Project Background

DeSoto County Steering Committee

Cardiology Clinical Integration Team

Current Project Status

Project Background

The Heartland Rural Health Network (HRHN) consists of over twenty-five (25) organizations, including a Critical Access Hospital, four other hospitals, all of the County Health Departments from the five county area the Network serves, our Area Health Education Center, federally qualified community health centers and representatives from consumers, local governments, and others.  HRHN is the largest of nine (9) networks in the State.  It covers an area of 4,870 square miles.  This region includes some of the most rural counties in the State.  DeSoto County is 647.3 square miles and has 50.6 persons per square mile.  This area has also been designated as medically underserved and/or health professional shortage area.

The State of Florida passed the enabling legislation that authorized the creation of rural health networks in 1993.  That legislation was very specific in delineating the purpose for these networks.  The legislation states that rural health networks should: 1) Provide an effective continuum of care for all patients served by the Network, 2) ensure the availability of a comprehensive array of services either directly, by contract, or through referral agreements, 3) reduce outmigration and increase the utilization of rural hospitals and other rural health care providers, 4) enhance access to high quality health care and ensure that it is efficiently delivered, 5) support the economy and protect the health and safety of rural residents, 6) serve as laboratories to determine the best way of organizing rural health services. 

HRHN designed a model called the Health Care Services Integration Model, which, if properly implemented, is expected to ensure that the Network can effectively meet the legislative intent for which they were created.  The Integration Model moves the Network into a relationship whereby the leadership and staff will be working side by side with health care providers in resolving health care delivery issues common to almost all rural areas.  It will also align Network activities with the needs and interests of its members thus ensuring the Network's sustainability.  The integration model will reduce outmigration, expand services, increase revenues to local providers, greatly enhance the access to care and make certain that it is efficiently delivered.  The Network's goal is to develop a model that is so effective that other Networks in the State of Florida may want to replicate it. 

Patient outmigration in rural counties is often times very rampant.  DeSoto County has one hospital to serve the community.  In 2002, 62.7% of inpatient cases were leaving the county for care at various hospitals located throughout the state of Florida.  The Health Care Services Integration Model is a way to identify infrastructure and/or process problems within a selected service line (i.e.: cardiology, obstetrics, gastroenterology, etc).  Data is presented to a Steering Committee, which is appointed by HRHN and includes representatives from the local area hospitals, the local County Health Department, federally qualified community health center, one or more local physicians, preferably the Chief of Staff from the local hospital, the Clinical Integration Coordinator, the Network's Health Planning Director, and the Network's Executive Director and others as may be deemed appropriate.  The Steering Committee reviews the data provided by the Network and approves the health care service line to be studied by the Clinical Integration Team, provides oversight, guidance and on-going evaluation of each project, monitors and measures results and outcomes, and facilitates decisions and provides unwavering support to the project.  Once the Steering Committee selects a service line to be studied the Clinical Integration team is created.

The Clinical Integration Team is composed of key individuals that are involved in the delivery of health care services within a specific service line.  The membership of the Team is appointed by the Health Care Services Steering Committee and the make-up of the Team may be different for each service line to be studied.  The membership of the Clinical Integration Team consists mainly of physicians, nurses, physician office/clinic managers, hospital administration representatives, Emergency Medical Service representatives, local Health Department representatives, and representatives of tertiary care providers, clinical integration coordinator, health planner, and others as appropriate. 

The Clinical Integration Team gives consideration to some of the following issues within each service line selected.  Examples of issues addressed include:

1. Where patients are going for inpatient and outpatient health care services.
2. What resources are available locally for the provision of inpatient and outpatient services within the specific service line being studied.
3. Where patients are being referred by local physicians and hospitals when care cannot be provided locally.
4. What health care services are currently not being provided at the local level that could and should be provided?  What would it take to develop and implement these services?
5. What local services are not being used by out-of-the-area providers that could or should be used?  How can we assure an effective continuum of care by encouraging referrals back to these local providers once the patient has been referred out of the area.

Once the Clinical Integration Team has considered and responded to issues such as listed above, they will develop a prioritized agenda for addressing the issues, problems, and concerns that have been identified for the selected service line being studied.  Flow charting any process problems that need to be addressed helps to identify problems caused by encumbrances in each specific process and to decide how these encumbrances can be resolved.  Changes that involve processes considered to be within the "ownership" of those organizations represented by members of the Clinical Integration Team should be implemented.  Any recommendations that are outside of the "ownership" of the membership of the Clinical Integration Team should be referred to the Health Care Services Steering Committee for action or follow-up.

In addition to focusing on identified "process" problems, the Clinical Integration Team also identifies infrastructure issues that need to be addressed in order for the Team to accomplish it's purpose.  Infrastructure issues can relate to but are not limited to the following: