A Community Health Nursing Plan of Care Lack of Health Care Providers In Mecosta County Pam Beringer, Erin Burdi, Debra Francik , and Ashley Jacobson
Transcript
A Community Health Nursing Plan of Care
Lack of Health Care Providers In Mecosta County
Pam Beringer Erin Burdi Debra Francik and Ashley Jacobson
Assessment amp AnalysisEpidemiological Concepts
Host Due to the ldquoruralrdquo classification of Mecosta County residents of this community
are at an increased risk for a shortage of Health Care Providers (HCPrsquos)
Assessment amp AnalysisEpidemiological Hosts
Rural areas (also referred to as the country andor the
countryside) are settled places outside towns and
cities (Farlex 2010 para 1)
According to the US Census Bureau the classification of ldquoruralrdquo includes all territories populations and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000)
Assessment amp Analysis Epidemiological Host
In the year 2000 the Mecosta County total population census was 40553
(MSUE2007)
The rural population of Mecosta County was 28780 residents or 706 of the total population (US Census Bureau 2000)
27642 (96 )of these residents lived in Non-Farm areas amp 1138 (4) of residents lived in farm areas (MSUE 2007 p5)
Assessment amp Analysis
United States 21 59061367 281421906
Michigan 253 2 518987 9938444
Mecosta 706 28780 40553
Percentage of Population
Rural Population Census Total Population
Rural Population Comparison
According to Census Data Mecosta County has a greater percentage of rural resident population than both the State amp National census
combined (US Census Bureau 2000)
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp AnalysisEpidemiological Concepts
Host Due to the ldquoruralrdquo classification of Mecosta County residents of this community
are at an increased risk for a shortage of Health Care Providers (HCPrsquos)
Assessment amp AnalysisEpidemiological Hosts
Rural areas (also referred to as the country andor the
countryside) are settled places outside towns and
cities (Farlex 2010 para 1)
According to the US Census Bureau the classification of ldquoruralrdquo includes all territories populations and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000)
Assessment amp Analysis Epidemiological Host
In the year 2000 the Mecosta County total population census was 40553
(MSUE2007)
The rural population of Mecosta County was 28780 residents or 706 of the total population (US Census Bureau 2000)
27642 (96 )of these residents lived in Non-Farm areas amp 1138 (4) of residents lived in farm areas (MSUE 2007 p5)
Assessment amp Analysis
United States 21 59061367 281421906
Michigan 253 2 518987 9938444
Mecosta 706 28780 40553
Percentage of Population
Rural Population Census Total Population
Rural Population Comparison
According to Census Data Mecosta County has a greater percentage of rural resident population than both the State amp National census
combined (US Census Bureau 2000)
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp AnalysisEpidemiological Hosts
Rural areas (also referred to as the country andor the
countryside) are settled places outside towns and
cities (Farlex 2010 para 1)
According to the US Census Bureau the classification of ldquoruralrdquo includes all territories populations and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000)
Assessment amp Analysis Epidemiological Host
In the year 2000 the Mecosta County total population census was 40553
(MSUE2007)
The rural population of Mecosta County was 28780 residents or 706 of the total population (US Census Bureau 2000)
27642 (96 )of these residents lived in Non-Farm areas amp 1138 (4) of residents lived in farm areas (MSUE 2007 p5)
Assessment amp Analysis
United States 21 59061367 281421906
Michigan 253 2 518987 9938444
Mecosta 706 28780 40553
Percentage of Population
Rural Population Census Total Population
Rural Population Comparison
According to Census Data Mecosta County has a greater percentage of rural resident population than both the State amp National census
combined (US Census Bureau 2000)
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Epidemiological Host
In the year 2000 the Mecosta County total population census was 40553
(MSUE2007)
The rural population of Mecosta County was 28780 residents or 706 of the total population (US Census Bureau 2000)
27642 (96 )of these residents lived in Non-Farm areas amp 1138 (4) of residents lived in farm areas (MSUE 2007 p5)
Assessment amp Analysis
United States 21 59061367 281421906
Michigan 253 2 518987 9938444
Mecosta 706 28780 40553
Percentage of Population
Rural Population Census Total Population
Rural Population Comparison
According to Census Data Mecosta County has a greater percentage of rural resident population than both the State amp National census
combined (US Census Bureau 2000)
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis
United States 21 59061367 281421906
Michigan 253 2 518987 9938444
Mecosta 706 28780 40553
Percentage of Population
Rural Population Census Total Population
Rural Population Comparison
According to Census Data Mecosta County has a greater percentage of rural resident population than both the State amp National census
combined (US Census Bureau 2000)
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Vulnerable Groups ldquoTo be considered vulnerable a person or group generally has aggravating
factors that place them at greater risks for ongoing poor health status then other at-risk personsrdquo (Fisher pg 533)
An example ldquo A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems If that man also had an income below the poverty level no health insurance and stressors related to living conditions he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider would have problems accessing tests and procedures for diagnosis and ongoing monitoring and would have difficulty obtaining and paying for the appropriate medicationsrdquo(Fisher pg 5330
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Specific groups this especially effects
According to Fisher ldquoA vulnerable population is a group or groups that are more likely to develop health-related problems have more difficulty accessing health care to address those health problems and are more likely to experience a poor outcome or a shorter life span because of those health conditionsrdquo (Fisher pg 533)
Characteristics traits and different circumstances enhance the potential for poor health (Fisher pg 533)
ldquoDepartment of Health and Human Services had identified certain groups as more vulnerable to health risks including the poor the homeless disabled the severely mentally ill the very young and the very oldrdquo (Fisher pg 533)
Not all people at risk for poor health are considered vulnerable
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Community Groups of Interest
ldquoWhat is it like to live in a small rural town What do nurses know about rural populations and their nursing needs Although each community is unique the experience of living in a small town is similar in all 50 statesrdquo (Fisher pg 820-821)
The typical rural lifestyle is characterized by the following
Greater spatial distances between people and services An economic orientation toward the land and nature Work and recreational activities that are cyclic and seasonal Social interaction that facilitate informal face-to-face negotiations
because most if not all residents are either related or acquainted (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Community Groups of Interest
ldquoThere is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that systemrdquo (Fisher pg 825)
The community decision making model helps to identify a problem and try to come up with a solution The steps in the model are
- 1 Identify the problem- 2 Assess the communityrsquos perspective- 3 Analyze the data- 4 Develop a long-range plan- 5 Take action- 6Evaluate the program
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Existing Health Resources in Mecosta
ldquoThere is ongoing debate as to whether anything is unique about rural nursing practice because nursing care is similar
regardless of the settingrdquo (Fisher pg 822)
There is little information in periodical and in nursing texts on what actually makes communitypublic health nursing
different in rural settings (Fisher pg 824)
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Community Groups of Interest
ldquoIn brief for rural residents a small town is the center of trade for a region and its churches and schools usually are the centers for socializationrdquo (Fisher pg 821)
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher pg 821)
Assessment amp Analysis Community Groups of Interest
Community Groups that might be interested in helping are
Churches Nursing Students Volunteers Nurses Community Centers American Red Cross
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
There are Three Major Factors that Influence Rural Health
1 Availability of Services
2 Accessibility of Services
3 Acceptability of Services(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Rural Health Influences
Availability of Services ldquorefers to the existence of services and
sufficient personnel to provide those servicesrdquo
(Maurer amp Smith 2009 p815)
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Rural Health Influences
Acceptability of Servicesldquorefers to the degree to which a particular is offered in a manner
congruent with the values of a target populationrdquo(Maurer amp Smith 2009 p816)
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp Analysis Rural Health Influences
Barriers to Acceptability
Traditions of Handling
personal problems without
professional Help
Beliefs about the Cause of a Disorder amp the Appropriate Healer
Knowledge DeficitSpecific Conditions and Value of Prevention and Treatment
Confidentiality amp
Anonymity in a
ldquoEverybody knows
Everyonerdquo community
setting Urban Orientation of
most HCPrsquos
(Maurer amp Smith 2009 p816)
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Assessment amp AnalysisRural Health Influences
Accessibility of Servicesldquo refers to the ability of a person to obtain and afford
needed servicesrdquo (Maurer amp Smith 2009 p815)
Common Barriers to Accessibility IncludeLong Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care ProvidersInequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements(Maurer amp Smith 2009 p815)
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Multiple factors also affect specific groups Lower socioeconomic status Lifestyle behaviors The psychological impact of poverty Genetic inheritance Race Ethnicity Gender Poor education Poor health Sudden change in financial situation
(Fisher pf 541)
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Health Professional shortage areas
ldquoConcerns about rural health care services especially in regions with insufficient numbers of all types of health care providers(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990rsquosrdquo (Fisher pg 809)
ldquoThe US Bureau of the Census estimates that there are 54 million people living in rural areas of the United States They make about 15 (20) of the total population but are spread out across 45 (80) of the land areardquo (Fisher pg 809)
Assessment amp Analysis Shortage of Health Care Providers
As of 2005 Mecosta County had only 34
Practicing Physicians located in Big Rapids
area to care for a Population of 42391
That lsquos a 1 1247 Physician-Patient
Ratio
As of 2005 in the State of Michigan
there are 25146 active physicianswith a State
Population of 10120860
Thatrsquos a 1420Physician ndashPatient
Ratio (excluding physicians with unknown
addresses inactive statuses and osteopathy)
Assessment amp Analysis Epidemiological Agents
Major Health Problems for Rural AreasAccidents amp Trauma
Chronic Illness
Suicide amp Homicide
Alcohol amp Drug Abuse
Assessment amp Analysis Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1 Heart Disease2 Cancer
3 Chronic Lower Respiratory Disease
4 Stroke
5 Unintentional Injuries
6 Diabetes Mellitus
7 Alzheimerrsquos Disease
8 PneumoniaInfluenza
9 Kidney Disease
10 Intentional Self Harm
(Michigan Surgeon Generalrsquos Health Status Report 2010)
>
Assessment amp AnalysisEpidemiological Agents
The Top Ten Causes of Morbidity Mortality for the State of Michigan where nearly identical to those of Mecosta County
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
(Michigan Surgeon Generalrsquos Health Status Report 2010)
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Nursing Diagnosis
Risk for Increased Mortality amp Morbidity in Mecosta County
related to
Lack of Health Care Providers
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Increase the availability of preventative health resources and measures to citizens
of Mecosta County to decrease the burden on current Health Care Providers
(HCP)
Rationale If Residents of Mecosta County have Access to Preventative Care amp become Proactively Involved with Personal
Health the Over-all Community will Benefit from Improved Health amp Reduction of Health Services Required
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Michigan Center for Rural Health
ldquoSupporting and engaging rural Michigan communities and their residents in eating healthy being physically active and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life Collaborative efforts involving communities schools worksites families and others are needed to create environments that support sustainable healthy behaviorsrdquo
(Michigan Center for Rural Health 2008 pg23)
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Primary Prevention ldquoPrimary prevention is aimed at altering the
susceptibility or reducing the exposure of persons who are at risk for developing a specific diseaserdquo (Fisher Pg 170)
ldquoPrimary prevention includes general health promotion and specific protective measures in the pathogenesis stage which are designed to improve the health and well-being of the populationrdquo (Fisher pg 170)
Plan Primary Prevention
Sources for Volunteers amp Community Venues
VolunteersProfessors amp Nursing Students
from Ferris State University located in Big Rapids
Health Care Personnel from Local Mecosta County Hospital
amp Private Practices Church Volunteers
VenuesChurches
Community CentersCounty Hospital
Urgent Care Centers
Plan Primary Community Prevention
Utilize Local Volunteers amp Venues to Educate amp Encourage Preventative Health Measures amp
Provide Free Health Screenings that Target Top 10 Causes of Morbidity amp Mortality in Mecosta
County
For the purpose of this power point we will only show examples
for the top three causes of morbidity amp mortality in Mecosta
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
EducationProper Exercise amp Nutrition According to American Heart Association
Guidelines
Stress Reduction
Early Signs amp Symptoms of Heart Attack
>
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Primary Prevention Services
CancerAssessment of Risk Factors
(Genetics Lifestyle amp Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection Signs amp Symptoms
Self Screening Tools
(Self-Breast amp Testicular Exams)
Smoking Cessation
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Primary Prevention Services
StrokeRisk Assessment
(Genetics Lifestyle Environmental)
EducationNutrition amp Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs amp SymptomsSlurrre
d
Speech
Facial DroopHemi-paresis Numbness ampTingling
Dysphasia
Blurred Vision
>
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Secondary Prevention
ldquoSecondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression thereby preventing disability or complicationsrdquo (Fisher pg 171)
Examples1Preventing transmission of a communicable disease 2 Preventing or slowing of a disease3 Preventing complications from a disease
(Fisher pg 171)
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Tertiary Prevention
ldquo Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for personrsquos who have experienced a loss of function resulting from a disease process or injuryrdquo (Fisher pg 171)
We need to provide Education to people Nursing Care Referrals Resources
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan
Offer Incentives for Future HCPrsquos to Practice in the Mecosta County area
Rationale Through offering Incentives for HCPrsquos to practice in the Mecosta area one can increase the number of HCPrsquos to residents
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Reason Healthcare Providers Avoid Practicing in Rural Areas
ldquoThe reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilitiesrdquo (Health Professions Resource Center 2006)
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Plan Recruitment amp Retention
Recruitment and Retention of HCPrsquos is a challenge for rural areas
Nationally there is a projected provider shortage along with a projected increase in demand for
services as the baby-boomer population reaches retirement age
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health 2008 pg23)
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20 the number of rural health sites approved as Michigan State Loan Repayment sites
Increase by 10 the number of rural providers participating in the State Loan Repayment Program (MSLRP)
Increase by 20 the number of rural health sites approved as National Health Service Corps sites from 127 to 152 Increase by 10 the number of National Health Service Corps provider placements at rural sites Develop a retention model to assist rural hospitals certified rural health clinics and
federally qualified health centers in their retention planning efforts Develop a rural component to the ldquoPractice Michiganrdquo campaign to promote the
benefits and positive aspects of rural practice
(Michigan Center for Rural Health 2008 pg29-30)
Plan Recruitment amp Retention The Michigan Center for Rural Health
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Measurable Outcomes
Increased number of HCPrsquos in Mecosta County
Decrease in HCP to Patient Ratio
Attendance Rate of gt 60 to Local Prevention Seminars amp Screenings
Less admissions into the hospital
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions
(Beringer 2010)
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Intervention
ldquoAn intervention is an interference so as to modify a process or situationrdquo ldquoAn intervention is
designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patientrdquo
(Farlex 2010)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan
The approved goals by the Advisory Group for rural residents are
Access to dental care
Access to mental health
Access to primary care amp specialty care
Practicing health professionals
Targeted education amp training opportunities
The number of applications and admissions into health professions amp training programs
The rate of obesity
The activity level of the population
Healthy eating in the community
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
(Michigan Center for Rural Health 2008 pp 1-2)
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Available Services In Mecosta County
34 Physicians
Hospice care
Nursing Care
Social services
Home care aide or homemaker services
Volunteer care
Physical occupational andor speech therapy
Respite care
Grief support
Spiritual care
EMS Services
(Jacobson 2010)
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Recruitment amp Retention in Mecosta County
Recognize the shortage of health care providers
Evaluating the ratio of health care providers to the number of patients
Showcase the environment to draw health care workers to the area
Describe the different religious organization
Illustrate the different cultural groups in the area
Highlight the civic activates and cultural arts available in the area
Offer incentives for relocation
Illustrate the recreation activities that are offered in the area
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Health Care ProvidersMecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center (2010)
Mecosta County Medical Center provides services inMaternityCardiopulmonary amp RehabilitationCritical Care UnitEmergency CareHome Health CareInpatient Medical RehabilitationLaboratory ServicesMedical ImagingNutrition and Dietary ServicesOccupational MedicineOutpatient Physical RehabilitationPharmacySpecialty ClinicsSurgical Services
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Mecosta County is classed as a Micropolitan area with two Rural areas bordering it
There are no free clinics located in the county or surrounding counties
(Michigan 2010)
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The shortage of Health Care Providers is an issue with todayrsquos economy Extending care and services suffer due to cut back in the budgets The existing care institutions needs to reach out to communities and other businessrsquos to facilitate the growing need for health care providers and facilities Community involvement can increase awareness of services in the community
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Showcasing Mecosta CountyMecosta County offers diverse terrain
Rolling hills
Marsh land for wild life
(Ertman 2010)
Northern woods for stunning color
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9Lutheran Church - 2United Church of Christ - 1The Wesleyan Church - 3Evangelical Lutheran Church in America - 1Evangelical Free Church of America - 1Free Methodist Church of North America - 4Christian Churches and Churches of Christ - 3Wisconsin Evangelical Lutheran Synod - 2Church of Jesus Christ of Latter-day Saints - 1Episcopal Church - 1Presbyterian Church - 1Church of God ndash 3
Old Order Amish - 3Christian Reformed Church in North -America - 1General Association of Regular Baptist Churches - 1Assemblies of God - 2Church of God (Cleveland Tennessee) - 1Conservative Baptist Association of America - 1Church of the Nazarene - 1Community Church of Christ - 1Seventh-Day Adventist Church - 1Sothern Baptist Convention - 1Churches of Christy - 1Baharsquoi ndash 15 members (no congregations)Salvation Army - 1Buddhists - 1
(Rousseau 2010)
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Population Affiliation Percentage in Mecosta
County Lutheran Church (11)
United Methodist Church
(14)
United Church of Christ
(5)
Catholic Church (28)
The Wesleyan Church (5)
Other (37)
(Rousseau 2010)
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are
bull German (26) bull English (11) bull United States or American (10) bull Irish (9) bull Polish (5) bull Dutch (4) bull French (except Basque) (4)
Amish also reside in the area
(Dixon 2010)
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Highlighting The Activities That Are Provided In The Community Can Enhance The Benefits Of Living In A Small Rural Area
Monthly Rise lsquoNrsquo ShinersquosMonthly Business After HoursMecosta County Community and Family EXPOPioneer Group Chamber OpenAnnual Morley Free Festival Bike ShowAnnual Labor Day Arts and Crafts FestivalBulldog BonanzaAnnual Mecosta County Community Holiday Gala
Showing the activities that are monthly amp annually gives a feel of community closeness
( Rousseau 2010)
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service
Repaying student loans
Health care workers that work in the more remote areas receive higher pay
(Shinohara 2010)
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Mecosta County Offers A Wide Range Of Recreation For Everyone
City Parks - 14
Lakes and Rivers - 5
Hiking
Camping ndash x3 local areas
Mountain Biking ndash x4 different areas
Ferris State Racquet amp Fitness Center
Hunting
Snowmobiling
Cross Country Skiing Francik 2010
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary secondary and tertiary preventive care is ideal but the services that provide this care may be hard for rural areas to access
Reaching out to the local venues for participation Provide health fairs Promote community physical activities Provide screening services in different areas of the community Provide workshops on good nutrition Provide stress management classes Provide information on social support in the community (Pender 2006)
Ways to reach out and help other people
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Primary Medical Care Providers
53 free clinics are located in Michigan with only 10 located in the northern part of Michigan
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
(Michigan Center for Rural Health 2008)
Provide primary care that is reimbursed by health care payers
Eight counties in the northern part of Michigan have no hospitals Out-patient clinics is the only available health care facility
Health departments are shared with other larger districts
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Objectives Form a committee to target healthy eating and fitness to decease
heart disease
Encourage school participation by Replacing vending machine with water amp health alternatives Encourage the use of healthy models when preparing lunches Have healthy eating seminars for families Encourage the local farmers and markets to form a partnership with
school for lower rates for food purchases Develop exercise programs that include the whole family at affordable rates Encourage a partnership with Ferris State Racquet and Fitness Center
Decreasing health problems decreases the work load of HCPrsquos
(Michigan Center for Rural Health 2008)
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Increase Education
Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate the whole community
Develop web resources with learning material premade meal planning quick and easy to follow recipes tips on sales and coupons and interactive games on healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
(Michigan Center for Rural Health 2008)
Provide informational hotlines for the community to call
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Vulnerable members of the community
Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly handicapped poverty stricken and people with lack of transportation
Provide information on Meals on Wheels Women Infant and Children (WIC) and transportation alternatives schedules
Encourage local venues to assist with transportation shopping and companionship
(Michigan Center for Rural Health 2008)
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
An evaluation is a critical appraisal or assessment a judgment of the value worth character or effectiveness of that which is being assessed (Farlex 2010)
Evaluation
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
Plan the evaluation Collect evaluation data Analyze the data Report the evaluation Implement the results
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process
Our evaluation would consist of
∆ Did the number of HCPrsquos increase during the time frame ∆ If the number of HCPrsquos increased did the work load decrease ∆ Did attendance increase at the screenings seminars and other events held ∆ Did the hospital admissions decrease and was it due to our interventions
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Did the number of HCPrsquos increase during the time frameIf the number of HCPrsquos did not increase different means of recruiting incentives and advertising may be needed
If the number of HCPrsquos increased did the work load decrease
This is based on the increase of the HCPrsquos If the number of HCPrsquos did not increase the work load would not decrease
If the number of HCPrsquos increased did the work load decrease
Outcomes
If the attendance increased and was above 60 as planned what was more beneficial the screenings seminars andor the events held
If the attendance was below 60 reevaluation of the area held in time held and type of screening seminar or event was held
Did hospital admission drop and what type of admission have decreased
If hospital admissions did not drop what type of patients continue to get admitted
Did attendance increase at the screenings seminars and events held
Did the hospital admissions decrease and was it due to our interventions
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Conclusions and Recommendations
Conclusions from the data would be formed with all involved parties
amp
Recommendations are made and changes are made if needed
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Federal Authority in Health Care
Responsible for protecting the health of its population
Regulates interprets the law and administers services mandated by law
Responsible for supervision and compliance with health law regulations
Involved indirect services
Maurer amp Smith 2009 p 64
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
State Authority in Health CareFinances care of the poor and disabled
Manages Medicaid programs
Operates state mental health hospitals
Oversees licensure and regulation of health providers and facilities
Attempts to control health care costs
Regulates insurance companies Maurer amp Smith 2009 p 68
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
County Authority
Health department
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
State Childrens Health Insurance Program (SCHIP)
School health programs
Mental health programs
Community health educationMaurer amp Smith 2009 p 69
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Hypothetical State Superagency Incorporating the Health Department
Maurer amp Smith 2009 p 69
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
0
20
40
60
80
100
62
81 80 80 84
6679
61
81
RaceEthnicity
RaceEthnicity
Percentage
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
Increase the Number of People with Health Insurance
(Healthy 2010)
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
FEMALE MALE0
10
20
30
40
50
60
70
80
90
FEMALEMALE
Increase the Number of People with Health Insurance Female vs Male
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
POO
R
NEAR PO
OR
MID
DLEH
IGH
MECO
STA COUNTY
OUTSID
E MECO
STA CO
UNTY
WIT
H DIS
ABILIT
Y
WIT
HOUT D
ISABIL
ITY
0
20
40
60
80
100
66 69
9183
80 83 83
FAMILY INCOME LEVEL
FAMILY INCOME LEVEL
Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997 Note Age adjusted to the year 2000 standard population
(Healthy 2010)
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
(Wolf 2010)
Percentage of Uninsured Rises In USA
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Uninsured Increase Cost to Area Hospitals in 2000
HospitalName
Uninsured Patient Pay Costs
Uninsured StateCosts
Total Uninsured
Costs
Uninsured Payments
NetUninsured
Costs
Mecosta County General Hospital 809784 0 809784 15455 794329
Memorial Medical Center of West
Michigan958577 0 1123980 953934 170046
Metropolitan Hospital Grand Rapids Michigan
7861364 0 8604570 1028514 7576056
(Citizens 2000)
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Public Policy ImplicationsForm a committeecoalition to work with local agencies
to support the recruitment of primary care providers
Offer incentives to attract primary health care providers
Increase the availability of free health clinics
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Support GroupsHealthy People 2010
American Nurses Association (ANA)
Institute of Medicine
State Childrenrsquos Health Insurance Program (SCHIP)
American College of Health Care Executives
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Founded on data that enable progress and trends to be tracked Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans
The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population
(Healthy 2010)
Healthy People 2010Supports Access to Quality Health Care
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
American Nurses AssociationANA believes health care is a basic human right that should be provided to all
individuals
ANA believes that the health care system must ensure access which means health care services must be affordable available and acceptable
ANA believes that all individuals should have access to a standard package of essential health care services
ANA believes the health care system must be redirected from the overuse of more expensive technology‐driven hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services
ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine ndash safe effective patient‐centered timely efficient and equitable (New Hampshire Nurses Association 2010)
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Institute of MedicineMission Statement is to serve as adviser to the nation to improve health
The IOM asks and answers the nationrsquos most pressing questions about health and health care Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely Each year more than 2000 individuals members and nonmembers volunteer their time knowledge and expertise to advance the nationrsquos health through the work of the IOM
Many of the studies that the IOM undertakes begin as specific mandates from Congress still others are requested by federal agencies and independent organizations While our expert consensus committees are vital to our advisory role the IOM also convenes a series of forums roundtables and standing committees as well as other activities to facilitate discussion discovery and critical cross-disciplinary thinking (National Academy of Sciences 2010)
(National Academy of Science 2010)
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
State Childrenrsquos Health Insurance Program
The State Childrens Health Insurance Program or SCHIP was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line
(National Center for Public Policy Research 2010)
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs In keeping with this role healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay (American College of Healthcare Executives 2008)
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Healthcare Executives Developing and communicating access-to-care policies within their organizations
and to the community Managing their organizations efficiently to help underwrite healthcare costs
associated with uncompensated and undercompensated care Collaborating with other healthcare providers in their community to develop
shared approaches to ensure access to care Encouraging and assisting trade and other professional associations to take
proactive roles in access-to-care issues Promoting shared leadership and funding responsibilities among government
healthcare organizations employers private insurers and consumers Organizing grassroots advocacy efforts to secure needed funding from local state
and federal government bodies Organizing or participating in local state and regional initiatives to resolve access
problems Spearheading discussions with key decision makers (eg legislators) and key
stakeholders (eg public agencies) to identify community health priorities so available resources can be allocated equitably and effectively (American College of Healthcare Executives 2008)
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
RecommendationsBased on the provider responses some possible ways to increase the supply of health care professionals in rural areas include bull Increasing the interest of high school students in medical professions especially in the rural areas because providers who were raised in a rural area appear more likely to practice in a rural area bull Retaining students as they progress along the education pipeline from high school through residency bull Providing more incentives such as loan repayment bull Providing incentives specifically targeted to those who will practice in rural areas bull Increasing awareness of the need in rural areas among healthcare providers from other places bull Promoting and advertising the positive aspects of living and working in rural areas including greater purchasing power2
bull Providing funds to upgrade the facilities and equipment in rural areas bull Providing more opportunities for resident training
(Health Professionals Resource Center 2006)
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
Unsupportive GroupsAdding health care providers can change the cost of providing
services to a community causes conflict due to over stretched budgets and lack of increased government assistance
The following may object to changes that will bring health care providers to the community
Consumers who have private insurance and do not want there taxes increased to support those who lack health care
Providers who may have to care for the uninsured without proper compensation
Maurer amp Smith 2009 p 74
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
References
American Nurses Association (2010 July) Nursing Agenda Fro Health Care Reform Retrieved November
20 2010 from httpwwwnhnurseorg
Barnes J Barnett L Wightman T Emge A Johnson S (2008) Michigan strategic opportunities for rural health improvement Michigan Center for Rural Health April Retrieved from wwwmcrhmsuedu
Beringer P(2010) Mecosta county assessment people demographics population and trends per race ages and genders including levels of education Ferris State University wwwferrisedu
Boughton B (2009) Improving Healthcare Access Quality and Efficiency An Expert Interview with Public
Policy Analyst Robert Doherty Retrieved November 19 2010 from Medscape Medical News
httwwwmedscapecom Citizens Research Council of Michigan (2000) Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System Retrieved November 21 2010 from CRC Online Almanac httpwwwcrcmichorg
Dixon B (2010) Mecosta county assessment people culture Ferris State University wwwferrisedu
Ertman H (2010) Environment environmental quality Ferris State University wwwferrisedu Farlex (2010) The free dictionary Retrieved November 24 2010 from httpmedical dictionarythefreedictionarycomevaluation
Francik D (2010) Mecosta county recreation Ferris State University wwwferrisedu
Health People 2010 (2010) Healthy People Retrieved November 20 2010 from httpwwwhealthypeoplegov
Health Professions Resource Center (2006 September) Recruitment and Retention of Health Care Providers in Texas Retrieved November 19 2010 from httpwwwdshsstatetxus
Jacobson A (2010) Social systems types of health care providers Ferris State University wwwferrisedu
Maurer F A (2009) CommunityPublic Health nursing practice Health for families and populations (4th ed) St Louis MO Elsevier Saunders
Mecosta County Medical Center (2010) Advance care with a personal touch Retrieved November 23 2010 from httpwwwmcmcbrcomnb_linksasp
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
Assessment amp Analysis Rural Health Influences (2)
Assessment amp Analysis Rural Health Influences (3)
Assessment amp Analysis Rural Health Influences
Multiple factors also affect specific groups
Health Professional shortage areas
Assessment amp Analysis Shortage of Health Care Providers
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Assessment amp Analysis Epidemiological Agents
Nursing Diagnosis
Plan
Michigan Center for Rural Health
Primary Prevention
Plan Primary Prevention
Plan Primary Community Prevention
Plan Primary Prevention Services
Plan Primary Prevention Services (2)
Plan Primary Prevention Services (3)
Plan Secondary Prevention
Plan Tertiary Prevention
Plan (2)
Reason Healthcare Providers Avoid Practicing in Rural Areas
Plan Recruitment amp Retention
Measurable Outcomes
Slide 40
Slide 41
Slide 42
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Slide 53
Slide 54
Slide 55
Slide 56
Slide 57
Slide 58
Slide 59
Slide 60
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Federal Authority in Health Care
State Authority in Health Care
County Authority
Hypothetical State Superagency Incorporating the Health Departm
Slide 70
Slide 71
Slide 72
Slide 73
Uninsured Increase Cost to Area Hospitals in 2000
Public Policy Implications
Support Groups
American Nurses Association
Institute of Medicine
State Childrenrsquos Health Insurance Program
American College of Healthcare Executives
Healthcare Executives
Recommendations
Unsupportive Groups
References
Slide 86
National Academy of Sciences (2010 October 10) Institute of Medicene Retrieved November 20 2010 from httpwwwiomedu
National Center for Public Policy Research (2007) SCHIP Information Center Retrieved November 20 2010 from httpwwwschip-infoorg
New Hampshire Nursing Association (2010 July) Nursing Agenda For Health Care Reform Retrieved November 20 2010 from httpwwwnhnurseorg
Wolf R (2010 September 17) Number of uninsured Americans rises to 507 million Retrieved November 19 2010 from USA Today from httpusatodaycom
Michigan Surgeon Generalrsquos Health Status Report (2010) Healthy Michigan 2010 Retrieved from httpwwwmichigangovdocumentsHealthy_Michigan_2010_1_88117_7pdf
Michigan State University Extension Team (2007 January 27) Mecosta County Profile Retrieved from httpweb1msuemsueducountyprofilesmecostaMecostapdf
Pender N J Murdaugh C L amp Parsons M A (2006) Health Promotion in Nursing Practice Upper Saddler River Pearson Education Inc
Rousseau S (2010) Mecosta county religious system Ferris State University wwwferrisedu
US Census Bureau (2002 April 30) Census 2000 Urban and Rural Classification Retrieved from httpwwwcensusgovgeowwwuaua_2khtml
US Census Bureau (2007 April) United States Summary 2000 Population and Housing Unit Counts Retrieved from wwwcensusgovcensus2000pubsphc-3html
Shinohara R (2010 February 15) Group advocates incentive to lure health care workers Anchorage Daily News Retrieved from httpwwwadncom
Slide 1
Assessment amp Analysis
Assessment amp Analysis Epidemiological Hosts
Assessment amp Analysis Epidemiological Host
Assessment amp Analysis (2)
Vulnerable Groups
Specific groups this especially effects
Assessment amp Analysis Community Groups of Interest
Assessment amp Analysis Community Groups of Interest (2)
Assessment amp Analysis Existing Health Resources in Mecosta
Assessment amp Analysis Community Groups of Interest (3)
Assessment amp Analysis Community Groups of Interest (4)
