Rural Health Exam

Chronic

long-lasting

structural racism

groups of people are systematically treated differently through both overt and covert policies, programs, and behaviors

privacy

the right of individuals to hold information about themselves in secret, free from the knowledge of others

confidentiality

the assurance that information about identifiable persons or release of it will not be disclosed without consent

Hill-Burton Act

funded states to create hospitals and health centers in rural areas

Medicare

insurance program that provides medical assistance to people over the age of 65, end-stage renal disease, and people under 65 with certain disabilities

• Part A: inpatient/outpatient hospital service or skilled nursing facilities

• Part B: doctor care and services received as outpatient and some preventive care

• Part C: Medicare advantage plans

• Part D: drug coverage

Affordable Care Act

health reform law focused on expanding insurance coverage for US citizens. it’s primary goal was to increase access to affordable health insurance for millions of Americans without coverage and to make health insurance more affordable for those already covered

Office of Rural Health Policy

Created within the Health Resources and Services Administration to address issues in rural health

• extends support for rural hospitals through several programs

• rural health research center programs dedicate work to policy-relevant research in rural areas on healthcare & population health

3 functions of government essential to public health

Assessment - monitor health, diagnose, and investigate

Policy Development - inform and educate, mobilize community partnerships, develop policies

Assurance - enforce laws, provide care, assure competent workforce, evaluate

American Recovery and Investment Act of 2009

signed into law to stimulate the economy, create jobs, modernize infrastructure, become energy independent, and preserve and improve affordable health care
- millions of dollars allocated for healthcare training through grants, scholarships, loans, and loan repayments

3 main goals of federal efforts to improve rural health

1. increase access

2. improve quality of care

3. decrease costs

What payment model dominated U.S. healthcare before the ACA?

fee for service

HRSA Bureau of Health Professions

Addresses workforce shortages and lack of diversity by identifying high-need areas and funding education, training, and workforce development. They support low income and uninsured populations by providing grants and technical assistance to federally funded health centers serving these populations

Emergency Medical Treatment & Labor Act

Mandate that requires anyone coming into an emergency department to be stabilized and treated regardless of their insurance or ability to pay

Rural-Urban Commuting Area Codes

A classification system for US census tracts based on population density, urbanization, and daily commuting patterns. Current codes draw from the 2010 Census and the 2006-2010 American Community Survey

Value-Based Care

Programs and providers being awarded and incentivized for the quality of care they give to people

Quality adjusted life year

generic measure of disease burden, including both the quality and quantity of life lived

• used in economic evaluation to assess the value of medical interventions

• one of these equates to one year in perfect health

• it’s the measure of both the quantity and quality of life lived use to assess the value for money of a medical intervention

Rural Health Clinic

Program intended to increase access to primary care services for patients in rural communities. They can be public, nonprofit, or for-profit healthcare facilities. To receive certification, they must be located in rural, underserved areas.

• required to use a team approach of physicians working with non-physicians to provide services

• the clinic must be staffed at least 50% of the time with a NP, PA, or CNM

• main advantage is enhanced reimbursement rates for providing Medicare and Medicaid services

Allied Health

health professions that are distinct from medicine and nursing

• they include dental hygienists, diagnostic medial monographers, dietitians, medical technologists, occupational therapists, PT,etc.

Barriers to Rural Health Care

• Cost/decreased funding

• lack of medical doctors in rural settings

• recruitment and renting — lower pay, lack of spousal job opportunities, longer levels

• rural patient demography - older meaning more complex and advanced diseases

OSHA - Occupational Safety and Health Act

• Set workplace standards

• facilitated public and workplace awareness of the real and potential hazards of different workplaces

Primary Occupational Exposure

includes inhalation followed by skin absorption when crops such as fruits and vegetables are picked or harvested by bare hands

Secondary Occupational Exposure

occurs when farm workers take work apparel and shoes home, thus exposing family members

Tertiary Occupational Exposure

a consequence of aerial crop spraying or dusting, which spreads pesticide to nearby homes and surroundings, including pollution of ground and surface water

acculturative stress

refers to stress that occurs from acculturation. acculturations refers to process of change that happens when two or more cultures come into contact, where balancing and adjustment of cultures occurs when one acquires new practices or values and adapts to a new environment

Ageism

stereotyping or discriminating people based on their age

Minority Stress Model

Framework to understanding the health risks disparities between LGBTQ and heterosexual individuals. This model posits that the conflicting nature in sexual or gender values between the LGBTQ community and heterosexual individuals creates various stressors in the minority’s lives which leads to long-term health issues in the minority population

Chief Health Strategist

Lead public health coordinator in a community — must be able to engage the community and leverage asses; interpret and present data; develop, implement, and monitor policies, plans, and processes

Windshield/Walking Survey

Direct observation of the community from a car or on foot

Stakeholder Analysis

Used to determine who needs to be included in the assessment process.

MAP-IT

Mobilize, Assess, Plan, Implement, Track

Health Belief

Precontemplation, contemplation, preparation/action, maintenance

Precede-Proceed Model

Evaluation framework for assessing health needs for design and implementing public health promotion/disease prevention programs

• Precede:

- Social Assessment, Epidemiological Behavioral and environmental assessment, Educational and ecological assessment, administrative and policy assessment

• Proceed

- implementation, process evaluation, impact evaluation, outcome evaluation

Federalism

describes the system of government where two or more levels have power'

• crucial for rural: states sometimes collaborate on rural issues

visioning

the process of imagining an improved future for the community. It requires group understanding and buy-in to be effective.

coleadership

involves shared responsibility across individuals or organizations, where members voluntarily contribute expertise and resources toward a common goal.

community readiness

how willing a community is to accept change, based on awareness, motivation, and resistance.

community mobilization

the process of organizing people and resources to take action on a shared issue, starting with identifying target populations and stakeholders.

stakeholders

include organizations and individuals involved in or affected by the issue. Identifying them helps coordinate efforts and avoid duplication.

Coalition vs. partnership?

A coalition is informal and loosely organized, while a partnership is more formal with defined roles and agreements (e.g., MOUs).

leadership styles

transformational

transactional

authentic

servant

adaptive