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The California
AHEC and its Relationship with Community
Health Centers
Presenter: Heather Karr Anderson, MPH
California AHEC and HETC Programs, USCF-Fresno
Research shows that the best way to adequately
staff CHCs is to train health professionals
in community settings. In 1993, the California
AHEC received State funding that matched
Federal grant awards to develop a new
initiative to create and expand a residency
program at CHCs or at community-based
clinics. Results of this initiative include
the development of five new residency
programs and the expansion of three residency
programs. The collaboration between the
AHEC and CHCs is the only program to open
new residency slots in 20 years. In addition
to creating 90 new family medicine residency
slots, it has enabled the development
of clerkships and payment for faculty
time. The Clinic Consortia has also been
initiated, which is comprised of 13 administrative
umbrella agencies for 330 clinics throughout
the State. Seven of the ten California
AHEC centers are now located within Clinic
Consortia or CHCs. Future directions
include initiating a statewide collaboration
with the California Primary Care Association,
the AHEC, and CHCs to improve access to
and the quality of care to medically underserved
populations.
GEC/HC Linkages
Presenter: Ronni Chenoff, PhD
Arkansas GEC
Every county in Arkansas is designated
as medically underserved at some level,
with a large percent classified as HPSAs.
In efforts to provide adequate health
care services to this population, GEC
and CHC linkages have been developed to
provide: quality education in geriatrics
to rural health professionals; education
to faculty in the health professions;
and training to primary health care providers
to serve as student training sites. Community
Health Centers of Arkansas is a collaboration
of 11 FQHCs that manage approximately
50 rural-based health clinics.
The collaboration provides training to
physicians, nurses, social workers, pharmacists,
dietitians, physical therapists, occupational
therapists, dental health professionals,
speech and hearing professionals, and
psychologists. Health professions training
is conducted via CE/CME symposia on nutrition
and aging, geriatric medicine, and best
practices in the continuum of care, including
other courses co-sponsored with the Geriatric
Research Education and Clinical Center
(GRECC). Other trainings include: AR-GEM
self study curriculum in geriatrics; mandatory
and elective modules; coaching and mentoring
workshops; clinical observation and mentoring;
and curriculum development (dental, nutrition,
surgery). Training is conducted by various
means such as interactive video teleconferences,
VHS, DVDs, and online audio and PowerPoint
lectures. Evaluation of this collaboration
is done through the biannual needs assessment,
alternate year surveys, program evaluations,
follow-up phone surveys, HRSA annual reports,
Institute on Aging reports, GRECC annual
reports, and management briefings.
Challenges Associated
with Building Linkages among Academic
Institutions and Medical Facilities
Presenter: Mary Amundson, MA
Center for Rural Health, North Dakota
In 2005, funding under the Quentin N.
Burdick Program was provided to 17 States—Arizona,
Georgia, Hawaii, Idaho, Illinois, Kansas,
Kentucky, Nebraska, New Mexico, North
Carolina, North Dakota, New York, Ohio,
Oklahoma, South Carolina, Tennessee, and
West Virginia. Funded programs work to
increase access to health care and to
build the health care workforce. For
example, 4,303 trainees have provided
over 300,000 health service encounters.
Training covers multiple disciplines—94
percent of funded programs provide training
in social work, psychology, and/or counseling,
89 percent of funded programs provide
nursing training, 61 percent provide training
in medicine, 58 percent provide training
in occupational and physical therapy;
and over 40 percent provide training to
nutritionists, physician assistants, and
professionals in public health.
An example of a Burdick-supported program
is North Dakota’s Project CRISTAL, which
includes the University of North Dakota
(medicine, nursing, social work, psychology,
clinical lab science, nutrition, dietetics,
occupational therapy, physical therapy),
Turtle Mountain Community College, Fort
Betthold Community College, Minot State
University (radiology technology), health
care facilities, and community agencies.
Project CRISTAL’s main goal is to improve
health care services to populations residing
on the Turtle Mountain Indian Reservation
in Belcourt and New Town by developing
a curriculum designed to provide interdisciplinary
training. As a result of the program,
an interprofessionl course was developed
and 80 students from different disciplines
participated in the course. In addition,
students were provided the experience
of working with Native American populations.
The National Health
Education and Training Centers Program:
Linkages with the Community Health Centers
Presenter: Rosebud Foster, EdD
Nova Southeastern University
HETCs are funded to improve the health
of low-income and minority populations
in severely underserved border and non-border
areas through use of incentives to attract
and retain health care personnel and by
emphasizing wellness in public health
education. HETCs encourage communities
to utilize their own resources to enhance
public health, provide community health
education and health provider training,
and target special populations such as
people of color, the disadvantaged and
culturally and linguistically diverse
communities.
In FY 2005, five border HETCs and six
non-border HETCs received funding. Border
HETCs are located in States within 300
miles of the US-Mexico border and in Florida.
The non-Border HETCs are located in States
with severely disadvantaged, underserved
populations in rural and urban areas.
In 2005, non-Border HETCs included Arkansas,
Georgia, Hawaii, Kentucky, Washington,
and Wisconsin. HETC programs establish
an advisory board of health service providers,
educators, and consumers from the service
area. Programs provide: training and
education programs for health professions
students; training in health education
services, including training to prepare
CHWs; and support through education and
other services.
In their work to address unmet health
care needs, HETCs work with CHCs. In
FY 2005, HETCs worked with approximately
100 CHC sites, providing over 219,000
contact hours of CE to over 20,000 participants,
of which 3,000 were from CHC sites. In
addition, HETCs enabled community-based
training of nearly 7,500 health professions
trainees including: 2,057 allopathic and
osteopathic medical students; 2,130 nursing,
APN, and PA students; 1,259 dental, pharmacy,
public health, mental health, and other
allied health students; and 2,020 CHWs.
HETCs also reached nearly 13,000 9-12
grade students with health professions
career enrichment services.
An example of a HETC-CHC linkage is the
Florida Border HETC Program, which is
a statewide partnership between Nova Southeastern
University, the University of Florida,
University of Miami, and the University
of South Florida. The program includes
eight local, community-based HETCs serving
urban, rural agricultural and migrant
communities. The Florida HETC program
works with approximately 40 community/migrant
health centers and county health department
sites, in which training is provided to
medical students and residents, dental
students and residents, nursing students
and nurse practitioners, and numerous
students in other disciplines.
Allied Health Linkages
Presenter: Richard Oliver, PhD
University of Missouri–Columbia
The Certification in Interdisciplinary
Geriatric Assessment Program is a 3-year
program for allied health professionals,
which offers a 25-hour certificate from
the School of Health Professions. It
is funded through HRSA’s Allied Health
Program. The certificate program primarily
targets professionals in the fields of
health psychology, occupational therapy,
physical therapy, respiratory therapy,
and speech language pathology. The program
delivers educational programming in research,
assessment, and treatment information
to health professionals providing services
in underserved or un-served areas of Missouri
and promotes the use of an interdisciplinary
team with patients that have complex medical
issues. Educational programs include:
geriatric lecture series; geriatric resource
library; a newsletter; virtual health
care team; website; and workshops.
Health Disparities
Collaborative: Workforce Development Collaborative
Presenter: Ahmed Calvo
Bureau of Primary Health Care, Health
Resources and Services Administration
The Workforce Development Collaboratives
are designed to build partnerships between
health centers, residency training programs,
AHECs, GECs, and the NHSC. These collaboratives
address the recruitment and retention
of health care professionals and explore
the development of interdisciplinary education
and training models.
An example of a collaborative is the
Grown-Our-Own Program at San Ysidro Health
Center (SYHC), which focuses on the development
of a long-term strategy to identify and
recruit medical students interested in
working with communities and health centers.
It is a partnership between Scripps, UCSD
School of Medicine, and the San Ysidro
Health Center Network. Scripps developed
a curriculum and a GME apparatus to provide
structure and accreditation opportunities.
UCSD faculty provided lectures as well
as advanced electives and research opportunities.
Medical students in the program provide
care to SYHC patients, many of whom face
multiple challenges in accessing and remaining
in the health care system. The creation
of this residency program has affected
recruitment and retention of clinicians
at SYHC—graduates remain within the community,
as do the practitioners involved in the
Grow-Our-Own Program. The residency program
has helped to attract internists, pediatricians,
and other physicians dedicated to serving
in health centers. Many also maintain
a focus on research and teaching.
CHC Workforce
Presenter: Gary Hart, Ph.D.
Rural Health Research Center, University
of Washington
The National Health Center Workforce
Survey Study was conducted collaboratively
by the University of Washington Rural
Health Research Center, the University
of South Carolina Rural Health Research
Center, and the National Association of
Community Health Clinics. The study was
funded by HRSA’s Office of Rural Health
Policy, Bureau of Primary Health Care,
and Bureau of Health Professions. The
study explored: 1) staffing needs of federally
funded health centers by provider type;
2) health center recruitment issues; and
3) workforce issues for health centers
depending on characteristics and locations.
The survey findings indicate that the
most common health centers are community
based. Others include centers serving
the homeless, migrant health centers,
and health centers based in schools or
public housing. A majority of the grantees
(n=731) in the study were urban health
centers with large populations and general
care sites.
The majority of FTE providers in health
centers were “other” nurses, followed
by registered nurses (RNs) and family
practitioners (FPs). Health centers have
high vacancy rates for psychiatrists,
obstetricians/gynecologists, dentists,
FP/general practitioners, pharmacists,
RNs, nurse practitioners (NPs), general
medicine, general pediatricians, and physician
assistants (PAs). All these professionals
are actively recruited by health centers.
Overall, 30 percent of all physicians
in health centers have an obligation,
with half committed to NHSC and others
with J-1 visa waivers, scholarships, or
state loans. Provider vacancy rates differ
by provider type and location. The vacancy
rate is highest for family practitioners
in isolated small mountainous rural areas.
Dentist vacancies are highest in small
and isolated rural areas of the West Coast.
In urban areas, RNs are the most difficult
to recruit, followed by FPs and NPs.
In large rural areas, both FPs and RNs
are equally hard to recruit. In small
rural and isolated small rural areas,
FPs are the hardest to recruit followed
by RNs and NPs. Some challenges to recruitment
are spouse employment, lack of cultural
activities, compensation, housing, workload,
schools, and facility conditions. Strategies
to improve recruitment include: higher
salaries; more loan repayment opportunities;
greater visibility; more minority training;
better job banks; portable benefits packages;
better recruitment tools; and more residency
slots. Formal retention plans are also
needed.
HRSA – Supported
Health Centers
Presenter: Richard Lee
Bureau of Primary Health Care, Health
Resources and Services Administration
HRSA provides Federal grant funding to
over 1,000 health center grantees, with
a total of over 3,800 comprehensive service
sites that deliver primary and preventive
care. Health centers that receive Federal
Section 330 grants through HRSA are identified
by CMS as FQHCs and receive cost-based
Medicare/Medicaid reimbursement. These
centers are required to include the involvement
of the community and consumers, primarily
through governing boards. Other fundamental
principles include: focusing on the needs
of the underserved; providing care regardless
of the ability to pay; providing comprehensive
primary health care; assuring high quality
care delivered by professional staff;
and establishing partnerships in the public
and private sectors.
In FY 2006, 1,006 grantees received $1.8
billion in funding, served 13.1 million
patients, and provided 52.2 million patient
encounters. Slightly over half the health
centers are in rural areas. Forty (40)
percent of patients are uninsured, 91
percent having incomes below 200 percent
of poverty level, and 63 percent of the
patients are minorities.
A typical health center has an annual
budget of $6 million and provides general
primary care, preventive screenings, chronic
disease management, and enabling services.
On average, health centers employ 90 staff
members—25 clinicians, 17 clinical support
staff, 29 enabling patient support staff,
and 19 administrative staff. A major
source of funding for health center programs
is Medicaid, which makes up 36 percent,
followed by Federal grants, which account
for 22 percent of funding. Other sources
include State/local contributions, a small
percentage from Medicare, self pay, public
contributions, and other third party payments.
An FQHC Look-Alike program is a health
center that operates under the same fundamental
principles as health center grantees,
but does not receive grant funds. Such
a program must be governed by a board
where the majority of members are consumers.
In addition, it must serve all individuals
regardless of their ability to pay and
provide comprehensive primary care. FQHC
Look-Alike program benefits include enhanced
Medicaid and Medicare reimbursement, participation
in discounted drug pricing programs, and
eligibility to receive NHSC providers.
Currently, there are 123 Look-Alike programs
in 20 States.
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