Hardee
County Steering Committee
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. Hardee
County is 637.4 square miles and has 42.3 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. Hardee
County has one hospital to serve the community. In 2002, 87% 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, general surgery, 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 its purpose. Infrastructure issues can
relate to but are not limited to the following:
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Once recommended
changes have been implemented within the selected service/product line,
continued monitoring, data gathering and re-evaluation will be done to
determine if the improvements sought have been realized. Once all
activity pertaining to the first service line has been completed and the
Clinical Integration Team as well as the Steering Committee is satisfied
with the results that have been achieved then a second service line to
be studied is selected by the Steering Committee and the process
described above is repeated. This process is continued until all service
lines selected have been addressed.
The grant was awarded in May 2003 and funding is for three years, ending
May 2006. Please check back regularly to get updates on the issues being
addressed and the accomplishments of the project.