Community APGAR Project: Comparing Results from the National Database

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Community APGAR Project: Comparing Results from the National Database. David Schmitz, MD, FAAFP Associate Director of Rural Family Medicine Family Medicine Residency of Idaho Presented to: 2013 IRHA Conference Indianapolis, IN Date: August 8, 2013. Presentation Overview .
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Community APGAR Project: Comparing Results from the National Database David Schmitz, MD, FAAFP Associate Director of Rural Family Medicine Family Medicine Residency of Idaho Presented to: 2013 IRHA Conference Indianapolis, IN Date: August 8, 2013 Presentation Overview Database
  • The Critical Access Hospital Community Apgar Questionnaire (CAH CAQ)
  • Background
  • Purpose
  • Development
  • National Results across States
  • Case Study One and Two
  • Next Steps
  • Research, Education and Policy Initiatives
  • Apgar Solutions
  • Questions/Comments for Discussion
  • Acknowledgements Database
  • Funding provided by
  • Initial funding for the development of the Community Apgar Program was provided by the Idaho Department of Health and Welfare, Office of Rural Health and Primary Care.
  • Other funding
  • Wyoming Health Resources Network
  • Center for Rural Health, University of North Dakota School of Medicine and Health Sciences
  • Wisconsin Office of Rural Health, University of Wisconsin-Madison School of Medicine and Public Health
  • Maine Primary Care Association
  • Alaska’s Area Health Education Center (AHEC), Alaska Center for Rural Health, University of Alaska-Anchorage
  • Ed Baker, PhD, Professor and Director, Boise State University Center for Health Policy (CHP), Co-developer of the Community Apgar Program
  • Lisa MacKenzie, MHS, Research Assistant, CHP
  • Logan Kinney, Undergraduate Research Assistant, CHP
  • Background Database
  • How did we get here – Why research?
  • Boise State University: Ed Baker, PhD
  • Family Medicine Residency of Idaho: Dave Schmitz, MD
  • Office of Rural Health and Primary Care: Mary Sheridan
  • An intersection of workforce, education and advocacy
  • Practical knowledge, relationships, experience and investment
  • Answering needs and necessary questions
  • Applied research: Development of tools
  • Partnerships with those with “skin in the game”
  • Apgar Database Score for Newborns
  • Devised in 1952 by Virginia Apgar, an anesthesiologist, as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth
  • Determined by evaluating the newborn baby on five simple criteria (Appearance, Pulse, Grimace, Activity, Respiration) on a scale from zero to two, then summing up the five values thus obtained
  • Mind Mapping DatabaseApgar Scoring How Ready is this Child? A New Response Databaseto the Same Old Problem…
  • What if there was a similar test for hospitals – quick and repeatable with intervention measures on standby – to assess readiness for recruiting physicians?
  • Something new
  • Something based on quantifiable data
  • Something that incorporates the whole community
  • Something that shows people on graphs and charts where they are and how to achieve their goals.
  • A History of Community DatabaseApgar
  • Year 3 (2009)
  • Examining the Trait of Grit and Satisfaction in Idaho Physicians [Published in the Journal of the American Board of Family Medicine]
  • Community Apgar Program (CAP) Pilot for Critical Access Hospitals in Idaho
  • Nursing Community Apgar Questionnaire (NCAQ)
  • Year 1 (2007)
  • Idaho Family Physician Rural Work Force Assessment Pilot Study [Published in the Journal of Rural Health]
  • Years 5-7 (2011/2013)
  • Expansion of the Community Apgar Program (CAP) for Critical Access Hospitals and Community Health Centers - Idaho, Wyoming, North Dakota, Wisconsin and Alaska (CAHs)
  • - Idaho and Maine (CHCs)
  • Year 4 (2010)
  • Community Health Center Community Apgar Questionnaire (CHC CAQ) [Published in the Rural and Remote Health Journal]
  • Community Apgar Program (CAP) for Community Health Centers in Idaho
  • Community Apgar Solutions Pilot Project
  • Year 2 (2008)Critical Access Hospital Community Apgar Questionnaire (CAH CAQ) [Published in the Rural & Remote Health Journal]
  • Purpose Database
  • The Critical Access Hospital Community Apgar Questionnaire (CAH CAQ) is a validated tool used in a rural community self-evaluation to assess assets and capabilities in recruiting and retaining physicians.
  • Designed to be a real-time assessment tool providing guidance for the most helpful interventions at the present.
  • Developed to differentially diagnose a CAHs relative component strengths and challenges
  • prioritize improvements
  • identify marketing opportunities
  • CAH CAQ Development Database
  • The CAH CAQ
  • Questions aggregated into 5 Classes
  • Geographic
  • Economic
  • Scope of Practice
  • Medical Support
  • Hospital and Community Support
  • Each Class contains 10 factors for a total of 50 factors/questions representing specific elements related to recruitment and retention of family medicine physicians in rural areas
  • Three open-ended questions
  • CAH CAQ Development: DatabaseClass/Factor Examples The Community DatabaseApgar Program (CAP)
  • Year 1 of Program
  • Participants mailed the CAH CAQ survey with consent form [IRB approval from Boise State University]
  • CAH CAQ surveys administered in separate structured one hour interviews for each participant
  • CAH CAQ Board Reports
  • Individual data from each critical access hospital reviewed with Board of Directors each year of the program
  • Action plans developed in Year 1 for improvement in areas identified by the CAH CAQ
  • State level results presented at state selected forum
  • Aggregate state level data
  • Review of hospital specific analytics
  • Case study input by state research partner
  • The Community DatabaseApgar Program
  • Year 2 of Program
  • Second round of CAH CAQ surveys
  • Year 2 Board presentation focuses on movement towards achieving improvement identified in Year 1
  • Making the most of the CAP:
  • community self-evaluation
  • prioritizing improvement plans
  • advertising and interviewing
  • negotiation strategies and contract construction
  • The CAQ Value Proposition Database
  • Beyond “Expert Opinion”
  • A new approach to the old problem of physician recruiting
  • Self-empowering for the community: knowledge as power, not an outside “headhunter”
  • Beyond physician recruitment to community improvement
  • Future of the CAH CAQ Database
  • With further research and collaboration, this tool could also be used to share successful strategies communities have used to overcome challenges which may be difficult or impossible to modify.
  • CAH CAQ surveys may be useful in identifying trends and overarching themes which can be further addressed at state or national levels.
  • States Participating/Interested Database
  • States Participating in the CAP
  • States Interested in Implementing the CAP
  • Results Database Top 10 Advantages - CAH Database Top 10 Challenges - CAH Database Top 10 Importance - CAH Database Top 10 DatabaseApgar Factors - CAH Bottom 10 DatabaseApgar Factors - CAH
  • Cumulative DatabaseCAH Community Apgar Score by Hospital – Across Five States
  • Cumulative DatabaseCAH Community Apgar Score by Hospital - Across Five States
  • Top 10 Advantages - CHC Database Top 10 Challenges - CHC Database Top 10 Importance - CHC Database Top 10 DatabaseApgar Factors - CHC Bottom 10 DatabaseApgar Factors - CHC
  • Cumulative DatabaseCHC Community Apgar Score by Facility – Across Two States
  • Cumulative DatabaseCHC Community Apgar Score by Facility – Across Two States
  • Case Study One Database Hospital X Database Comparative Cumulative Apgar Score Hospital X Database Comparative Cumulative Apgar Score for Geographic Class Hospital X Database Comparative Cumulative Apgar Score for Economic Class Hospital X Database Comparative Cumulative Apgar Score for Scope of Practice Class Hospital X Database Comparative Cumulative Apgar Score for Medical Support Class Hospital X Database Comparative Cumulative Apgar Score for Community and Hospital Support Class Hospital X Database Top 10 Cumulative Apgar Variance Factors across All 50 Factors Hospital X Database Bottom 10 Cumulative Apgar Variance Factors across All 50 Factors Case Study Two Database CHC X Database Comparative Cumulative Apgar Score CHC X Database Comparative Cumulative Apgar Score for Geographic Class CHC X Database Comparative Cumulative Apgar Score for Economic Class CHC X Database Comparative Cumulative Apgar Score for Scope of Practice CHC X Database Comparative Cumulative Apgar Score for Medical Support CHC X Database Comparative Cumulative Apgar Score for Facility and Community Support CHC X Database Top 10 Cumulative Apgar Variance Factors across All 50 Factors CHC X Database Bottom 10 Cumulative Apgar Variance Factors across All 50 Factors Next Steps Database
  • Continue to expand the Critical Access Hospital and Community Health Center Community Apgar Programs
  • NOSORH initiative
  • Expand the Nursing Critical Access Hospital Community Apgar Program
  • NWRRHC
  • Washington
  • Consider development CAP to other workforce bottleneck areas (e.g., PAs, NPs, and CEOs)
  • Mine the national comparative database
  • Research, education and policy initiatives
  • Expand and refine the “Apgar Solutions” initiative
  • Research, Education and Policy Initiatives DatabaseTop 10 Apgar Factors – Y1 CAH Overall Research, Education and Policy Initiatives DatabaseBottom 10 Apgar Factors – Y1 CAH Overall Research, Education and Policy Initiatives DatabaseTop 10 Apgar Factors – North Dakota CAH Research, Education and Policy Initiatives DatabaseBottom 10 Apgar Factors – North Dakota CAH Education, Policy and Research Initiatives DatabaseTop 10 Apgar Factors – Maine CHC Education, Policy and Research Initiatives DatabaseBottom 10 Apgar Factors – Maine CHC Apgar Solutions – Idaho Database
  • Apgar factor – “Mental Health”
  • Staffing and access to care
  • Ancillary mental health staffing low
  • Physician burden providing direct mental health service high
  • ASTHO grant funded onsite strategic planning
  • Team based mental health care
  • Integrated Behavioral Health
  • Apgar Solutions – Idaho Database
  • Apgar factor – “Employment Status”
  • Physician contracting
  • Best practices in flexible physician contracting
  • Constructing the win-win in physician recruitment
  • ASTHO grant funded onsite strategic planning
  • Expert CFO/Physician team
  • Contract models and role play
  • Apgar Solutions – North Dakota Database
  • Apgar factor – “Perception of Community”
  • Candidate’s first impression – usually virtual
  • Facilities have outdated websites and few materials to send to interested providers
  • No chance to highlight their strengths
  • Compounds perception of isolation
  • University of ND Center for Rural Health
  • Pilot project to create marketing package for CAHs in need
  • Marketing materials
  • Website, marketing videos, printed materials
  • Apgar Solutions – North Dakota Database
  • Process:
  • Send skilled staff to rural community
  • Full day of video interviews, photos, etc…
  • Pilot package was offered at no cost to facility
  • Outcomes
  • New website, marketing videos, printed branding
  • Facility has more modern online presence
  • Staffing
  • 3 CRH staff members
  • Travel
  • Questions/Comments for Discussion Database
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