennsylvania’s capital that educate members of the Pennsylvania General Assembly and their staff about rural health issues and resources.

Louis A. ditzel Jr. Award for Quality improvement

Cole Memorial Hospital in Coudersport, Pennsylvania (Potter County), received the Louis A. Ditzel, Jr. Award for Quality Improvement in Rural Health. Cole Memorial, a Critical Access Hospital, was recognized for being named one of the nation’s “Top Performers on Key Quality Measures” by the Joint Commission on the Accreditation of Healthcare Organizations, making it one of just 18 percent of more than 3,400 accred-ited hospitals in the United States to earn this distinction for attaining excellence in accountability measure performance.

The hospital was also one of only six teams selected to pres-ent at the National Rural Health Association’s Rural Quality Clinical Conference in July 2012 for its work in care transitions and hospital readmissions.

Featured from l-r are Jim Rogers, chairman of Sullivan County Action, Inc.; award winner Joan Gruver; and Darla Bortz, Sullivan County Commissioner with the Community Rural Health Leader of the Year Award.

Rep. Matt Baker (R-68th District ) poses with Lisa Davis, PORH director, after receiving the Rural Legislator of the Year award.

Cindi Hardesty, vice-president and chief nurse executive (l) and Ed Pitchford, president and CEO of Cole Memorial Hospital, accept the Award for Quality Improvement from Lisa Davis, PORH director.

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The Jennifer S. Cwynar Rural Health Undergraduate Summer Internship Program is named in memory of Jennifer S. Cwynar, a 2008 graduate of Penn State’s undergraduate program in health policy and administration, who served as PORH’s intern in the summer of 2008. Cwynar died on January 6, 2010, as the result of injuries sustained in a traffic accident near her home in Turtle Creek, Pennsylvania. The Jennifer S. Cwynar Rural Health Undergraduate Internship Program exposes Penn State undergraduate students to the unique health care access, affordability, and quality issues facing rural Pennsylvanians. The internship gives students the opportunity to research rural health policy and legislation; assist with the planning of state-wide continuing education events; participate in meetings with key state, regional, and national rural health policymakers and stakeholders; and pursue self-directed interests that further their educational and professional goals.

Because of a generous financial contribution given by the Cwynar family, PORH offers an “externship experience” to the office’s intern. In the summer of 2013, PORH hosted Melissa Herder, a Penn State undergraduate health policy and administration student. Herder took the lead on developing the layout and content for a website on the Patient Protection and Affordable Care Act that will be used by Penn State Extension with consumers seeking health insurance. She used her fluency in Spanish to translate documents for a Critical Access Hospital in order to bring them into compliance with language access regulations. And she pursued her passion for public health by visiting several federally qualified health centers (FQHCs) to observe and learn first-hand about providing primary care to medically underserved populations. But perhaps the most rewarding experience was her exposure to and working with the migrant health program in the southcentral part of the

state and assisting with outreach and health care services at migrant farm worker camps.

Melissa’s externship experience surpassed her expectations. “It was wonderful,” she said repeatedly. The visits to the camps were especially illuminating. “I had no idea that people actu-ally lived like that,” she remarked. And it was apparent that her time with the migrant farmworker program may greatly influence the direction she takes when she graduates since she has now expressed an interest in a graduate program in public health so that she can work with migrant populations.

THE JENNifER s. cWyNAR RURAL HEALTH UNdERgRAdUATE sUmmER iNTERNsHiP PROgRAm

“I had no idea that people actually lived like that.”

–iMelissaiHerder

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mEdiA

Our flagship publication: Pennsylvania Rural Health magazine

PORH’s bi-annual magazine, Pennsylvania Rural Health, highlights issues affecting the health status of rural Pennsylvanians, showcases rural health initiatives across the commonwealth, and offers information on state and federal rural health policy and legislation. The magazine is distributed to over 2,000 health care professionals and organizations across the state and nationally, announced via Twitter and Facebook, and posted on the PORH website, www.porh.psu.edu.

Highlights from issues published in 2012-13 include articles on:

u the Marcellus Shale drilling boom in Pennsylvania and its impact on rural health care services;

u medical transportation services for rural veterans;

u Level IV Trauma Center development in rural Pennsylvania;

u innovative programs to increase healthy food choices and manage chronic disease;

u efforts to mitigate pesticide exposure among migrant farm workers;

u infant mortality rates in Appalachia;

u federal funding to support rural community infrastructure; and

u graduate education programs for rural health care administrators.

PORH Website

PORH’s website is a primary source of information for funding opportunities, specific PORH-sponsored continuing education events, rural health-related publications, state and national

conferences and trainings, and rural health-related information and resources. Be sure to visit PORH’s website on a regular basis at www.porh.psu.edu.

Using social media

PORH continued to improve its visibility through Twitter and Facebook. Like “Pennsylvania Office of Rural Health” on Facebook and sign up to follow “PORH” on Twitter at: twitter.com/PORH to receive information about upcoming conferences and workshops; recently-released publications, including Pennsylvania Rural Health magazine; and some fun and interesting facts about rural health.

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TARgETEd PROJEcTs

medicare Rural Hospital flexibility grant Program

For more than ten years, the administration of the Medicare Rural Hospital Flexibility (Flex) Program was a collaboration between the Pennsylvania Department of Health (PA-DOH) and PORH. During the fall of 2012, the federal grant to sup-port the program was transferred from the Commonwealth to be administered directly by PORH. The PA-DOH now joins other state agencies and organizations such as the Hospital and Healthsystem Association of Pennsylvania, Quality Insights of Pennsylvania, Inc., the Pennsylvania Trauma Systems Association, and a number of other organizations as important partners in the implementation of the program.

In order to receive CAH designation, a hospital must be located at least fifteen miles by secondary roads or mountainous ter-rain from another hospital or be designated as a “necessary provider.” The hospital also must be limited to no more than twenty-five inpatient beds and it must provide twenty-four-hour emergency care services. All of Pennsylvania’s thirteen CAHs are located more than thirty-five miles from another hospital or were certified by the Commonwealth before January 1, 2006, as a “necessary provider” of health care services to residents within a particular area. Hospitals achieving CAH status are eligible for reimbursement of Medicare inpatient and outpatient services at 101 percent of their allowable and reasonable costs. This is in recognition of the fact that lower-volume hospitals need an enhanced payment structure to remain financially viable.

Leaders from Pennsylvania’s CAHs participate in the Pennsylvania Critical Access Hospital Consortium. Created in 2002 under PORH’s leadership, the consortium is a rural health network that focuses on performance improvement networking using the Balanced Scorecard management tool as a common framework and data collection model. Funded through grants from the Flex program, the consortium offers a

highly coordinated, efficient, and cost-effective forum for CAH leadership to manage individual hospital strategy, compare performance among peers, and share best practices to achieve better clinical outcomes and stronger financial performance.

The CAHs continued their long history of success. Corry Memorial Hospital opened its new facility in September 2012 and Endless Mountains Hospital and Troy Community Hospital will open new facilities in 2013. Two CAHs received significant national recognition this year when Muncy Valley Hospital was named a Top 100 Critical Access Hospital by Hospital Strength Index based upon the hospital’s strong met-rics in quality, market, and finances. Cole Memorial Hospital was named one of the nation’s Top Performers on Key Quality Measures by The Joint Commission. The Cole Memorial team was recognized for exemplary performance in using evidence-based clinical processes to improve care for heart attack, heart failure, pneumonia, surgical care, children’s asthma, stroke and venous thrombo-embolism, and inpatient psychiatric services. Cole Memorial also received the 2012 Louis Ditzel Award, Jr. Award for Quality Improvement.

central

capitalsoutheast

Northeast

southwest

Northwest

13 critical Access Hospitals

in Pennsylvania

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Clinical outcome improvements have been achieved through collaboration with Quality Insights of Pennsylvania, Inc. (QIP), Pennsylvania’s Quality Improvement Organization (QIO). Led by QIP, all thirteen CAHs participated in the Agency for Healthcare Research and Quality (AHRQ) Hospital Culture of Patient Safety survey process and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training in 2012-13. TeamSTEPPS is an evidence-based teamwork system designed to improve communication and teamwork skills among health care professionals with an emphasis on patient safety assessment and interventions.

Pennsylvania was one of the first states in the nation to have all CAHs agree to participate in the federal Office of Rural Health Policy’s (ORHP) Medicare Beneficiary Quality Improvement Program (MBQIP), which began in September 2011. This program drives quality improvement within the nation’s 1,300+ CAHs through developing a common set of metrics for reporting and sharing best practices in clinical care for rural Medicare beneficiaries served by these hospitals. Beginning in July 2012, Pennsylvania’s CAHs began reporting their CMS outpatient core measures and their Hospital Consumer Assessment Healthcare Providers and Systems’ (HCAHPS) patient satisfaction data. The third phase of the program, beginning in September 2013, will focus on medication veri-fication orders and emergency department transfer measures. Pennsylvania’s CAHs also participate in iVantage’s Hospital Strength Index which permits the hospitals to benchmark financial, market, and quality domains against CAH peer and PPS hospitals.

For the fourth consecutive year, PORH partnered with The Pennsylvania State University’s Department of Industrial Engineering to implement an individualized senior under-graduate student capstone project at a Critical Access Hospital. Muncy Valley Hospital and its affiliate organization, The Williamsport Hospital, collaborated on projects that addressed acuity-based staffing for long-term care, nursing unit supply

chain process analysis, and patient family waiting room analysis.

Continuing with the efficiency training once again through Penn State Continuing Education, the Toyota Production System for Healthcare was offered. This year’s participants were Tyrone Hospital and Fulton County Medical Center. CAH staffs learned Lean concepts and implemented projects that save time and money for their organizations.

PORH and the Pennsylvania Trauma System Foundation (PTSF) continued to collaborate to strengthen rural trauma care in Pennsylvania. Flex funds also supported rural trauma education programming at PTSF’s annual conference, and PORH continued to provide Flex funding to cover fees for three CAHs pursuing Level IV Trauma Center accredita-tion: Cole Memorial, Fulton County Medical Center, and Troy Community Hospital. Level IV Trauma Center objectives are to provide enhanced trauma services in rural underserved areas with a focus on optimizing trauma care within the Emergency Department and to provide initial care and stabilization of traumatic injury while arranging transfer to a higher level of trauma care.

PORH also gave Flex funding for the development of the Rural Trauma Team Development Course (RTTDC) which supports training to rural hospitals from Level I and II Trauma Centers on enhancing patient care and expediting trauma patient transfer.

Through collaboration with The Hospital and Healthsystem Association of Pennsylvania (HAP) and the Health Research Educational Trust (HRET), Flex funding was provided for the Critical Access Hospitals to participate in a learning network and to implement performance improvement programs based upon their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. Patient experience of care, as measured by HCAHPS, is consistently correlated with hospital quality.

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The small Rural Hospital improvement grant Program

In 2012-13, the federally-funded Small Rural Hospital Improvement Grant Program (SHIP) provided funding to twenty small (fewer than forty-nine beds) rural hospitals in Pennsylvania to help them measure their level of clinical qual-ity reporting and prepare for new payment methodologies, including value-based purchasing and bundled payment systems.

Twelve of the twenty-one hospitals used this funding to sub-scribe to an online benchmarking tool, Rural Performance Management (RPM), a performance improvement system developed to assist small rural hospitals in comparing their performance, internally and externally, with other like-sized hospitals. RPM utilizes the Balanced Scorecard concept as a framework for helping hospitals link strategic objectives to their performance improvement programs to align hospital staff and clinician activities with the hospital’s goals. The remaining eight hospitals applied funds to projects focusing on hospital-specific performance improvement.

The Pennsylvania Rural Health farm Worker Protection safety Program

The Pennsylvania Rural Health Farm Worker Protection Safety Program continues to provide technical and compli-ance assistance to Pennsylvania’s agricultural producers in understanding and implementing the federal Environmental Protection Agency’s (EPA) Worker Protection Standard (WPS) regulation. This regulation gives agricultural workers the basic principles and practices of pesticide safety, including pesticide safety training, application information, and decontamination supplies. Although the WPS focuses on employee safety, these regulations also can provide a safer environment for farm own-ers and their families.

sHiP provided funding

to 20 small, rural

Pennsylvania hospitals

The program uses individual farm visits, presentations at grow-ers’ meetings, and the development of safety training materials to assist growers and their employees in understanding and implementing the WPS. All outreach is designed to be cultur-ally appropriate and accessible by English-speaking; Hispanic; and Amish, Mennonite, and other Anabaptist farmers.

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PORH’s rural health farm worker

protection safety specialist provided

over 250 assistance visits

and a dozen presentations

medicaid managed care Expansion

trainings were held with more

than 180 in attendance

During the 2012-13 year, PORH’s rural health farm worker protection safety specialist traveled more than 15,000 miles throughout the Commonwealth, providing over 250 assistance visits and presenting a dozen presentations on WPS at trade group and pesticide meetings.

Through the program, new materials continued to be developed to educate the diverse audience. A WPS training DVD for the nursery industry was developed and work on training materials for the Anabaptist community was initiated. These and other materials will be updated when the EPA releases revised WPS regulations.

Program staff conducted outreach for on-going research projects on the health impacts of pesticide use and provided input into the design of future research on the use of Personal Protective Equipment (PPE) by farm owners and migrant and immigrant farmworkers.

This program continues to be a collaborative effort among PORH, the Penn State Pesticide Education Program, and the Pennsylvania Department of Agriculture.

medicaid managed care Expansion Outreach and Education in Rural Pennsylvania

With support from the National Organization of State Offices of Rural Health’s funding for state-based collaborative projects, PORH teamed up with the Pennsylvania Health Law Project to implement “A State Partnership for Medicaid Managed Care Expansion Outreach and Education in Rural Pennsylvania.” Through the project, trainings were offered in rural regions of the state where Pennsylvania’s Medicaid managed care program, HealthChoices, was being implemented. Targeted audiences included rural community-based agencies, health care providers, and consumers on the details of eligibility and enrollment into HealthChoices. During the last few months of the fiscal year, five trainings were held with more than 180 in attendance with more planned for the first five months of the 2013-14 fiscal year.

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REsEARcH EffORTs

Exploring the community impacts of marcellus shale drilling

In 2012-13, researchers at Penn State, including PORH’s director, continued their investigation into the community impacts of Marcellus Shale drilling through the Marcellus Shale Impacts Study: Chronicling Social and Economic Change in North Central and Southwestern Pennsylvania. This project explored the effects of Marcellus Shale development in the four counties in the state that have seen the highest level of drilling activity: Bradford, Lycoming, Washington, and Greene. The research examined changes in economic and workforce devel-opment; population and industrial changes; and the impacts on housing, health and human services, public safety, and educa-tion, with an emphasis on low-income families, youth, and new residents. The results of the project will inform policy makers at the state and local levels about the implications of Marcellus Shale development. The project is funded by the Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly.

identifying factors that contribute to Rural Women’s Health disparities

The Rural Women’s Health Care Project (RWCHP), initiated in 2010 by researchers at The Pennsylvania State University, aimed to understand the perspectives of primary care physi-cians who provide health care services for women living in rural communities in Central Pennsylvania. Women in rural areas are known to experience health disparities with regard to cancer screening, reproductive health services, and other key primary care areas. The goal of the RWHCP was to better understand the reasons for those disparities from physicians’

perspectives in order to identify potential mechanisms to improve the delivery of primary care to women residing in rural areas.

In 2010, PORH’s research associate, Marianne Hillemeier, professor of health policy and demography at Penn State, and her collaborators, interviewed rural primary care providers representing family medicine, internal medicine, general prac-tice, and obstetrics-gynecology to identify barriers to providing these services specific to rural areas and provide targets for future intervention studies. The researchers found that primary care providers perceived several barriers to accessing mental health care among their rural patients, including a lack of mental health providers and services in communities; lower incomes; and lack of health insurance or underinsurance, which limits options for referral for services. They also found that the social stigma associated with treatment for mental health issues prevents some women from seeking care, as do norms of self-reliance and independence. Results of the project will be published in 2013-2014 in Rural and Remote Health, the Journal of Interpersonal Violence, and Mental Health in Family Medicine.

19 PORH.psu.edu

LOOkiNg AHEAd TO 2013–14

In 2013-14, PORH will continue to devote attention to enhancing current programs, creating new initiatives, and using appropriate technology to serve rural health stakeholders as effectively and efficiently as possible. Please let us know how we can assist you!

PORH sTAff

Lisa Davis, M.H.A., Director and Outreach Associate Professor of Health Policy and Administration

Marianne Hillemeier, Ph.D., M.P.H., Faculty Associate

Chris Calkins, Ph.D., M.P.H., Faculty Associate

Larry Baronner, M.S., M.Ed., Critical Access Hospital Coordinator

Terri Klinefelter, B.S., Outreach Coordinator

Jim Harvey, B.S., Rural Health Farm Worker Protection Safety Specialist

Devon McChesney, Budget/Staff Assistant

20 2012-13 ANNUAL REPORT

PENNsyLVANiA OfficE Of RURAL HEALTH

Working to Enhance the Health status of Rural Pennsylvanians

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WWW.PORH.PsU.EdU

Pennsylvania Office of Rural HealthThe Pennsylvania State University

202 Beecher-Dock HouseUniversity Park, PA 16802-2315

Telephone: 814-863-8214Fax: 814-865-4688

porh@psu.edu

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Pennsylvania Office of Rural HealthThe Pennsylvania State University202 Beecher-Dock HouseUniversity Park, PA 16802-2315