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Federal Office of Rural Health Policy
A Role for State Offices of Rural Health
in Addressing COPD in Rural America
Paul Moore, D.Ph.Senior Health Policy Advisor,
Federal Office of Rural Health PolicyExecutive Secretary, National Advisory Committee
on Rural Health and Human Services
National Advisory Committee on Rural Health and Human Services 2
Why COPD?• In 2015: age-adjusted prevalence of doctor-diagnosed COPD among rural
counties was nearly twice as high (8.2%) as that of urban areas (4.7%).
Figure: Unadjusted prevalence of COPD among adults ages 18+, by county – United States, 2015[1]
National Advisory Committee on Rural Health and Human Services 3
Why COPD?• In 2015: age-adjusted prevalence of doctor-diagnosed COPD among rural
counties was nearly twice as high (8.2%) as that of urban areas (4.7%).[1]
• Higher estimated COPD prevalence among rural, poor communities, suggesting that rural residence and poverty are independent COPD risk factors.[2]
• Rural-related Risk Factors Higher rates of smoking among adults[3] and exposure to secondhand smoke
among children[4]
Environmental and occupational exposures (e.g., farming, coal mining)
• Barriers accessing care (e.g., lack of transportation, lack of access to pulmonologists).
[1] Croft, Janet B., et al. “Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, 2015.” MMWR Report, 67.7 (2018): 205-211. DOI: 10.15585/mmwr.mm6707a1.[2] Raju, Sarath, et al. “Rural residence and poverty are independent risk factors for COPD in the United States.” American Journal of Respiratory and Critical Care Medicine. (2018). DOI: 10.1164/rccm.201807-1374OC. [3] Meit, Michael, et al. “The 2014 rural-urban chartbook.” Report. (October 2014). Rural Health Reform Policy Research Center. Retrieved from https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf.[4] Vander Weg, Mark W., et al. “Tobacco use and exposure in rural areas: Findings from the Behavioral Risk Factor Surveillance System.” Addictive Behaviors, 36.3 (2011): 231-236. DOI: 10.1016/j.addbeh.2010.11.005
National Advisory Committee on Rural Health and Human Services
The Rural Community Embraced the Challenge
National Advisory Committee on Rural Health and Human Services
Implementation in Rural Settings
As a follow-up, in June 2018, the Federal Office of Rural Health Policy (FORHP) hosted another gathering to begin establishing actionable commitments to implementing the goals of the COPD National Action Plan in rural areas.
The group revisited the goals of the COPD National Action Plan and reviewed rural differences in COPD outcomes and access to care. The bulk of the working meeting was centered on rural challenges and proposing next steps to resolve those issues.
Some of the major takeaways attendees discussed included:Payment and Reimbursement in Rural AreasRural WorkforceCOPD Treatment in Rural SettingsAddressing Comprehensive COPD Care in Rural Areas
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COPD in Rural America and the Resources Available to Help Support Providers
Kristine SandeNOSORH Annual Conference Oct 17,2019
ruralhealthinfo.org
What is COPD?
https://www.ruralhealthinfo.org/rural-monitor/rural-copd/
Several conditions in the “group:”• Chronic bronchitis• Emphysema• Asthma• Others
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Why Focus on COPD?
40.332.0
36.241.9
47.052.8 54.5
0
10
20
30
40
50
60
U.S. Overall Large metrocenter
Large fringemetro
Medium metro Small metro Micropolitan Noncore
COPD Deaths per 100K
Source: CDC MMWR, Urban-Rural County and State Differences in Chronic Obstructive Pulmonary Disease — United States, 2015
COPD National Action Plan Goals
1• Empower people with COPD, their families, and caregivers to recognize and
reduce the burden of COPD.
2• Improve the prevention, diagnosis, treatment, and management of COPD by
improving the quality of care delivered across the health care continuum.
3• Collect, analyze, report, and disseminate COPD-related public health data that
drive change and track progress.
4• Increase and sustain research to better understand the prevention,
pathogenesis, diagnosis, treatment, and management of COPD.
5• Translate national policy, educational, and program recommendations into
research and public health care actions.
https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan
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How is COPD diagnosed?
• Clinical suspicion• Presence of three “cardinal symptoms”
• Chronic cough• Sputum production• Shortness of breath
• Spirometry is the cornerstone of COPD diagnosis
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Treatments for COPD
Primary three treatments:• Inhaled medicine (bronchodilators)• Oxygen• Pulmonary rehab
Flu and pneumococcal vaccine also very important for COPD patients
COPD Awareness Month #COPD
Learn More Breathe Better: https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-betterOutreach toolkit: https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-better/copd-awareness-monthState prevalence shareables: https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-better/social-media-resources
RHIhub Products Related to COPD
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Rural MonitorBringing Change for Rural COPD Patients: Possibilities with the COPD National Action Plan
Pulmonary Health in Rural America: Cause and Impact of Work-Related Lung Diseases
Understanding the Many Roles of COPD Foundation State Captains: Q&A with John Linnell
Coming in November: Article on diagnosis of COPD in rural areas
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Video
Narration: Ted KoppelInterviewees:• Grace Anne Dorney Koppel, Dorney-Koppel Foundation• Dr. Meredith McCormack, Johns Hopkins• Dr. Tony Punturieri, NHLBI• Dr. Anil Singh, Allegheny Health Network
https://youtu.be/COUzdbH826k
The Challenges of Chronic Disease in Rural Areas: Chronic Obstructive Pulmonary Disease (COPD)
ruralhealthinfo.org
Webinar Recording
https://www.ruralhealthinfo.org/webinars/nacrhhs-update-on-copd
Chronic Disease Topic Guide
https://www.ruralhealthinfo.org/topics/chronic-disease
Models & InnovationsBrowse by topic: Chronic respiratory conditions
https://www.ruralhealthinfo.org/project-examples
New: COPD Toolkit
Finding Other COPD Resources on RHIhub
Online Library
• Find resources, funding, news and events • Browse by topic: Chronic respiratory conditions
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Search the RHIhub site
Search terms:• COPD• Chronic
Obstructive Pulmonary Disease
• Chronic respiratory diseases
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Contact, Connect, & Stay Informed
RHIhub Contact Info:[email protected]
facebook.com/RHIhub@ruralhealthinfo
Kristine Sande, [email protected]
TASC COPD Resources and Efforts
Caleb SiemProgram Specialist
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2018 Fiscal Year (FY) COPD Supplemental Project
In response to the COPD National Action Plan, the goal of the 2018 Fiscal Year (FY) Chronic Obstructive Pulmonary Disease (COPD) Supplemental Project, supported by the Federal Office of Rural Health Policy (FORHP), was to address rural disparities in COPD services and to provide resources and technical assistance to rural hospitals and provider-based clinics in order to address these disparities.
The COPD Supplemental Project resulted in the following resources and efforts: • “A Rural Hospital Guide to Improving Chronic Obstructive
Pulmonary Disease”• The Rural COPD Podcast series• Three webinars• Dissemination of a COPD/Pulmonary Rehab assessment.
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COPD Workgroup
• Dr. Dan Doyle• Dr. Ira Moscovice• Karla Weng• Dr. Mark Lindsay• Michelle Collins• Pat Schou• Lannette Johnston• Grace Anne Dorney
Kopple• Dr. Don Uden
• Owmy Bouloute• Paul Moore• Dr. Antonello
Puntrurieri• Neyal Ammary-Rish• Carla Wilber• Kristine Sande• Lindsay Corcoran• Terry Hill• Sally Buck• Caleb Siem
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Rural COPD Resources and Efforts Collection
.
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TASC has created a Rural COPD Resources and Efforts page on The Center website that provides links to the guide, the podcast series, the webinars, and other organizations’ resources regarding COPD.
https://www.ruralcenter.org/tasc/rural-copd-resources-and-efforts
COPD Webinars
1. COPD Prevalence and Impact Webinar (April 2, 2019)• Discover the scope and scale of COPD matters in rural America
• Understand the personal impact of COPD
• Learn about national initiatives and FORHP efforts
• Hear an example of state-level efforts underway with COPD
2. COPD Finance Webinar (June 19, 2019)• Discover the financial importance of providing COPD/Pulmonary Rehab care
• Examine the reimbursements aspects of COPD-related care.
3. August TASC 90 – COPD Guide (August 15, 2019)• Understand the new COPD resources recently created
• Disperse the COPD guide to critical access hospitals and provider-based rural health clinics
• Learn about the other resources available from partner organizations
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The Rural COPD Podcast Series
The Rural COPD Podcast series discussed COPD and its prevalence in rural America
• The Rural COPD Podcast: Episode 1 -- This episode features Grace Ann Dorney Kopple, COPD Foundation, COPD patient.
• The Rural COPD Podcast: Episode 2 -- This episode features Paul Moore, Pharmacist, Executive Secretary, National Advisory Committee on Rural Health and Human Services, Senior Health Policy Advisor, FORHP.
• The Rural COPD Podcast: Episode 3 -- This episode features Dan Doyle, MD, a physician at New River Health Association, a federally qualified health center (FQHC) in West Virginia
• The Rural COPD Podcast: Episode 4 -- This episode features Michelle Collins, a registered respiratory therapist at Lincoln Health, Franklin Memorial Hospital, and Central Maine Medical Center in Maine
• The Rural COPD Podcast: Episode 5 -- This episode features Lindsay Corcoran and Laurie Daigle of Stroudwater Associates.
• The Rural COPD Podcast: Episode 6a -- This episode features Tracy Conroy, Valerie Roark, and Connie Wilson of Daviess Community Hospital
• The Rural COPD Podcast: Episode 6b -- This episode features Steve Barnett of McKenzie Health System.
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COPD/Pulmonary Scope of Services Assessment
In collaboration with Stroudwater Associates, TASC created and dispersed a COPD/Pulmonary Scope of Services Assessment in order to further understand efforts in current and future COPD treatment. The assessment was intended for rural hospitals, critical access hospitals, and rural clinics that already have Pulmonary Rehab programs, facilities who plan to implement a program, and facilities currently facing barriers to starting a program.
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Assessment Findings
• 50% currently offer Pulmonary Rehab service• 49% do not
• Barriers• Staffing (72.8%)• Capital (60.9%)• Space (55%)• Medical Oversight (42.6%)• Low patient volume• Reimbursement• Unfamiliar with program
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A Rural Hospital Guide to Improving Chronic Obstructive Pulmonary Disease
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Find the full guide here.
Get to know us better:http://www.ruralcenter.org
Caleb Siem, MHProgram Specialist(218) 216-7043
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Chronic Lower Respiratory Disease 2015 – 3rd leading cause of death (N=155,041) 2016 – 4th leading cause of death (N=154,596) 97% are COPD
Costs of COPD $32 billion on COPD-related patient care in 2010 $49 billion by 2020 Does not include billions in indirect costs
15-16 million Americans have diagnosed COPD 6.1% in 2016 Millions more may have undiagnosed COPD symptoms Rural populations had the greatest risk in 2015
COPD: “Low Hanging Fruit”
• COPD is under-diagnosed in primary care settings, with most cases identified during an exacerbation or after significant loss of lung function
• Therapies are available to improve lung function, reduce exacerbations, and improve health status
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Finding COPD Patients in Primary Care Settings
CDC. Unpublished pulmonary rehabilitation location data, 2015-2017.
Access to Pulmonary Rehabilitation: very limited especially in rural settings
What a natural role for State Offices of Rural Health
in Addressing COPD in Rural America.
Thank you.
Q&A
