Oklahoma State University Center for Rural Health 4th Annual Stakeholders & Partners Advisory Council Meeting

Oklahoma State University Center for Health Sciences Tulsa, Oklahoma November 10, 2008 OSU Center for Rural Health • 1111 W. 17th Street • Tulsa, OK • 74107 • (918)584-4310 • http://ruralhealth.okstate.edu

Oklahoma Office of Rural Health

© 2008 Oklahoma State University

Rural Health Policy Advocacy  Physician Reimbursement  “Necessary Provider” Issue  Collaboration between Community Health Centers (CHC) and local providers  State Coverage Initiative (Insurance Commissioner)  Attended Speaker’s Healthcare Reform Task Force  Quality initiative with Darlene Bainbridge and OFMQ  Revising the State Rural Health Plan  Rural Mental Health Issues

© 2008 Oklahoma State University

Rural Hospital Support & Advocacy Critical Access Hospitals, 2008

© 2008 Oklahoma State University

Rural Hospital Support & Advocacy Hospitals Eligible for the Small Hospital Improvement Program, 2008

© 2008 Oklahoma State University

Community Health Engagement Process Goals  Increase use of local health services  Expand services  Attract more providers  Resolve local issues

© 2008 Oklahoma State University

Overview of Community Health Engagement Process  Composed of approximately 30 members representing entire community.  Meets four times over lunch hour, generally during a four month period.  Community members are experts, the Center provides data and facilitators.  Four reports are completed and presented to the Community: • • • •

Economic Impact Health Services Directory Community Health Survey Community Data & Information

 Visit http://www.okruralhealthworks.org to download copies of the reports. © 2008 Oklahoma State University

Community Health Engagement Process

© 2008 Oklahoma State University

Oklahoma Area Health Education Centers

© 2008 Oklahoma State University

© 2008 Oklahoma State University

Community Campus A Community Campus unites a community by encouraging and empowering its citizens to be actively involved in the recruitment, education, and ultimate support of local and visiting students who will become their healthcare resource and leadership. This includes physicians and other health professionals/technologists. Keys to a community campus are:  Faculty – healthcare preceptors and community leadership;  Classrooms – clinics, hospitals, and healthcare agencies and their patients;  Recruiters – middle schools, high schools, and regional universities; and  Adjunct Faculty – Center for Rural Health including AHEC and the State Office of Rural Health © 2008 Oklahoma State University

Community Campus Partnerships Goals  To empower the community to take ownership of efforts to recruit, train and retain health care professionals for local and regional practice.  To foster collaborative partnerships between universities and communities.  To develop an intentional, coordinated system of community-based medical and health professional education and clinical experiences.

© 2008 Oklahoma State University

Criteria for a Community Campus  Community Requirements: • Robust medical infrastructure: physicians, hospital, clinics, public health, other health care professionals, and sufficient population base. • Temporary housing for students. • Community infrastructure: social opportunities, community projects for students, basic amenities. • Committed community based educators for required core curriculum.

© 2008 Oklahoma State University

Benefits of a Community Campus  For the Community • Enhanced citizen participation in health care system development. • Access to university expertise. • Recruit potential providers. • Learn about new health care delivery methods/systems. • Realize connection of education to economy. • Recognition as communitybased health care education training sites.

© 2008 Oklahoma State University

 For the University • New Faculty and training sites. • Increased trust and respect from community. • Community developed as a resource and advocate. • Community-based research opportunities. • Faculty learns first hand what communities expect from new graduates.

Benefits of a Community Campus (continued)  For the Students • Learning is direct and immediate • Learn to work within community context • Learn to be an involved citizen • Communication skills enhanced • Reflection skills developed • Interdisciplinary training opportunities • Potential employment opportunities

© 2008 Oklahoma State University

Community Campus Development Committee  Members: • Community leaders and service organizations • OSU Extension Service – Agricultural Economics • Oklahoma CareerTech • OSU Center for Rural Health • Oklahoma Office of Rural Health • Other university healthcare training programs • Oklahoma Area Health Education Centers

© 2008 Oklahoma State University

OSU Center for Rural Health

© 2008 Oklahoma State University

Osteopathic Medical Education Timeline

Note: This timeline only shows a sample of the didactic training, clinical education, and residency training opportunities available to OSU College of Osteopathic Medical Students. The entire osteopathic medical education curriculum can be found at http://www.healthsciences.okstate.edu/student/academic_info/year_by_year.cfm

© 2008 Oklahoma State University

Non-Healthcare Occupations

Allied Health (Training)

CareerTech

Oklahoma Higher Education

Clinical Rotations (Tulsa, Durant, Lawton or Enid ) 2 years

Healthcare Occupations Practicing Physician

Pre-Secondary Education (7th – 12th grades) Community Campus © 2008 Oklahoma State University

OSU-CHS (Tulsa) 2 years

Rural Oklahoma

Residency (Tulsa, Durant, Lawton or Enid ) 3+ years

Allied Health (Professionals)

Encouraging Rural & Primary Care Practice Osteopathic Medical Students Completing Rural Clinical Rotations, AY07-08

© 2008 Oklahoma State University

Encouraging Rural & Primary Care Practice Osteopathic Residency and Internship Programs, 2008

© 2008 Oklahoma State University

Encouraging Rural & Primary Care Practice Pre-Doctoral Training Grant

 OSU Center for Rural Health Staffing Enhancements • Rural Medical Education Coordinator (Ph.D./Ed.D. level) • Four Regional Coordinators • Data Analyst

 Rural Medical Education Curriculum • Perspectives for Rural Health (Spring 2009) • Rural Medical Care (Fall 2009)

 Expanded Early Rural Experiences • Summer Rural Externship • Early Rural Experiences

 Rural Health Student Organization © 2008 Oklahoma State University

Encouraging Rural & Primary Care Practice Perspectives in Rural Health (Spring 2009)             

Introduction to Rural Health Oklahoma’s State Office of Rural Health Oklahoma’s Area Health Education Centers Role of the Rural Preceptor and their Rural Lifestyle Centers for Medicare and Medicaid & Oklahoma’s Policies and Politics Rural Leadership Role and Local, State, and Federal Issues Non-Physician Clinicians in Rural Practice Rural Hospital: Not a Small Urban Model Telemedicine and Rural Health Care Medical Examiner’s Role in Oklahoma Electronic Health Records Introduction to Practice Management Introduction to Billing and Coding

© 2008 Oklahoma State University

 Assignments : • Rural Site Assessments (journal) • Selected Readings • MTC Trip • Rural Hospital Tour • Rural Residency Program Tour • Physician Interview and Clinic Tour • Lunchtime Site Presentations

Encouraging Rural & Primary Care Practice Rural Medical Care (Fall 2009)  Patient Education, Communication and  Prevention of Disease  Rural Occupational Health: Accidents in the Rural Setting  Mental Health in the Rural Setting  Serving as the Team Physician  Neurology in Rural  Emergency Medicine in Rural ER  Review of the Geriatric Syndromes  Palliative Care and End of Life  Evaluation of Gait and Activities of Daily Living   Pediatric Practice in Rural  Obstetrics and Gynecology in the Rural Setting  Pediatric Cardiology for the Rural Physician © 2008 Oklahoma State University

Labs- Exams and Procedures: • • • • • • • • • • •

Mental Status Examinations Sports Physical Examinations Neurological Examinations Sideline Sports Injury Exam Pediatric Screening for Cardiac Disease The Newborn Examination Fracture Splinting and Immobilization Difficult Wound Closures Chest Tubes Emergency Tracheotomy Starting IV Lines & Catheterization

Tours: • Rural Rehabilitation or Mental Health Facility • Rural Nursing Home or Hospice

OSU Physicians Clinics Expanding into Rural and Underserved Areas

 Michael Ogle, D.O. - Director, OSU Physicians Rural Clinic Services • Enid Clinic – Managed by OSU Center for Rural Health since 2007 – Staffed by 1 Physician Assistant – Certified

• Country Club Gardens (Tulsa) – Managed by OSU Center for Rural Health since 2008 – Staffed by 1 Advanced Registered Nurse Practitioner

• Exploring Future Sites – Okemah, Pawnee and others

© 2008 Oklahoma State University

“…a greater emphasis on primary care can be expected to lower the costs of care, improve health through access to more appropriate services, and reduce the inequities in the population’s health.” (pg. 458-459) Source: Starfield, B., L. Shi, and J. Macinko. 2005. “Contribution of Primary Care to Health Systems and Health,” The Milbank Quarterly. 83(3): 457-502.

© 2008 Oklahoma State University

Grants & Research

© 2008 Oklahoma State University

Grant Funding & Match, Prior 12 months Grant Funding OSU Match Total

© 2008 Oklahoma State University

$10,109,136 $1,669,789 $11,778,925

Grant Funding & Match, Prior 12 months

© 2008 Oklahoma State University

USDATelemedicine Grant USDA Grant

© 2008 Oklahoma State University

State of the State’s Rural Health  A Snapshot of Current Conditions (2007)  Workforce Issues: Physicians & Hospitals (2008)  Workforce Issues: Non-Physician Clinicians, Allied Health Professionals & Other Health Care Facilities (2009)  Risk Factors and Roadblocks (2010)  Special Interest Topics (2011)

© 2008 Oklahoma State University

Available as a printable PDF at: http://ruralhealth.okstate.edu Select the “Research & Data” link © 2008 Oklahoma State University

Designation of Counties by Rural, Urban, or Mixed Based on Rural-Urban Commuting Area (RUCA) Codes

© 2008 Oklahoma State University

Non-Physician Clinicians & Allied Health Professionals  Based on the underlying premise that Oklahoma is facing a shortage of non-physician clinicians and allied health professionals now and in the future.  How does the supply in rural Oklahoma differ vis-à-vis urban Oklahoma?  Some of the professions addressed: • Physician assistants • Nurses • Dentists • Physical therapists • Mental health professionals

© 2008 Oklahoma State University

Active Dentists in Oklahoma

© 2008 Oklahoma State University

Other Health Facilities  To better understand the access to important health care facilities (other than hospitals) in rural Oklahoma. Examples include: • Pharmacies • Hospice facilities • Nursing homes

 Also, to describe and differentiate between various federally sponsored health facilities. • Federally Qualified Health Facilities (FQHC) • Community Health Facilities (CHC) • Rural Health Clinics (RHC)

© 2008 Oklahoma State University

Rural Health Clinics in Oklahoma

© 2008 Oklahoma State University

For Additional Information… OSU Center for Rural Health OSU Center for Health Sciences 1111 West 17th Street Tulsa, OK 74107-1898 Phone: 918.584.4310 Fax: 918.584.4391 900 N. Portland Ave. Suite BT200 Oklahoma City, OK 73107 Phone: 405.945.9197 Fax: 405.945.9186 http://ruralhealth.okstate.edu

© 2008 Oklahoma State University

Oklahoma AHEC OSU Center for Health Sciences 1111 West 17th Street Tulsa, OK 74107-1898 Phone: 918.582.1989 Fax: 918.584.4396 http://ahec.okstate.edu

Individual Contact Information William Pettit, D.O. Associate Dean & Associate Professor for Rural Health 918.584.4379 [email protected]

Val Schott, MPH Director, Center for Rural Health 405.945.9197 [email protected]

C. Michael Ogle, D.O. Director, OSU Physicians Rural Clinic Services 580.977.5000 [email protected]

Dennis Carter, D.O. Endowed Rural Health Professor 2008-2010 Poteau

Richard Perry, M.A. Director, OkAHEC 918.584.4378 [email protected]

Jeff Hackler, M.B.A., J.D. Director, Grants & Resource Development 918.584.4611 [email protected]

Vicky Pace, M.Ed. Clinical Training Coordinator 918.584.4332 [email protected]

Chad Landgraf, M.S. GIS Specialist 918.584.4376 [email protected]

Toni Hart Program Coordinator 918.584.4368 [email protected]

Matt Janey Program Coordinator 918.584.4377 [email protected]

Rod Hargrave FLEX Program Coordinator 405.945.9196 [email protected]

Corie Kaiser Health Consultant 405.945.9194 [email protected]

Morgan Farquharson Clinical Coordinator 918.584.1989 [email protected]

Dora Johnson Administrative Assistant 918.584.4310 [email protected]

Billie Bowman Stacy Huckaby Administrative Assistant Administrative Assistant 405.945.9197 918.582.1989 [email protected] [email protected]

Kelby Owens Southeast Rural Coordinator Durant

© 2008 Oklahoma State University

Augelica Burrell Southwest Rural Coordinator Lawton

Jan Barber Sherry Eastman Administrative Coordinator Program Specialist II 918.584.4360 918.584.4375 [email protected] [email protected]

Vacant Northwest Rural Coordinator Enid

Alexandra Bryant Northeast Rural Coordinator Tahlequah