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Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices

July 1, 2014 Comments off

Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices
Source: Agency for Healthcare Research and Quality

Managing and treating obesity is particularly challenging for primary care practices. Although evidence suggests the potential for improving eating and physical activity behaviors by effectively linking primary care practices and community resources, establishing such linkages may be especially challenging in rural areas, where limited availability of and access to services may compound standard barriers.

In 2010 the Oregon Rural Practice-based Research Network (ORPRN) received funding from the Agency for Health Care Research and Quality for research into “Integrated Primary Care Practices and Community-based Programs to Manage Obesity.” Over a 2-year period we worked with eight primary care practices and community-based health coalitions in four rural Oregon communities to:

  1. Evaluate local clinic and community factors necessary to develop sustainable linkages between primary care and community resources for obesity management.
  2. Design, implement, and evaluate a participatory process using practice facilitation and community-health development principles to achieve these linkages.

We used the findings from this 2-year process to develop this toolkit to help other primary care clinics that want to improve linkages with community-based resources for obesity management. This process highlights strategies to build on the ties that often already exist in rural areas. Although our process is tailored to rural settings, we anticipate that many of the strategies will be beneficial for urban practices and communities to consider. This toolkit offers key steps in our process, providing tools and recommended steps that we encourage you to adapt to fit your local setting.

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Reconnecting Small-Town America by Bus: New Federal Transit Rules Spur Investment

May 26, 2014 Comments off

Reconnecting Small-Town America by Bus: New Federal Transit Rules Spur Investment
Source: AARP Research

Millions of rural residents have lost access to scheduled intercity bus service in recent years as the nation’s largest private carriers have focused on profitable, longer-haul interstate travel. This video and Spotlight on the Issues illustrates how one state has created a successful public–private initiative to restore service to its rural communities. What Washington State has accomplished serves as a model for other states looking to take advantage of alternative local match requirements.

Audit of VHA’s Mobile Medical Units

May 16, 2014 Comments off

Audit of VHA’s Mobile Medical Units
Source: U.S. Department of Veterans Affairs, Office of Inspector General

At the request of the House Committee on Appropriations, the Office of Inspector General (OIG) conducted a review of VA’s use of Mobile Medical Units (MMUs) to assess whether the Veterans Health Administration (VHA) is fully utilizing MMUs to provide health care access to veterans in rural areas. We found that VHA lacks information about the operations of its MMUs and has not collected sufficient data to determine whether MMUs improved rural veterans’ health care access. VHA lacks information on the number, locations, purpose, patient workloads, and MMU operating costs. We determined VHA operated at least 47 MMUs in fiscal year 2013. Of these, 19 were funded by the Office of Rural Health (ORH) and the remaining 28 were funded by either a Veterans Integrated Service Network or medical facility. Medical facilities captured utilization and cost data in VHA’s Decision Support System (DSS) for only 6 of the estimated 47 MMUs. If VHA consistently captured these data, it could compare MMU utilization and costs with other health care delivery approaches to ensure MMUs are providing efficient health care access to veterans in rural areas. These weaknesses occurred because VHA did not designate specific program responsibility for MMU management, define a clear purpose for its MMUs, or establish policies and guidance for effective and efficient MMU operations. As a result of limited MMU data, we were unable to fully address the committee’s concerns. However, it is apparent that VHA cannot demonstrate whether the almost $29 million ORH spent, as well as unknown medical facility funding for MMUs, increased rural veterans’ health care access and the extent to which MMUs can be mobilized to support its emergency preparedness mission. We recommended the Under Secretary for Health improve the oversight of MMUs by assessing their effect on rural veterans’ health care access, establishing specific program responsibilities, policies, and guidance, including requirements to capture MMU data in DSS, and supporting emergency preparedness plans. The Under Secretary for Health concurred with our recommendations and provided an acceptable action plan. We will follow up on the implementation of the corrective actions.

CRS — What Is the Farm Bill? (updated)

April 22, 2014 Comments off

What Is the Farm Bill? (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The farm bill is an omnibus, multi-year piece of authorizing legislation that governs an array of agricultural and food programs. Titles in the most recent farm bill encompassed farm commodity price and income supports, farm credit, trade, agricultural conservation, research, rural development, bioenergy, foreign food aid, and domestic nutrition assistance. Although agricultural policies sometimes are created and changed by freestanding legislation or as part of other major laws, the farm bill provides a predictable opportunity for policy makers to comprehensively and periodically address agricultural and food issues. The farm bill is renewed about every five years.

CRS — Wilderness: Legislation and Issues in the 113th Congress

March 5, 2014 Comments off

Wilderness: Legislation and Issues in the 113th Congress (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

The Wilderness Act of 1964 established the National Wilderness Preservation System and directed that only Congress can designate federal lands as part of the system. Free-standing bills to designate wilderness areas are typically introduced and considered in each Congress; such bills are not amendments to the Wilderness Act, but typically refer to the act for management guidance and sometimes include special provisions. Numerous wilderness bills were introduced in the 112th Congress, but it was the first Congress since 1966 that did not add to the wilderness system. The 112th Congress was the first in decades not to designate additional wilderness; the only wilderness law that was enacted reduced the size of a wilderness area. Many bills to add to the wilderness system have been introduced in the 113th Congress.

Wilderness designation can be controversial. The designation generally prohibits commercial activities, motorized access, and human infrastructure from wilderness areas; however, there are several exceptions to this general rule. Advocates propose wilderness designations to preserve the generally undeveloped conditions of the areas. Opponents see such designations as preventing certain uses and potential economic development in rural areas where such opportunities are relatively limited.

The Delivery of Pretrial Justice in Rural Areas: A Guide for Rural County Officials

January 14, 2014 Comments off

The Delivery of Pretrial Justice in Rural Areas: A Guide for Rural County Officials (PDF)
Source: National Association of Counties

This publication outlines the obstacles many small counties face when considering pretrial justice programs and offers recommendations to overcome these challenges. A joint report from NACo and the Pretrial Justice Institute (PJI).

Emerging Energy Industries and Rural Growth

December 9, 2013 Comments off

Emerging Energy Industries and Rural Growth
Source: USDA Economic Research Service

This report builds on findings from recent studies led by U.S. Department of Agriculture, Economic Research Service researchers investigating the economic effects of the emerging energy industries—unconventional natural gas extraction, wind power development, and corn-based ethanol production—in rural areas of the United States in the last decade.

Emerging Energy Industries and Rural Growth

November 25, 2013 Comments off

Emerging Energy Industries and Rural Growth
Source: USDA Economic Research Service

This report builds on findings from recent studies led by U.S. Department of Agriculture, Economic Research Service researchers investigating the economic effects of the emerging energy industries—unconventional natural gas extraction, wind power development, and corn-based ethanol production—in rural areas of the United States in the last decade.

Rural America at a Glance, 2013 Edition

November 19, 2013 Comments off

Rural America at a Glance, 2013 Edition
Source: USDA Economic Research Service

Rural America at a Glance, 2013 Edition highlights the most recent indicators of social and economic conditions in rural areas. This year’s edition focuses on the U.S. rural economy, including employment trends, poverty, and population trends.

Rural Veterans at a Glance

November 19, 2013 Comments off

Rural Veterans at a Glance
Source: USDA Economic Research Service

Nearly 4 million veterans reside in rural (nonmetropolitan) America. They are a rapidly aging and increasingly diverse group of men and women who still comprise over 10 percent of rural adults despite consistently declining numbers.

Selected charts from Ag and Food Statistics: Charting the Essentials

October 18, 2013 Comments off

Selected charts from Ag and Food Statistics: Charting the Essentials
Source: U.S. Department of Agriculture Economic Research Service

This collection of nine charts and maps presents essential information on the farm sector, food spending and prices, food security, rural communities, and the interaction of agriculture and natural resources.

Explaining the rural-urban gap in infant mortality in India

September 27, 2013 Comments off

Explaining the rural-urban gap in infant mortality in India
Source: Demographic Research

Background:
Prior studies suggest that infant mortality in rural areas of India is substantially higher than in urban areas. However, little is known about the determinants explaining such excess of rural mortality.

Objective:
This study systematically assesses the role of socioeconomic and maternal and child health (MCH) care-related programme factors in explaining the rural-urban gap in infant mortality during the past two decades.

Methods:
Long-term changes in rural and urban infant mortality were assessed using Sample Registration System (SRS) data. Binary logistic regression was used to analyse the association between socioeconomic and MCH care-related programme factors and infant mortality using data from the three rounds of the National Family Health Survey (NFHS). Fairlie’s decomposition technique was applied to understand the relative contribution of different co-variates to the rural-urban gap in infant mortality.

Results:
Relative inequality between rural and urban India has increased over time. The rural-urban gap in infant mortality can be largely explained by the distributions of the co-variates in rural and urban area. The largest part of the rural disadvantage in infant mortality is attributable to the underlying disadvantage in household wealth and maternal education, whereas breastfeeding and knowledge of Oral Rehydration Solution has contributed to narrowing the gap. The share of women using modern contraceptive methods and the percentage of fully vaccinated children in the community have also contributed to widening the rural-urban gap in infant mortality.

Conclusions:
In addition to strengthening MCH programmes in rural areas, substantial efforts must also be made to improve household wealth and female education levels.

Selected charts from Ag and Food Statistics: Charting the Essentials

September 18, 2013 Comments off

Selected charts from Ag and Food Statistics: Charting the Essentials
Source: U.S. Department of Agriculture, Economic Research Service

This collection of nine charts and maps presents essential information on the farm sector, food spending and prices, food security, rural communities, and the interaction of agriculture and natural resources.

Traffic Safety Facts — Rural/Urban Comparison

August 24, 2013 Comments off

Traffic Safety Facts — Rural/Urban Comparison (PDF)
Source: National Highway Traffic Safety Administration

This fact sheet contains statistics on motor vehicle fatal crashes based on data from the Fatality Analysis Reporting System (FARS). FARS is a census of fatal crashes within the 50 States, the District of Columbia, and Puerto Rico (although Puerto Rico is not included in the national totals). Rural and urban boundaries are determined by the State highway departments and approved by the Federal Highway Administration.

In 2011, there were 29,757 fatal crashes resulting in 32,367 fatalities. Rural areas accounted for 54 percent (16,053) of the fatal crashes and 55 percent (17,762) of the fatalities as compared to urban areas that accounted for 46 percent (13,578) of the fatal crashes and 45 percent (14,464) of the fatalities. Additionally, 126 fatal crashes resulting in 141 fatalities occurred in areas where land use was unknown. According to the latest rural and urban population data from the Census Bureau, 19 percent of the U.S. population lived in rural areas, however, rural fatalities accounted for 55 percent of all traffic fatalities in 2011.

Most Critical Access Hospitals Would Not Meet the Location Requirements If Required To Re-enroll in Medicare

August 15, 2013 Comments off

Most Critical Access Hospitals Would Not Meet the Location Requirements If Required To Re-enroll in Medicare
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
The Critical Access Hospital (CAH) certification was created to ensure that rural beneficiaries are able to access hospital services. Medicare reimburses CAHs at 101 percent of their reasonable costs, rather than at the rates set by prospective payment systems or fee schedules.
Currently, hospitals can be certified as CAHs if they meet a variety of regulatory requirements, including being located at least a certain driving distance from other hospitals (including CAHs) and being located in rural areas. These two requirements are known as the distance requirement and the rural requirement, respectively. Collectively, the two requirements are known as the location requirements. Prior to 2006, States could exempt CAHs from the distance requirement by designating them as “necessary provider” (NP) CAHs. NP CAHs are permanently exempt from meeting the distance requirement.

HOW WE DID THIS STUDY
We plotted the locations of CAHs and other hospitals onto digital maps to determine whether CAHs would meet the location requirements if they were required to re-enroll in Medicare. Additionally, we calculated (using 2011 claims data) the potential savings to Medicare and beneficiaries if CMS were to decertify CAHs that would not meet the location requirements.

WHAT WE FOUND
Nearly two-thirds of CAHs would not meet the location requirements if required to re-enroll. The vast majority of these CAHs would not meet the distance requirement. CMS does not have the authority to decertify most of these CAHs, as most of these CAHs are NP CAHs. However, if CMS were authorized to reassess whether all CAHs should maintain their certifications and concluded that some should be decertified, Medicare and beneficiaries could realize substantial savings. If CMS had decertified CAHs that were 15 or fewer miles from their nearest hospitals in 2011, Medicare and beneficiaries would have saved $449 million.

WHAT WE RECOMMEND
Because the CAH certification results in increased spending for both Medicare and beneficiaries, CMS should ensure that the only CAHs to remain certified would be those that serve beneficiaries who would otherwise be unable to reasonably access hospital services. We recommend that CMS (1) seek legislative authority to remove NP CAHs’ permanent exemption from the distance requirement, thus allowing CMS to reassess these CAHs; (2) seek legislative authority to revise the CAH Conditions of Participation to include alternative location-related requirements; (3) ensure that it periodically reassesses CAHs for compliance with all location-related requirements; and (4) ensure that it applies its uniform definition of “mountainous terrain” to all CAHs. CMS concurred with our first, third, and fourth recommendations, but did not concur with our second recommendation.

CRS — Broadband Loan and Grant Programs in the USDA’s Rural Utilities Service

July 25, 2013 Comments off

Broadband Loan and Grant Programs in the USDA’s Rural Utilities Service (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Given the large potential impact broadband access may have on the economic development of rural America, concern has been raised over a “digital divide” between rural and urban or suburban areas with respect to broadband deployment. While there are many examples of rural communities with state of the art telecommunications facilities, recent surveys and studies have indicated that, in general, rural areas tend to lag behind urban and suburban areas in broadband deployment.

Citing the lagging deployment of broadband in many rural areas, Congress and the Administration acted in 2001 and 2002 to initiate pilot broadband loan and grant programs within the Rural Utilities Service (RUS) at the U.S. Department of Agriculture (USDA). Subsequently, Section 6103 of the Farm Security and Rural Investment Act of 2002 (P.L. 107-171) amended the Rural Electrification Act of 1936 to authorize a loan and loan guarantee program to provide funds for the costs of the construction, improvement, and acquisition of facilities and equipment for broadband service in eligible rural communities. The RUS/USDA houses two assistance programs exclusively dedicated to financing broadband deployment: the Rural Broadband Access Loan and Loan Guarantee Program and the Community Connect Grant Program.

For the broadband loan program, the Administration’s FY2013 budget proposal requested $8.915 million to subsidize a loan level of $94.139 million. The Administration requested $13.379 million for broadband grants in FY2013. The Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6) funds the broadband loan program at $4 million (supporting a loan level of approximately $42 million) and the Community Connect grant program is funded at $10.372 million.

The 110th Congress considered reauthorization and modification of the loan and loan guarantee program as part of the 2008 farm bill. The Food, Conservation, and Energy Act of 2008 became law on June 18, 2008 (P.L. 110-246). Title VI (Rural Development) contains authorizing language for the broadband loan program.

The 112th Congress considered reauthorization of the broadband loan program in the 2012 farm bill. While the 2012 farm bill was not enacted by the 112th Congress, Title VII of the American Taxpayer Relief Act of 2012 extended farm bill programs by one year (through September 30, 2013). In the 113th Congress, 2013 farm bill legislation passed by the House and Senate (H.R. 2642/S. 954) includes the broadband program reauthorization provisions previously contained in the 2012 farm bill.

Safety in Numbers: Are Major Cities the Safest Places in the United States?

July 23, 2013 Comments off

Safety in Numbers: Are Major Cities the Safest Places in the United States? (PDF)
Source: Annals of Emergency Medicine

Study objectives:
Many US cities have experienced population reductions, often blamed on crime and interpersonal injury. Yet the overall injury risk in urban areas compared with suburban and rural areas has not been fully described. We begin to investigate this evidence gap by looking specifically at injury-related mortality risk, determining the risk of all injury death across the rural-urban continuum.

Methods:
A cross-sectional time-series analysis of US injury deaths from 1999 to 2006 in counties classified according to the rural-urban continuum was conducted. Negative binomial generalized estimating equations and tests for trend were completed. Total injury deaths were the primary comparator, whereas differences by mechanism and age were also explored.

Results:
A total of 1,295,919 injury deaths in 3,141 US counties were analyzed. Injury mortality increased with increasing rurality. Urban counties demonstrated the lowest death rates, significantly less than rural counties (mean difference¼24.0 per 100,000; 95% confidence interval 16.4 to 31.6 per 100,000). After adjustment, the risk of injury death was 1.22 times higher in the most rural counties compared with the most urban (95% confidence interval 1.07 to 1.39).

Conclusion:
Using total injury death rate as an overall safety metric, US urban counties were safer than their rural counterparts, and injury death risk increased steadily as counties became more rural. Greater emphasis on elevated injury-related mortality risk outside of large cities, attention to locality-specific injury prevention priorities, and an increased focus on matching emergency care needs to emergency care resources are in order. [Ann Emerg Med. 2013;-:1-15.]

Rural Broadband At A Glance, 2013 Edition

July 12, 2013 Comments off

Rural Broadband At A Glance, 2013 Edition
Source: U.S. Department of Agriculture, Economic Research Service

Rural Internet and broadband adoption rates still lag behind urban rates in the United States. This report presents data on urban and rural household Internet and broadband subscription rates and explores some of the primary causes for lower rates in rural areas.

Patterns of Care for Rural and Urban Children with Mental Health Problems

July 8, 2013 Comments off

Patterns of Care for Rural and Urban Children with Mental Health Problems (PDF)
Source: University of Southern Maine (Maine Rural Health Research Center)

Controlling for demographic and risk factors, rural children are as likely as urban children to have an attention deficit or hyperactivity disorder (ADHD) diagnosis and less likely to have any other type of psychiatric diagnosis. Initially observed higher prevalence of mental health diagnoses among rural children is explained by underlying differences in demographic characteristics and risk factors, such as higher rates of poverty, public coverage, mental health impairment, and lower prevalence of minorities. Rural children with the highest mental health need are no more or less likely to be diagnosed or treated for mental health conditions. However, among those with a possible impairment, rural children are less likely to be diagnosed with a psychiatric illness other than ADHD and are less likely to receive counseling.

Global Monitoring Report 2013 : Rural-Urban Dynamics and the Millennium Development Goals

May 24, 2013 Comments off

Global Monitoring Report 2013 : Rural-Urban Dynamics and the Millennium Development Goals
Source: World Bank

The Global Monitoring Report 2013: Rural-Urban Dynamics and the Millennium Development Goals examines rural-urban disparities in the achievement of the Millennium Development Goals (MDGs) and how urbanization, if managed well, can contribute to the attainment of these goals. The report provides information about the differences in progress toward the MDGs across geographical areas and recognizes that urban populations are better off than their rural brethren. However, unfettered urbanization can cause migrants and the urban poor to end up in slums where attainment of the MDGs lags. GMR 2013 calls for an integrated strategy to better manage the planning-connecting-financing formula of urbanization. Notwithstanding the importance of urbanization in poverty reduction and MDG attainment, rural areas remain a huge challenge—one that underscores the importance of policies that can improve rural livelihoods. The rural-urban spectrum ranges from small towns to large cities. The general experience is that poverty is lowest in the largest cities and considerably higher in smaller towns. The MDGs reflect the basic needs of all citizens, and governments should aim to meet them fully in both urban and rural areas. However, resources are scarce, so priorities must be set and trade-offs made. The report argues that the sequencing of actions be tailored to local conditions when it comes to the degree of urbanization and rural-urban differences in MDG outcomes. The world has met four global MDG targets. New estimates confirm the 2012 reports that MDG 1.a—reducing the $1.25-a-day poverty rate (2005 purchasing power parity)—was reached in 2010, falling below half of its 1990 value. The world also met part of MDG 7.c—to halve the proportion of people without safe access to drinking water—in 2010. MDG 7.d—to improve significantly the lives of at least 100 million slum dwellers by 2020—was also achieved. Finally, the first part of MDG 3.a—to eliminate gender disparity in primary education— was accomplished in 2010. Global progress on the full MDG 3.a (to eliminate gender disparity in primary and secondary education) is close to being on track. Global Monitoring Report 2013 was prepared jointly by the World Bank and the International Monetary Fund, with consultations and collaborations with regional development banks and other multilateral partners.

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