Jill Klingner | University of Minnesota, Duluth (original) (raw)

Papers by Jill Klingner

Research paper thumbnail of Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

Journal of Rural Health, Apr 4, 2012

Context: Quality measures focused on outpatient settings are of increasing interest to policy mak... more Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals, including Critical Access Hospitals. Methods: Researchers analyzed Medicare hospital outpatient claims and Hospital Compare outpatient quality measure data for rural hospitals to assess the volume of conditions addressed by the measures in rural hospitals. A literature review and information from national quality organizations were used to assess the external and internal usefulness of the measures for rural hospitals. A panel of rural hospital quality experts reviewed the measures and provided additional input about their usefulness and data collection issues in rural hospitals. Results: The rural relevant CMS outpatient measures include most of the Emergency Department (ED) measures. The outpatient surgical measures are relevant for the majority of rural hospitals providing outpatient surgery. Several measures were not selected as relevant for rural hospitals, including the outpatient imaging and condition-specific measures. Conclusions: To increase sample sizes for smaller rural hospitals, CMS could combine data for similar inpatient and outpatient measures, use composite measures by condition, or use a longer time period to calculate measures. A menu of outpatient measures would allow smaller rural hospitals to choose relevant measures depending on the outpatient services they provide. Global measures and care coordination measures would be useful for quality improvement and have sufficient sample size to allow reliable measurement in smaller rural hospitals.

Research paper thumbnail of Effectiveness of Mental Health First Aid: a meta-analysis

Mental Health Review Journal, Nov 28, 2019

Purpose-The purpose of this paper, a meta-analysis and systematic review of Mental Health First A... more Purpose-The purpose of this paper, a meta-analysis and systematic review of Mental Health First Aid (MHFA), is to focus on studies that reported trainees' mental health literacy, attitudes and helping-related behaviors, as well as the impact of the program for the people who came into contact with trainees (i.e. recipients). Design/methodology/approach-A systematic search included several online databases of published studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum. Findings-Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges' g ¼ 0.18-0.53) were found for the primary outcomes for the trainees with effects appearing to be maintained at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance was detected. Few studies examined the effects for those who received aid from a MHFA trainee. Preliminary quantitative evidence appeared lacking (Hedges' g ¼ −0.04 to 0.12); furthermore, a qualitative review found limited positive effects. Research limitations/implications-MHFA trainees appear to benefit from MHFA; however, objective behavioral changes are in need of greater emphasis. Additionally, considerably greater attention and effort in testing effects on distressed recipients is needed with future empirical investigations. Originality/value-This is the first known review that includes preliminary findings on the effects of MHFA on the distressed recipients of the aid. It is anticipated that this will prompt further investigation into the impact of MHFA. Keywords Mental health literacy, Stigma, Mental health training, Mental Health First Aid (MHFA), Mental health gatekeeper Paper type Literature review Despite the prevalence of mental illness, only around 11 percent of people seek psychological treatment (Wang et al., 2007). This may be due to a lack of awareness of the clinical significance of symptoms (Henderson et al., 2013). The fear of stigma and social rejection also appears to hamper treatment seeking (Corrigan et al., 2016; Feldman and Crandall, 2007), as adults with mental illnesses are often perceived by the general public as dangerous and burdensome (Parcesepe and Cabassa, 2012). Thus, public health interventions aimed at increasing awareness and help-seeking are warranted. Mental Health First Aid (MHFA) is a manualized interactive curriculum program that educates laypeople about mental illness; this includes individuals who experience emotional distress following life stressors as well as those with severe mental disorders. The main objectives are to increase the trainees' knowledge of mental health concerns, decrease stigmatizing attitudes toward people with mental health disorders and increase confidence and helping behaviors when mental health concerns are recognized in others (Kitchener and Jorm, 2002a, b). The training was originally formatted as either adult or youth focused of 8-or 12-h duration, and intentionally developed for wide dissemination with an accessible curriculum for non-mental health professionals in the community (e.g. first responders, teachers and coaches). The knowledge objective of MHFA aims to help participants recognize common mental health disorders, increase awareness of treatment options and self-help strategies and develop skills to use in a mental health crisis (Kitchener and Jorm, 2002a, b). Participants learn an "action plan"

Research paper thumbnail of Table 2, Comparison of Tennessee hospital composite scores for 12 AHRQ culture survey dimensions

Research paper thumbnail of Measuring Rural Hospital Quality

Journal of Rural Health, Oct 1, 2004

Research paper thumbnail of Implementing Healthy and Sustainable Food Practices in a Hospital Cafeteria: A Qualitative Look at Processes, Barriers, and Facilitators of Implementation

Journal of Hunger & Environmental Nutrition, Jul 1, 2011

Research paper thumbnail of Pharmacy Services in Rural Areas: Is the Problem Geographic Access or Financial Access?

Journal of Rural Health, Jun 1, 2002

Access to pharmacy services is an important rural health policy issue but limited research has be... more Access to pharmacy services is an important rural health policy issue but limited research has been conducted on it. This article describes rural retail pharmacies in Minnesota, North Dakota, and South Dakota, including their organizational characteristics, staffing, services provided, and planned future changes; examines the milability of pharmacy services and pharmacy closures in rural areas of these three states; and briefly discusses policy issues that affect the d e l i w y of pharmacy services in rural areas. Study data came from a phone survey of 537 rural pharmacies, an analysis of pharmacy licensure data, and phone interviews with clinic, public health, and social services staff in rural communities with potential pharmacy access problems. Using a standard of 20 miles to the nearest pharmacy, most rural residents of these three states currently have adequate geographic access to pharmacy services. H m u , rural pharmacists and clinic, public health, and social services staff ratefinan-cia1 access to pharmacy services for the elderly and the uninsured as a major problem. Key policy issues that will affect jkture access to pharmacy services in rural areas include pharmacy staffing and relief coverage; alternative methods of providing pharmacy services; the financial viability of rural pharmacies; and the potential impact of a Medicare prescription benefit on rural consumers and rural pharmacies. tudies of access to health care services in rural areas have traditionally focused on primary and specialty medical care and on hospital services. However, rural pharmacy ser-S vices have begun to receive more attention in recent years as a result of increased utilization of prescription medications, the rising costs of drugs, and pharmacy closures and pharmacist shortages in some rural areas (Epstein, 1996; Ranelli & Coward, 1996; Straub & Straub, 1999). Knapp, Paavola, Maine, Sorofman, and Politzer (1999) found that pharmacists are more widely distributed across rural areas of the United States than primary care physicians. Ranelli and Coward (1996) observed that rural elderly residents surveyed in Florida were much more likely than urban residents to use a pharmacy in another town (43% vs. 4%), but they did Support for this paper wcls provided by the Ofice of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. CSRUC 000244. The authors thank the members of the Rural Pharmacy Advisory Committee; the pharmacy survey respondents and community interview participants; and representatives of the Minnesota, North Dakota, and South Dakota Boards of Pharmacy and the South Dakota and North Dabta Pharmacist Associations, for providing information regarding rural pharmacy regulatory and policy issues.

Research paper thumbnail of Are rural residents less likely to obtain recommended preventive healthcare services?

American Journal of Preventive Medicine, Oct 1, 2001

Background: This study examined rural-urban differences in utilization of preventive healthcare s... more Background: This study examined rural-urban differences in utilization of preventive healthcare services and assessed the impact of rural residence, demographic factors, health insurance status, and health system characteristics on the likelihood of obtaining each service. Methods: National data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) and the 1999 Area Resource File were used to evaluate the adequacy of preventive services obtained by rural and urban women and men, using three sets of nationally accepted preventive services guidelines from the American Cancer Society, U.S. Preventive Services Task Force, and Healthy People 2010. Logistic regression models were developed to control for the effect of demographic factors, health insurance status, and health system characteristics. Results: Rural residents are less likely than urban residents to obtain certain preventive health services and are further behind urban residents in meeting Healthy People 2010 objectives. Conclusions: Efforts to increase rural preventive services utilization need to build on federal, state, and community-based initiatives and to recognize the special challenges that rural areas present.

Research paper thumbnail of Table 1, Patient safety intervention self-assessment results

Research paper thumbnail of Factors Associated With Healthy, Organic, Local, and Sustainable Food Choices

Research paper thumbnail of Development and Testing of Emergency Department Patient Transfer Communication Measures

Journal of Rural Health, Mar 31, 2011

Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1... more Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1 The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Methods: Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. Findings: It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Conclusion: Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013.

Research paper thumbnail of Evidence-Based Medication Safety Quality Improvement Programs and Strategies for Critical Access Hospitals

Over the past decade, medication safety has gained emphasis as a major health issue via numerous ... more Over the past decade, medication safety has gained emphasis as a major health issue via numerous high-profile safety events (Kilbridge 2002). It is estimated that adverse drug events (ADE) occur in 6.5% to more than 20% of hospitalized patients (Bates 1995, Classen 1991, Rozich 2003). Although many of these are avoidable, there is disagreement among researchers regarding which types of issues have the greatest impact on medication safety as well as the degree to which those issues are preventable (Classen 2003).

Research paper thumbnail of Table 2, Comparison of Tennessee hospital composite scores for 12 AHRQ culture survey dimensions

Research paper thumbnail of Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients

• Bundled payments may improve the quality of care in rural areas; however, the impact is likely ... more • Bundled payments may improve the quality of care in rural areas; however, the impact is likely to be unevenly distributed across geography and care systems. Purpose of the Study and Approach This report assesses how a change in payment structure (i.e. bundling reimbursement payments for acute and post-acute care episodes) may affect existing and

Research paper thumbnail of Evidence-Based Pneumonia Quality Improvement Programs and Strategies for Critical Access Hospitals

This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rura... more This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rural Health Policy (PHS Grant No. U27RH01080) Introduction This report focuses on evidence-based pneumonia Quality Improvement (QI) programs and strategies that are applicable to critical access hospitals (CAHS). The Flex Monitoring Team prepared this report as part of a larger project, whose purpose is 1) to identify successful evidence-based quality improvement (QI) programs and strategies related to acute myocardial infarction (AMI), pneumonia, heart failure and surgical care improvement that could be replicated in CAHs and 2) to disseminate information about these programs and strategies to State Flex Programs.

Research paper thumbnail of Implementation of Emergency Department Transfer Communication Measures in Minnesota Critical Access Hospitals

The Journal of Rural Health, 2014

Previously published findings based on field tests indicated that emergency department patient tr... more Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale.

Research paper thumbnail of Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

The Journal of Rural Health, 2012

Context: Quality measures focused on outpatient settings are of increasing interest to policy mak... more Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals, including Critical Access Hospitals. Methods: Researchers analyzed Medicare hospital outpatient claims and Hospital Compare outpatient quality measure data for rural hospitals to assess the volume of conditions addressed by the measures in rural hospitals. A literature review and information from national quality organizations were used to assess the external and internal usefulness of the measures for rural hospitals. A panel of rural hospital quality experts reviewed the measures and provided additional input about their usefulness and data collection issues in rural hospitals. Results: The rural relevant CMS outpatient measures include most of the Emergency Department (ED) measures. The outpatient surgical measures are relevant for the majority of rural hospitals providing outpatient surgery. Several measures were not selected as relevant for rural hospitals, including the outpatient imaging and condition-specific measures. Conclusions: To increase sample sizes for smaller rural hospitals, CMS could combine data for similar inpatient and outpatient measures, use composite measures by condition, or use a longer time period to calculate measures. A menu of outpatient measures would allow smaller rural hospitals to choose relevant measures depending on the outpatient services they provide. Global measures and care coordination measures would be useful for quality improvement and have sufficient sample size to allow reliable measurement in smaller rural hospitals.

Research paper thumbnail of Development and Testing of Emergency Department Patient Transfer Communication Measures

The Journal of Rural Health, 2011

Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1... more Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1 The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Methods: Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. Findings: It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Conclusion: Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013.

Research paper thumbnail of Rural Relevant Quality Measures for Critical Access Hospitals

The Journal of Rural Health, 2012

Purpose: To identify current and future relevant quality measures for Critical Access Hospitals (... more Purpose: To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Methods: Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. Findings: The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. Conclusions: All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting.

Research paper thumbnail of Table 1, Patient safety intervention self-assessment results

Research paper thumbnail of Effectiveness of Mental Health First Aid: a meta-analysis

Mental Health Review Journal

Purpose The purpose of this paper, a meta-analysis and systematic review of Mental Health First A... more Purpose The purpose of this paper, a meta-analysis and systematic review of Mental Health First Aid (MHFA), is to focus on studies that reported trainees’ mental health literacy, attitudes and helping-related behaviors, as well as the impact of the program for the people who came into contact with trainees (i.e. recipients). Design/methodology/approach A systematic search included several online databases of published studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum. Findings Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges’ g=0.18–0.53) were found for the primary outcomes for the trainees with effects appearing to be maintained at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance was detected. Few studies examined t...

Research paper thumbnail of Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

Journal of Rural Health, Apr 4, 2012

Context: Quality measures focused on outpatient settings are of increasing interest to policy mak... more Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals, including Critical Access Hospitals. Methods: Researchers analyzed Medicare hospital outpatient claims and Hospital Compare outpatient quality measure data for rural hospitals to assess the volume of conditions addressed by the measures in rural hospitals. A literature review and information from national quality organizations were used to assess the external and internal usefulness of the measures for rural hospitals. A panel of rural hospital quality experts reviewed the measures and provided additional input about their usefulness and data collection issues in rural hospitals. Results: The rural relevant CMS outpatient measures include most of the Emergency Department (ED) measures. The outpatient surgical measures are relevant for the majority of rural hospitals providing outpatient surgery. Several measures were not selected as relevant for rural hospitals, including the outpatient imaging and condition-specific measures. Conclusions: To increase sample sizes for smaller rural hospitals, CMS could combine data for similar inpatient and outpatient measures, use composite measures by condition, or use a longer time period to calculate measures. A menu of outpatient measures would allow smaller rural hospitals to choose relevant measures depending on the outpatient services they provide. Global measures and care coordination measures would be useful for quality improvement and have sufficient sample size to allow reliable measurement in smaller rural hospitals.

Research paper thumbnail of Effectiveness of Mental Health First Aid: a meta-analysis

Mental Health Review Journal, Nov 28, 2019

Purpose-The purpose of this paper, a meta-analysis and systematic review of Mental Health First A... more Purpose-The purpose of this paper, a meta-analysis and systematic review of Mental Health First Aid (MHFA), is to focus on studies that reported trainees' mental health literacy, attitudes and helping-related behaviors, as well as the impact of the program for the people who came into contact with trainees (i.e. recipients). Design/methodology/approach-A systematic search included several online databases of published studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum. Findings-Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges' g ¼ 0.18-0.53) were found for the primary outcomes for the trainees with effects appearing to be maintained at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance was detected. Few studies examined the effects for those who received aid from a MHFA trainee. Preliminary quantitative evidence appeared lacking (Hedges' g ¼ −0.04 to 0.12); furthermore, a qualitative review found limited positive effects. Research limitations/implications-MHFA trainees appear to benefit from MHFA; however, objective behavioral changes are in need of greater emphasis. Additionally, considerably greater attention and effort in testing effects on distressed recipients is needed with future empirical investigations. Originality/value-This is the first known review that includes preliminary findings on the effects of MHFA on the distressed recipients of the aid. It is anticipated that this will prompt further investigation into the impact of MHFA. Keywords Mental health literacy, Stigma, Mental health training, Mental Health First Aid (MHFA), Mental health gatekeeper Paper type Literature review Despite the prevalence of mental illness, only around 11 percent of people seek psychological treatment (Wang et al., 2007). This may be due to a lack of awareness of the clinical significance of symptoms (Henderson et al., 2013). The fear of stigma and social rejection also appears to hamper treatment seeking (Corrigan et al., 2016; Feldman and Crandall, 2007), as adults with mental illnesses are often perceived by the general public as dangerous and burdensome (Parcesepe and Cabassa, 2012). Thus, public health interventions aimed at increasing awareness and help-seeking are warranted. Mental Health First Aid (MHFA) is a manualized interactive curriculum program that educates laypeople about mental illness; this includes individuals who experience emotional distress following life stressors as well as those with severe mental disorders. The main objectives are to increase the trainees' knowledge of mental health concerns, decrease stigmatizing attitudes toward people with mental health disorders and increase confidence and helping behaviors when mental health concerns are recognized in others (Kitchener and Jorm, 2002a, b). The training was originally formatted as either adult or youth focused of 8-or 12-h duration, and intentionally developed for wide dissemination with an accessible curriculum for non-mental health professionals in the community (e.g. first responders, teachers and coaches). The knowledge objective of MHFA aims to help participants recognize common mental health disorders, increase awareness of treatment options and self-help strategies and develop skills to use in a mental health crisis (Kitchener and Jorm, 2002a, b). Participants learn an "action plan"

Research paper thumbnail of Table 2, Comparison of Tennessee hospital composite scores for 12 AHRQ culture survey dimensions

Research paper thumbnail of Measuring Rural Hospital Quality

Journal of Rural Health, Oct 1, 2004

Research paper thumbnail of Implementing Healthy and Sustainable Food Practices in a Hospital Cafeteria: A Qualitative Look at Processes, Barriers, and Facilitators of Implementation

Journal of Hunger & Environmental Nutrition, Jul 1, 2011

Research paper thumbnail of Pharmacy Services in Rural Areas: Is the Problem Geographic Access or Financial Access?

Journal of Rural Health, Jun 1, 2002

Access to pharmacy services is an important rural health policy issue but limited research has be... more Access to pharmacy services is an important rural health policy issue but limited research has been conducted on it. This article describes rural retail pharmacies in Minnesota, North Dakota, and South Dakota, including their organizational characteristics, staffing, services provided, and planned future changes; examines the milability of pharmacy services and pharmacy closures in rural areas of these three states; and briefly discusses policy issues that affect the d e l i w y of pharmacy services in rural areas. Study data came from a phone survey of 537 rural pharmacies, an analysis of pharmacy licensure data, and phone interviews with clinic, public health, and social services staff in rural communities with potential pharmacy access problems. Using a standard of 20 miles to the nearest pharmacy, most rural residents of these three states currently have adequate geographic access to pharmacy services. H m u , rural pharmacists and clinic, public health, and social services staff ratefinan-cia1 access to pharmacy services for the elderly and the uninsured as a major problem. Key policy issues that will affect jkture access to pharmacy services in rural areas include pharmacy staffing and relief coverage; alternative methods of providing pharmacy services; the financial viability of rural pharmacies; and the potential impact of a Medicare prescription benefit on rural consumers and rural pharmacies. tudies of access to health care services in rural areas have traditionally focused on primary and specialty medical care and on hospital services. However, rural pharmacy ser-S vices have begun to receive more attention in recent years as a result of increased utilization of prescription medications, the rising costs of drugs, and pharmacy closures and pharmacist shortages in some rural areas (Epstein, 1996; Ranelli & Coward, 1996; Straub & Straub, 1999). Knapp, Paavola, Maine, Sorofman, and Politzer (1999) found that pharmacists are more widely distributed across rural areas of the United States than primary care physicians. Ranelli and Coward (1996) observed that rural elderly residents surveyed in Florida were much more likely than urban residents to use a pharmacy in another town (43% vs. 4%), but they did Support for this paper wcls provided by the Ofice of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. CSRUC 000244. The authors thank the members of the Rural Pharmacy Advisory Committee; the pharmacy survey respondents and community interview participants; and representatives of the Minnesota, North Dakota, and South Dakota Boards of Pharmacy and the South Dakota and North Dabta Pharmacist Associations, for providing information regarding rural pharmacy regulatory and policy issues.

Research paper thumbnail of Are rural residents less likely to obtain recommended preventive healthcare services?

American Journal of Preventive Medicine, Oct 1, 2001

Background: This study examined rural-urban differences in utilization of preventive healthcare s... more Background: This study examined rural-urban differences in utilization of preventive healthcare services and assessed the impact of rural residence, demographic factors, health insurance status, and health system characteristics on the likelihood of obtaining each service. Methods: National data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) and the 1999 Area Resource File were used to evaluate the adequacy of preventive services obtained by rural and urban women and men, using three sets of nationally accepted preventive services guidelines from the American Cancer Society, U.S. Preventive Services Task Force, and Healthy People 2010. Logistic regression models were developed to control for the effect of demographic factors, health insurance status, and health system characteristics. Results: Rural residents are less likely than urban residents to obtain certain preventive health services and are further behind urban residents in meeting Healthy People 2010 objectives. Conclusions: Efforts to increase rural preventive services utilization need to build on federal, state, and community-based initiatives and to recognize the special challenges that rural areas present.

Research paper thumbnail of Table 1, Patient safety intervention self-assessment results

Research paper thumbnail of Factors Associated With Healthy, Organic, Local, and Sustainable Food Choices

Research paper thumbnail of Development and Testing of Emergency Department Patient Transfer Communication Measures

Journal of Rural Health, Mar 31, 2011

Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1... more Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1 The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Methods: Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. Findings: It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Conclusion: Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013.

Research paper thumbnail of Evidence-Based Medication Safety Quality Improvement Programs and Strategies for Critical Access Hospitals

Over the past decade, medication safety has gained emphasis as a major health issue via numerous ... more Over the past decade, medication safety has gained emphasis as a major health issue via numerous high-profile safety events (Kilbridge 2002). It is estimated that adverse drug events (ADE) occur in 6.5% to more than 20% of hospitalized patients (Bates 1995, Classen 1991, Rozich 2003). Although many of these are avoidable, there is disagreement among researchers regarding which types of issues have the greatest impact on medication safety as well as the degree to which those issues are preventable (Classen 2003).

Research paper thumbnail of Table 2, Comparison of Tennessee hospital composite scores for 12 AHRQ culture survey dimensions

Research paper thumbnail of Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients

• Bundled payments may improve the quality of care in rural areas; however, the impact is likely ... more • Bundled payments may improve the quality of care in rural areas; however, the impact is likely to be unevenly distributed across geography and care systems. Purpose of the Study and Approach This report assesses how a change in payment structure (i.e. bundling reimbursement payments for acute and post-acute care episodes) may affect existing and

Research paper thumbnail of Evidence-Based Pneumonia Quality Improvement Programs and Strategies for Critical Access Hospitals

This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rura... more This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rural Health Policy (PHS Grant No. U27RH01080) Introduction This report focuses on evidence-based pneumonia Quality Improvement (QI) programs and strategies that are applicable to critical access hospitals (CAHS). The Flex Monitoring Team prepared this report as part of a larger project, whose purpose is 1) to identify successful evidence-based quality improvement (QI) programs and strategies related to acute myocardial infarction (AMI), pneumonia, heart failure and surgical care improvement that could be replicated in CAHs and 2) to disseminate information about these programs and strategies to State Flex Programs.

Research paper thumbnail of Implementation of Emergency Department Transfer Communication Measures in Minnesota Critical Access Hospitals

The Journal of Rural Health, 2014

Previously published findings based on field tests indicated that emergency department patient tr... more Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale.

Research paper thumbnail of Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

The Journal of Rural Health, 2012

Context: Quality measures focused on outpatient settings are of increasing interest to policy mak... more Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals, including Critical Access Hospitals. Methods: Researchers analyzed Medicare hospital outpatient claims and Hospital Compare outpatient quality measure data for rural hospitals to assess the volume of conditions addressed by the measures in rural hospitals. A literature review and information from national quality organizations were used to assess the external and internal usefulness of the measures for rural hospitals. A panel of rural hospital quality experts reviewed the measures and provided additional input about their usefulness and data collection issues in rural hospitals. Results: The rural relevant CMS outpatient measures include most of the Emergency Department (ED) measures. The outpatient surgical measures are relevant for the majority of rural hospitals providing outpatient surgery. Several measures were not selected as relevant for rural hospitals, including the outpatient imaging and condition-specific measures. Conclusions: To increase sample sizes for smaller rural hospitals, CMS could combine data for similar inpatient and outpatient measures, use composite measures by condition, or use a longer time period to calculate measures. A menu of outpatient measures would allow smaller rural hospitals to choose relevant measures depending on the outpatient services they provide. Global measures and care coordination measures would be useful for quality improvement and have sufficient sample size to allow reliable measurement in smaller rural hospitals.

Research paper thumbnail of Development and Testing of Emergency Department Patient Transfer Communication Measures

The Journal of Rural Health, 2011

Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1... more Purpose: Communication problems are a major contributing factor to adverse events in hospitals. 1 The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Methods: Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. Findings: It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Conclusion: Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013.

Research paper thumbnail of Rural Relevant Quality Measures for Critical Access Hospitals

The Journal of Rural Health, 2012

Purpose: To identify current and future relevant quality measures for Critical Access Hospitals (... more Purpose: To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Methods: Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. Findings: The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. Conclusions: All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting.

Research paper thumbnail of Table 1, Patient safety intervention self-assessment results

Research paper thumbnail of Effectiveness of Mental Health First Aid: a meta-analysis

Mental Health Review Journal

Purpose The purpose of this paper, a meta-analysis and systematic review of Mental Health First A... more Purpose The purpose of this paper, a meta-analysis and systematic review of Mental Health First Aid (MHFA), is to focus on studies that reported trainees’ mental health literacy, attitudes and helping-related behaviors, as well as the impact of the program for the people who came into contact with trainees (i.e. recipients). Design/methodology/approach A systematic search included several online databases of published studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum. Findings Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges’ g=0.18–0.53) were found for the primary outcomes for the trainees with effects appearing to be maintained at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance was detected. Few studies examined t...