Do you remember this story from childhood about the train trying to make it up the hill and the phrase he used to motivate himself? I think I can, I think I can. Much of my life I have repeated these words to myself starting with achievements in sports as a child and young adult to college and then the challenges we face at work and life. My Facebook motto is “if you think you can do it, you can!” This is the motto that I believe our rural communities live by.
When the national reports are released in prominent journals stating that rural hospitals deliver poor quality of care, you don’t respond by denying these allegations with your words. Instead you respond by showing your data and outcomes. You show that of the measures that are rural relevant, your scores are meeting the national standards and are often above. When you review Hospital Compare, which all critical access hospitals voluntarily submit data to on a quarterly basis, often this data is suppressed due to low volume. Then you further show that your patient satisfaction scores are higher in rural than in urban and can be seen on the national HCAHPS.
When the federal government says that they want all providers and hospitals to implement an electronic medical record and become meaningful users to improve care coordination, you don’t respond by sticking your head in the sand. You respond by showing that all rural hospitals and over 80 percent of providers in the rural clinics, achieved stage one meaningful use. And by the way… Colorado was the third highest state in the nation to have the most hospitals and providers achieve stage one meaningful use. Thank you, CORHIO for pulling together all the partners in Colorado to assist in meeting this challenge.
When new approaches such as patient centered medical home recognition became the standard, you did not shy away from this challenge. You highlighted the fact that this is the way we care for our communities in rural. Although we only have a handful of rural health clinics with the official NCQA Recognition, most of our clinics would not be able to survive without focusing on the needs of the patient, and many are working towards receiving this official recognition. After all, our patients are our communities – teachers, neighbors, law enforcement, family neighbors and dear friends. This changes the conversation you have when treating a patient. Someone once told me that you should treat people like you’d like your mother to be treated, and this is the patient centered care in our rural communities.
We are now being challenged to face the shift in healthcare from volume to value. This of course is difficult for rural communities because we don’t have the volume in the community. The population is what the community population is. In fact, rural communities are aging and decreasing in population. By 2020, the total Colorado rural population will have decreased 4.6 percent. Many with the decision making power do not understand that the reason the critical access hospitals and rural health clinic programs were created is to ensure access to care in our rural communities. These communities are older and more vulnerable because of a variety of variables, most notably, geographic isolation, therefore requiring additional attention.
For six years now, critical access hospitals and rural health clinics (three years) have been collaborating to improve readmissions, focus on care coordination and communication, and to improve the processes and systems of care in heart failure, pneumonia, and diabetes through our iCare program. The latest data indicates that those communities participating in iCARE have 10 percent lower diabetes rates than rural averages, and 16 percent lower than statewide averages. Further, 30-day readmission rates are 31 percent lower than all other CAHs and 34 percent lower than the state average. We’ll soon be releasing an interactive data story board that outlines the improvements our communities have made because of this program.
Next month we have the opportunity to connect as rural communities, or as those that support rural communities, at the CRHC annual conference. This will be an exciting time to learn and share information on a variety of topics including, but not limited to health information technology, quality systems improvement, funders’ perspectives, and creating leadership through innovation. We hope that the general feeling our guests will embrace is one of I can, and one that celebrates the power of rural as a healthcare innovator.
Thank you for continuing to persevere and have that “I think I can” attitude.