VHA Office of Rural Health • http://www.ruralhealth.va.gov

DEPARTMENT OF VETERANS AFFAIRS Veterans Health Administration

Office of Rural Health (ORH)

STRATEGIC PLAN REFRESH

Fiscal Years 2012-2014

Mary Beth Skupien, PhD, MS, RN ORH Director

Sheila M. Warren, MPH, RN, CPHQ ORH Deputy Director

“Using Innovation and Technology to Improve Access and Quality”“Using Innovation and Technology to Improve Access and Quality”

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 1

VHA Office of Policy and Planning Office of Rural Health (ORH)

Fiscal Years 2012-2014

ORH Strategic Plan Refresh

Introduction

The VHA Office of Rural Health (ORH) was created in March 2007 to enhance access and quality of health care to nearly 3.4 million Veterans (41% of total enrolled Veterans) residing in rural and highly rural areas of the country. We know that these Veterans are increasingly made up of soldiers returning from Operation Enduring Freedom and Operation Iraqi Freedom and that 15% of them have at least one service connected disability.

Prior studies indicate that Veterans who live in rural settings have greater healthcare needs than their urban counterparts. Specifically, rural Veterans have lower health-related quality-of-life scores and experience a higher prevalence of physical illness compared to urban Veterans. While prevalence of most mental health disorders is lower for rural compared to urban Veterans, rural Veterans with mental health disorders are sicker as measured by lower health-related quality-of-life compared with urban Veterans. These differences in health-related quality-of-life scores, which equate to lower self-rated health status, among rural dwelling Veterans, are substantial, clinically meaningful and associated with increased demand for healthcare services. Despite greater health care needs, rural veterans are less likely to access health services for both physical and mental illness, either through the VA or the private sector. In particular, rural Veterans have lower access to care for chronic conditions such as hypertension and post-traumatic stress disorder.

To ensure that ORH programs and initiatives are meeting the health care needs of rural Veterans, ORH developed a profile of rural Veterans using several different sources. First, ORH conducted a geographical needs assessment to determine VA facility gaps in rural areas and then, a clinical needs assessment to better understand unmet clinical needs. ORH leadership has participated in numerous town hall meetings and listening sessions to better understand the perspective of rural Veterans on accessing VA health care and has met with the Veterans Rural Health Advisory Committee (VRHAC) 10 times to discuss their recommendations on how to improve the ORH program. This information, together with the Secretary’s priorities on improving care for homeless Veterans, reducing the back log of claims, and improving access to care provided the framework for the refresh of the ORH 2012 strategic plan.

In FY11, ORH formed a committee of internal and external stakeholders to refresh the ORH strategic plan for FY12 through FY14. The committee had members representing the following groups: the Veterans Rural Health Advisory Committee (VRHAC), VISN rural consultants (VRCs), the Veterans Rural Health Resource Centers (VRHRC), ORH Central Office, Medical

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Center Directors, the Office of Telehealth Services (OTS), the Office of Mental Health Services (OMHS), the Office of Geriatrics and Extended Care (GEC), State VA Offices, the Office of Health Informatics, the Office of Academic Affiliations (OAA), the Employee Education System (EES) and the Healthcare Retention and Recruitment Office (HRRO). Six workgroups were created from the committee to refresh the initiatives and action items associated with the strategic goals of ORH. The draft compilation of all recommendations was disseminated to a broad spectrum of VA field and program offices including all VISN directors, and VISN planners.

Each of the six ORH strategic goals have been updated with broadly agreed upon initiatives and associated action items that provide a path forward for ORH to continue to succeed in its mission. Many initiatives involve continuing to support existing collaborations, rural clinics, programs and projects that are clearly impacting rural Veterans. New initiatives have emerged to address the urgent need to recruit and retain health care providers to rural areas; determine gaps in telehealth services and infrastructure; evaluate new promising telehealth technologies; collaborate with VA research; expand partnerships with other private and public rural entities and expand specialty care services to rural areas.

Geographical Needs Assessment

A geographical needs assessment for each VISN was conducted by analysts from the Eastern Region – Veterans Rural Health Resource Center to identify potential geographic access gaps in primary, acute, and tertiary care in rural areas of the Veterans Health Administration. A met need is a service within a specific target population; in this case, Veterans outside of prescribed travel times to levels of care that is currently being addressed through existing resources that are available and accessible. An unmet need is a service within a specific target population that is not currently being addressed through existing services and activities because no services are currently available or available services are inaccessible. The access assessment focused on areas outside of 30 minutes travel time to VHA primary care, 90 minutes to VHA acute care, and 240 minutes (4 hours) to VHA tertiary care in FY10. In areas outside of VHA travel time bands, community resources were examined. More specifically, it was investigated (1) whether there are any Federally Qualified Health Centers, Community Health Centers, or community hospitals where partnerships might be forged to provide health care services to VHA enrollees in these areas; and (2) whether there are any Military Treatment Facilities or Indian Health System facilities in these areas that might be candidates for Federal sharing arrangements.

For the drive time to a tertiary facility analysis, all VISNs met the VHA FY10 access standard, with 92.4% of all enrollees within 240 minutes travel time. For the 90 minute drive time analysis, only two VISNs (19 and 23) did not meet the FY10 access standard to secondary care; however 79% of all enrollees meet the access standard to secondary care. For the 30 minute drive time analysis, 9 VISNs (6, 7, 9, 11, 15, 16, 19, 20, and 23) did not meet the VHA FY10

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 3

access standard to primary care. However, 77% of enrollees are within the VA standard for travel time to VHA primary care services.

Clinical Needs Assessment

VISN Rural Consultants (VRC) conducted clinical needs assessments for rural Veterans in each of the 21 VISNs. The goal of the clinical needs assessments was to identify the challenges and barriers for rural Veterans receiving healthcare at the VA. The data for the clinical needs assessments were collected in a variety of ways, including: Veteran comment cards collected from Veterans using rural community-based outpatient (CBOCs) clinics; rural Veteran focus groups; CBOC clinical staff focus groups; in-person interviews with rural Veterans; in-person informal surveys of rural Veterans, and in-person interviews of CBOC clinical staff. Many of the data collection tools that were used in the clinical needs assessments were adapted from examples that Veterans Rural Health Resource Center –Central Region (VHRC-CR) provided. The data collected was then complied by each VRC and reported as part of the VISN’s overall rural health needs assessment.

Individual responses (n= 547) from all VISNs were compiled into a report. As compared to urban Veterans, rural Veterans are older; however there are a disproportionate number of younger Veterans and women Veterans from recent conflicts returning to rural areas. There appears to be a decline in the demand for inpatient services from rural Veterans, but an increase in demand for outpatient services. The most important barriers to care continue to be transportation to VA facilities, distance to VA facilities, a lack of telehealth services in rural VA facilities, a lack of specialty care and urgent care at rural VA facilities, inadequate knowledge of VA eligibility, benefits and services, and difficulties in recruitment and retention of health care providers.

VRHAC FY11 Recommendations

In the VRHAC’s FY11 Annual Report, the committee focused on rural provider workforce issues and rural Veteran outreach. They recommended that VHA-ORH work in collaboration with Health and Human Services Health Resources Service Administration-Office of Rural Health Policy (HRSA-ORHP) to assess the rural health provider needs of the VHA in its outreach and CBOC clinics in rural areas as well as any other programs or facilities located in rural and highly rural areas that provide direct services to Veterans; and the impact of such needs on the Health Professional Shortage Areas (HPSA) designations for primary care and mental health in these rural areas. The Committee would like to see efforts made to collaborate and partner with existing rural health providers in sharing limited workforce resources through contracting or other means. Given that the VHA and HRSA fund services in these areas and provide training resources for health care providers, a joint effort to study the policies and resources available for these critically underserved rural areas could lead to increased access to

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quality rural health providers for both the of rural and highly rural Veterans and to broaden their understanding of VA benefits and programs.

Town Hall Meetings/Listening Sessions with Rural Veterans

In FY11, a variety of events including town hall meetings, listening sessions, outreach events and round table discussions with Veterans have been held in many areas of the country to increase VA/ORH awareness and understanding of Veteran needs and issues. The ORH Director and staff have participated in town hall events and listening sessions in Montana, Texas, South Dakota and Florida and one is planned in Maine on October 13th, 2011. The ORH Veterans Rural Health Resource Centers (VRHRCs) have conducted outreach events and have held numerous Veteran focus groups in Utah, California, Nevada, Iowa and Illinois and more are planned.

ORH FY12 Portfolio

ORH recently concluded its proposal review cycle for FY12 funding. Members of the ORH review committee were instructed to take into account results from the clinical needs assessment, the geographic needs assessment, town hall meetings, and the Secretary’s priorities, as well as project quality and access measures when reviewing each individual proposal. Approximately 41% of ORH FY12 funding will continue to support the CBOCs and outreach clinics recently established in rural areas, as well as transportation systems that deliver rural Veterans to VHA facilities. Nearly 14% of ORH funding will support the delivery of primary care in the homes of rural Veterans through the home-based primary care (HBPC) program. In order to continue and expand telehealth services in rural areas, 13.3% of ORH funding will support telehealth programs in CBOCs and outreach clinics. The remainder of ORH funding will support mental health initiatives, specialty care, rural Veteran outreach, women Veterans’ programs, and Project Access Received Closer to Home (ARCH) - a pilot program intended to improve access for eligible Veterans by connecting them to non-VA health care providers in their communities.

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ORH Strategic Plan Refresh

Fiscal Years 2012-2014

A. Goal One: Improve access and quality of health care delivery for rural and highly rural Veterans.

Initiative 1.1: Understand obstacles/barriers/disparities and issues that impact the access and quality of health care delivery in rural and highly rural areas.

Understanding and identifying how barriers to care affect access to and the delivery of quality health care are critical for the establishment of programs that directly impact the specific needs of rural and highly rural Veterans. ORH supports efforts to study these issues in order to improve evidence-based rural and highly rural Veteran health care. This initiative may lead to the modification of existing rural health care delivery efforts and identify new areas for expansion and development of clinical services to rural and highly rural Veterans based on the actions delineated below.

Action 1.1.1: Continue to support the identification, evaluation and measurement of access and quality obstacles/barriers/disparities in health care delivery for rural and highly rural Veterans. This effort includes examining policies and procedures that affect both VA and non-VA access issues.

Action 1.1.2: Support the dissemination of the information gathered in above efforts to ORH partners, VHA leadership, and other stakeholders.

Initiative 1.2: Promote innovative solutions to identified barriers to access and quality health care.

These efforts support the establishment and expansion of clinical programs to improve access and quality related to health care delivery for rural and highly rural Veterans. Included in these efforts are implementation and sustainment strategies for new and innovative clinical pilots. Special attention in the development and evaluation of new and innovative clinical pilots should focus on telehealth, mental health; special populations such as Native, women, and homeless Veterans, home based solutions, transportation strategies, and collaborative efforts between the VA and non-VA entities.

Action 1.2.1: Continue to support the development and implementation of new and innovative pilot programs that address the identified barriers to access and quality of health care delivery for rural and highly rural Veterans.

Action 1.2.2: Continue to support the development and implementation of ongoing evaluation strategies that specifically target new and innovative clinical pilots. The evaluations will include recommending sustainment, expansion and/ or exportation of new and innovative clinical pilots.

Action 1.2.3: Support the dissemination, adoption, and education efforts concerning successful pilot programs and best practices for rural and highly rural Veterans to other VISNs.

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B. Goal Two: Optimize the use of available and emerging health information technologies (Health IT) to improve access to care to Veterans residing in rural and highly rural areas.

Initiative 2.1: - Identification of gaps in tele-communications infrastructure, telehealth services, equipment in rural and highly rural communities.

The rural health program supports VA’s transformation to an integrated delivery system that emphasizes a full continuum of care in a patient-centered environment by providing care that will specifically address the needs of rural and highly rural Veterans in part through the use of telehealth technology. Clinical need assessments conducted by ORH indicate that there are telecommunications infrastructure gaps, and uneven distribution of telehealth services, personnel training and equipment.

Action 2.1.1: Support/participate in a baseline assessment of tele-communications (broadband) infrastructure in rural areas in collaboration with U.S. Federal Communications Commission, U.S. Department of Health and Human Services, Health Resources and Services Administration and Indian Health Services, and the National Rural Health Association and State Offices of Rural Health, as appropriate in order to ensure full telehealth capabilities at all VHA rural facilities.

Action 2.1.2: Document and monitor existing and emerging external telehealth network infrastructure resources and collaborate where feasible.

Action 2.1.3: In collaboration with OTS, inventory rural CBOC and outreach clinics regarding telehealth use, services, training, equipment and infrastructure needs.

Initiative 2.2: - Work with private and public counterparts to leverage new and existing technologies addressing priority areas of care for rural and highly rural Veterans.

ORH continues to partner with stakeholders to identify and improve technology adoption in an effort to expand services to Veterans living in rural and highly rural areas.

Action 2.2.1: Identify priority areas of care in rural and highly rural areas that could be significantly impacted by instituting new telehealth services.

Action 2.2.2: Continue to identify through collaboration with private and public counterparts new and innovative telehealth technologies that could be adopted to address rural Veterans health care needs.

Initiative 2.3: Streamline access to new and existing technological platforms.

In order to be successful in applying new technological platforms, it is vital to partner with appropriate VA and non-VA partners. As many as seven out of 10 Veterans receive some portion of their health care from private sector providers, often utilizing both the VHA and private sector systems. As a result, there is a need for being able to streamline sharing relevant medical information between various systems.

Action 2.3.1: Create a multi-disciplinary committee which includes ORH, VA Office of Information Technology, VA Office for Informatics and Analytics, Office of Telehealth Services and other program offices as appropriate to focus on leveraging Health IT solutions.

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Action 2.3.2: Support health information exchange efforts (Virtual Lifetime Electronic Record) in rural areas with state and local partners.

Initiative 2.4: Support existing and new telehealth initiatives.

Expansion of telehealth programs within VA has been a significant national effort. ORH has provided funds to support telehealth programs such as tele-retinal, tele-dermatology, tele-mental health, tele-pharmacy, tele-polytrauma, and tele-radiology in remote areas of the country. The Office of Telehealth Services (OTS) is a strong partner with ORH, working to expand existing telehealth programs and pilot new and innovative telehealth programs in the field. ORH has also funded telehealth projects through the Veterans Rural Health Resource Centers. Efforts include the tele-rehabilitation program in the Eastern Region that provides rehabilitation assessments and interventions in rural areas via video conferencing, and the mobile tele-retinal imaging pilot project that provides retinal imaging services in a convenient and cost-effective manner for rural Veterans served by CBOCs.

Action 2.4.1: Continue to work with VHA OTS to expand the availability of telemedicine services at VA facilities that serve rural and highly rural Veterans.

Action 2.4.2: Continue to support and evaluate demonstration projects of new models of care (especially specialty care) using telemedicine technologies.

C. Goal Three: Maximize utilization of existing and emerging studies and analyses to improve care delivered to rural and highly rural Veterans.

Initiative 3.1: Expand access to and use of VA studies and data.

ORH supports existing processes and initiates new processes to provide easier access to VA studies and data so that internal and external stakeholders can best take advantage of information for new analysis and program development.

Action 3.1.1: Continue to promote the use of the Rural Health Briefing Book and Rural Health Profile containing rural Veteran enrollee and utilization data.

Action 3.1.2: Continue to monitor and report quarterly on a national set of core performance measures that quantify access and quality of care delivered to rural and highly rural Veterans.

Action 3.1.3: Continue to disseminate information gathered from ORH-sponsored pilot projects, studies and programs to external stakeholders through the new ORH website, electronic newsletter, fact sheets, social media, conferences, publications and email alerts. The ORH materials are distributed electronically to contacts maintained in an access database. In addition, ORH staff will publish in peer-reviewed journals and will establish a presence at national rural health care and research meetings.

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Action 3.1.4: Review and utilize best practices of communication with rural Veterans (e.g., radio, town hall, local clergy, community organizations) to disseminate information regarding ORH program developments and impacts.

Initiative 3.2: Collaborate with VA Research and Development.

Action 3.2.1: Form an ad hoc committee consisting of personnel from ORH and the VHA Office of Research and Development (ORD) that meets periodically for information exchanges. These exchanges will inform the development of important research questions regarding the health disparities and clinical needs among rural Veterans, as well as health service delivery and cost-effectiveness issues in rural areas.

Action 3.2.2: Continue to partner with VA Health Services Research and Development (HSR&D) researchers for Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) applications

D. Goal Four: Improve availability of education and training for VA and non-VA service providers to rural and highly rural Veterans.

Initiative 4.1: Expand the use of distance learning technologies and other modalities for rural education program delivery to provide targeted training to address specific needs of rural providers.

ORH supports expanded use of distance education for VA and non-VA providers. ORH supports the continued use and expansion of satellite broadcast methods for reaching broad audiences. Additionally, ORH will provide targeted training opportunities and venues that will be selected to ensure maximum reach and utility to address specific needs as identified in the needs assessments. In addition, ORH will explore additional methods such as web-streaming to promote maximum flexibility in providing access to training for rural and highly rural providers.

Action 4.1.1: The VHA Employee Education System (EES) will conduct a rural health training/education needs assessment to help inform ORH on future education/training needs in rural health.

Action 4.1.2: In collaboration with the VHA Ethics Office and EES, ORH will develop an educational video entitled “Rural Health Ethics”.

Action 4.1.3: Develop new distance learning rural health training/educational modules based on needs assessment.

Action 4.1.4: In collaboration with OTS, ORH will expand telemedicine training to rural CBOC and outreach clinic personnel. In collaboration with the PACT Office, ORH will expand Patient Aligned Care Teams (PACT) training to CBOC and outreach clinic personnel.

Action 4.1.5: Continue expansion of the use of distance technology in order to provide education to staff at CBOCs.

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Initiative 4.2: Develop new education resources for health-care professionals.

ORH will expand available training for rural health providers. ORH will work to better integrate the topic of rural and highly rural Veterans into rural providers’ education and training and bring to their attention the challenges and opportunities in rural and highly rural communities.

Action 4.2.1: Continue and expand the Rural Health Training Program (RHTP). The RHTP is directed at medical students, nurse practitioners, and other allied health professionals. OAA will collaborate as needed regarding affiliation relationships and policies governing trainees in accredited programs.

Action 4.2.2: ORH will collaborate with OAA in developing a new VA Training Initiative directed at rural VA interdisciplinary teams, such as those at rural CBOCS, hub sites for rural telehealth services, or HBPC teams caring for rural Veterans.

Action 4.2.3: Develop and implement an education program on diagnostic procedures that will require physicians to complete pre-readings and knowledge assessments, view instructional videos, practice using procedure-specific simulation equipment, and undergo a full skill assessment using current practice standards and evidence based criteria under the evaluation of an appropriate medical peer. Provide a training model that could be applied at all VAMCs serving rural populations.

Action 4.2.4: Participate in the ‘HRSA Telehealth Resource Center Grant Program: CFDA 93.211, Northeast Telehealth Resource Center.

E. Goal Five: Enhance existing and implement new strategies to improve collaborations and increase service options for rural and highly rural Veterans.

VA’s collaborative efforts to improve access and quality of services available to rural and highly rural Veterans can take place through public-public and public-private partnerships. Internally VA program offices represent the primary platforms for collaboration and expansion of existing supportive initiatives for ORH.

Initiative 5.1: Continue existing and begin new collaborations with VA program offices.

Action 5.1.1: Maintain existing collaborations with the Office of Geriatrics and Extended Care, the Office of Mental Health, the Homeless Office, and the Women Veterans Health Strategic Health Care Group, by closely monitoring the performance of existing collaborative projects and by expanding/maintaining successful programs if funding allows.

Action 5.1.2: Conduct an assessment of rural outreach efforts and identify efforts that could be jointly coordinated with local facility’s My HealtheVet Coordinator to allow for immediate in-person authentication during an outreach event.

Action 5.1.3: Identify and engage other VA program offices for possible collaborations.

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Initiative 5.2: Continue to partner with various entities within the rural health community to establish or build upon existing outreach networks for rural Veterans.

ORH will take advantage of existing expertise and talent within the rural health community and build upon existing rural health networks to improve access and care for rural and highly rural Veterans through institutional collaborations. Potential collaborators include State Offices of Rural Health, HRSA Office of Rural Health Policy, HRSA Network Development and Outreach grantees, rural health programs sponsored by academic institutions, rural health researchers, and others.

Action 5.2.1: Inventory and assess effectiveness of current ORH –funded outreach activities using criteria developed by ORH leadership.

Action 5.2.2: Participate as a member of the VA National Veterans Outreach (NVO) Office outreach workgroups to provide representation for ORH, the VRC’s, and VRHRC’s; and to share information about the outreach needs of rural Veterans and ORH-supported outreach initiatives.

Action 5.2.3: Utilize the new (FY12) NVO Outreach Database and Outreach guide in order to identify VA outreach program and partners currently conducting outreach (such as OEF/OIF outreach), Yellow Ribbon events, etc.) in rural areas and collaborate (where possible and appropriate); to guide the planning and implementation of ORH – sponsored outreach initiatives, and to evaluate and analyze the effectiveness of outreach efforts.

Action 5.2.4: Identify additional rural areas of the country to target in rural Veteran outreach efforts to ensure that all rural Veterans have been contacted regarding their benefits and new local services.

Action 5.2.5: Identify State and local organizations in rural communities for outreach partnerships and collaborate where feasible.

Action 5.2.6: Facilitate partnerships between rural CBOCs and outreach clinic personnel with community health entities by helping to streamline process for contracting.

Action 5.2.7: To improve communications between ORH and its partners, further develop outreach contacts database including individuals from State Offices of Rural Health, HRSA Office of Rural Health Policy, and rural health researchers.

Initiative 5.3: Expand and develop public-public collaborations.

ORH will seek to expand public-public partnerships with agencies such as State Departments of Veterans Affairs, Department of Defense, HRSA, IHS, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Medicare and Medicaid Services (CMS), and others. Given the role of these organizations in providing access to health care services and health care coverage, ORH will seek to expand initiatives to address issues of co-managed care, information sharing and provider training, and related issues.

Action 5.3.1: Establish ongoing liaison with Strategic Action groups relevant to rural issues that are part of the DOD/VA Integrated Mental Health Strategy (IMHS). The IMHS centers on a coordinated public health model to improve the access, quality, effectiveness, and efficiency of mental health

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services. Recipients of these services include active duty service members, National Guard and Reserve Component members, Veterans, and their families.

Action 5.3.2: Establish and formalize relationship with the Substance Abuse and Mental Health Services Administration (SAMHSA) for information sharing and provider training.

Action 5.3.3: Establish relationship with US Department of Agriculture (USDA) cooperative extension for outreach to rural Veteran caregivers.

Action 5.3.4: Participate in the newly established White House Rural Council.

Initiative 5.4: Institutionalize public-private collaborations.

ORH will support ongoing collaborations with private sector health care providers to specifically address the needs of rural and highly rural Veterans. ORH will solicit input from private sector stakeholders on best practices and approaches.

Action Item 5.4.1: Collaborate with the National Rural Health Association (NRHA) to assist in the planning of their annual meeting; including organization of workshops, speakers and topics of interest.

Action Item 5.4.2: Organize regional virtual meetings with private sector providers and ORH staff to gain insight from private sector providers on health care needs of rural Veterans.

F. Goal Six: Develop innovative methods to identify, recruit and retain health care professionals and requisite expertise in rural and highly rural communities.

Another barrier to accessing services facing rural Veterans is the lack of health care providers available in rural communities. ORH will undertake several initiatives to ensure the development and deployment of highly trained professionals to meet the current and emerging health care needs of rural Veterans.

Initiative 6.1: Develop programs to increase health professionals’ awareness of rural practice.

The Student Educational Employment Program (SEEP) provides Federal employment opportunities to those who are enrolled or accepted for enrollment as degree seeking students taking at least half-time academic, technical, or vocational course load in an accredited high school, technical, vocational, 2- or 4-year college or university, graduate or professional school. The VA Learning Opportunities Residency (VALOR) nursing program provides opportunities for outstanding students to develop competencies in clinical nursing while at an approved VA health care facility. Increasing the use of the SEEP and VALOR programs in rural VA facilities will subsequently increase the awareness of VA educational/employment opportunities among college and university students.

HRRO’s VHA Marketing and Advertising section has proposed a comprehensive rural health marketing campaign, including the creation of web sites, pages, and banner ads specifically designed

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for individuals considering rural VA employment opportunities. A rural VA recruitment advertisement and tabletop has been distributed to and displayed at numerous national recruitment events, including the 2011 NRHA Conference. Other suggestions include the promotion of rural opportunities on social networking sites, including Facebook and YouTube.

Action.6.1.1: Increase use of SEEP and VALOR programs in areas designated rural and highly rural. VHA HRRO, who is responsible for administering these programs, will earmark funding specifically for use in facilities designated rural and highly-rural. VHA Placement Services will also develop an award to be presented to VALOR students upon graduation.

Action 6.1.2: Increase presence at colleges and universities with close proximity to rural VA health care facilities. HRRO will develop awards/recognition programs for presentation to students committed to rural practice at commencement ceremonies; identify and attend events in rural communities and upcoming rural health conferences, including the National Rural Health Conference in May 2012.

Action 6.1.3: HRRO Marketing and Placement Services will develop rural community awareness campaign to be rolled out at rural locations identified by HRRO to help develop rural provider workforce. HRRO will extend marketing scope to include additional demographics groups (high school students, families) with a vested interest in rural practice.

Initiative 6.2: Support existing and new workforce recruitment and retention efforts.

Identifying pertinent baseline information related to rural recruitment and retention is critical in developing effective workforce strategies. VHA Placement Recruitment Consultants provided HRRO leadership qualitative information on top occupational priorities, challenges, and opportunities in rural and highly rural VA health care facilities. VHA Placement Recruitment Consultants identified physicians, mental health and telemedicine professionals as high demand rural occupations. Positions such as Clinical Psychologists and Physical Therapists are considered more difficult to place in the rural HBPC/PACT settings. The identification of the challenges and opportunities will considerably improve rural recruitment efforts.

Many of the current strategies intended to increase recruitment and retention in rural health care facilities are aimed primarily at colleges, universities and established practitioners. Research has indicated that individuals who originate from rural areas are more likely to consider rural practice and employment than those from urban areas. Therefore, a more comprehensive approach to recruitment is needed. By extending its marketing scope, VHA Placement Services will be able to recruit strategically for the placement in rural and highly rural VA facilities. Targeting individuals with embedded interest in rural practice will improve both recruitment and retention efforts within rural VA facilities. However, recruitment strategies have to be developed in such a way to not destabilize or disrupt existing health provider resources in rural communities.

Significant collaborative opportunities also exist between VHA Placement Services and other local, state, and federal entities specializing in rural health needs and issues. Such opportunities include joint research efforts with colleges and universities, and collaborative opportunities with local and state offices of rural health. Establishing relationships with entities specializing in addressing rural health

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issues will significantly increase the awareness of potential collaborative research and placement opportunities with the VA.

Action 6.2.1: ORH will foster ongoing dialogue between VHA Placement Recruitment Consultants in HRRO and VISN Rural Consultants (VRCs) and HR and form a workgroup to identify top occupational priorities, challenges and opportunities for recruitment and retention at rural and highly rural VA health care facilities in order to develop a rural health workforce strategy.

Action 6.2.2: ORH will conduct a joint national rural health workforce study with Health Resources Service Administration –Office of Rural Health Policy (HRSA-ORHP) to examine shared workforce strategies and specific needs in order to gain evidence of existing ad hoc models and support needed for joint contracting of providers.

Action 6.2.3: ORH will evaluate regional and state models of rural provider retention strategies program.

Action 6.2.4: HRRO will establish relationships with community and state offices of rural health, rural program offices of colleges and universities. OAA will assist as needed in vetting accredited programs or schools and in establishing affiliation relationships.

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Appendix A

Table of Action Items, Person(s) Responsible, Quarterly Milestones

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tatio

n of

new

and

inno

vativ

e pi

lot p

rogr

ams

that

add

ress

the

iden

tifie

d ba

rrie

rs to

acc

ess

and

qual

ity o

f he

alth

car

e de

liver

y fo

r ru

ral a

nd h

ighl

y ru

ral V

eter

ans.

OR

H V

AC

O

Al W

est

M

ary

Cha

rlton

AL

Wes

t

Act

ion

1.2.

2: C

ontin

ue to

sup

port

the

deve

lopm

ent a

nd

impl

emen

tatio

n of

ong

oing

eva

luat

ion

stra

tegi

es th

at

spec

ifica

lly ta

rget

new

and

inno

vativ

e cl

inic

al p

ilots

. T

he

eval

uatio

ns w

ill in

clud

e re

com

men

ding

sus

tain

men

t, ex

pans

ion

and/

or

expo

rtat

ion

of n

ew a

nd in

nova

tive

clin

ical

pilo

ts.

OR

H V

AC

O

Al W

est

Mar

y C

harlt

on

Al W

est

S

heila

War

ren

Act

ion

1.2.

3: S

uppo

rt th

e di

ssem

inat

ion,

ado

ptio

n, a

nd

educ

atio

n ef

fort

s co

ncer

ning

suc

cess

ful p

ilot p

rogr

ams

and

best

pra

ctic

es fo

r ru

ral a

nd h

ighl

y ru

ral V

eter

ans.

VR

HR

C s

taff

OR

H

Com

mun

icat

ions

Nan

cy M

aher

Kris

ten

Win

g

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)

Initi

ativ

e 1.

2: P

rom

ote

inno

vativ

e so

lutio

ns

to id

entif

ied

barr

iers

to a

cces

s an

d qu

ality

he

alth

car

e.

Dev

elop

eva

luat

ive

crite

ria to

fa

cilit

ate

the

dete

rmin

atio

n of

and

th

e de

gree

to w

hich

an

OR

H-

fund

ed p

ilot p

rogr

am/

dem

onst

ratio

n pr

ojec

t ach

ieve

s su

cces

s or

failu

re.

Sub

mit

the

deve

lope

d ev

alua

tive

crite

ria to

the

OR

H P

ropo

sal

Rev

iew

Com

mitt

ee fo

r re

view

.

Stra

tegi

c G

oal O

ne: I

mpr

ove

acce

ss a

nd q

ualit

y of

hea

lth c

are

deliv

ery

for r

ural

and

hig

hly

rura

l Vet

eran

s.

FY

201

2 M

ilest

on

es3r

d Q

uar

ter

(Ap

r-Ju

n)

FY

201

2 M

ilest

on

es2n

d Q

uar

ter

(Jan

-Mar

)F

Y 2

012

Mile

sto

nes

4th

Qu

arte

r (J

ul-

Sep

)

Rel

ease

rev

ised

eva

luat

ive

crite

ria

to O

RH

Pro

posa

l Rev

iew

C

omm

ittee

to a

id in

del

iber

atio

ns.

Acc

ess/

Qua

lity

wor

kgro

up w

ill

prov

ide

FY

pro

posa

l rev

iew

as

sist

ance

to e

nsur

e th

at a

cces

s an

d qu

ality

are

add

ress

ed in

FY

13

OR

H p

ortfo

lio.

Est

ablis

h an

Acc

ess/

Qua

lity

Wor

kgro

up (

Lead

s: V

eter

an R

ural

H

ealth

Res

ourc

e C

ente

rs

(VR

HR

Cs)

Dep

uty

Dire

ctor

s,

incl

udes

add

ition

al V

RH

RC

sta

ff an

d V

ISN

rur

al c

onsu

ltant

s (V

RC

)).

Wor

kgro

up w

ill e

valu

ate

the

Offi

ce

of R

ural

Hea

lth (

OR

H )

Ann

ual

Rep

ort(

s) to

iden

tify

how

ob

stac

les/

barr

iers

/dis

parit

ies

have

be

en a

ddre

ssed

by

OR

H p

ortfo

lio

proj

ects

. Ide

ntify

Bes

t Pra

ctic

es.

Acc

ess/

Qua

lity

wor

kgro

up w

ill

exam

ine

exis

ting

polic

ies

and

proc

edur

es th

at a

ffect

VA

and

non

V

A a

cces

s/qu

ality

issu

es.

Wor

kgro

up w

ill r

epor

t fin

ding

s to

O

RH

VA

CO

.

Acc

ess/

Qua

lity

wor

kgro

up w

ill

addr

ess

the

gaps

inde

ntifi

ed in

the

eval

uatio

n to

info

rm a

nd g

uide

the

Act

ion

item

s fo

r in

itiat

ive

1.2.

and

to

set

the

prio

ritie

s/to

pics

for

FY

13

OR

H p

ortfo

lio.

Sup

port

the

OR

H C

omm

unic

atio

ns

lead

with

con

tent

for

and

part

icip

atio

n in

edu

catio

n,

diss

emin

atio

n, a

nd e

xpor

tatio

n ef

fort

s. D

evel

op tr

acki

ng fo

r va

rious

con

tent

and

par

ticip

atio

n su

ppor

t fro

m V

RC

s an

d V

RH

RC

s.

Dis

sem

inat

e a

man

agem

ent b

rief

base

d on

Q1

Act

ion

1.1.

1 to

OR

H

part

ners

, VH

A le

ader

ship

and

ot

her

stak

ehol

ders

.

Dis

sem

inat

e a

man

agem

ent b

rief

base

d on

Q2

Act

ion

1.1.

1 to

OR

H

part

ners

, VH

A le

ader

ship

and

oth

er

stak

ehol

ders

.

Dis

sem

inat

e a

man

agem

ent b

rief

base

d on

Q3

Act

ion

1.1.

1 to

OR

H

part

ners

, VH

A le

ader

ship

and

ot

her

stak

ehol

ders

.

Dis

sem

inat

e a

man

agem

ent b

rief

base

d on

Q4

Act

ion

1.1.

1 to

OR

H

part

ners

, VH

A le

ader

ship

and

ot

her

stak

ehol

ders

.

Pos

t pro

posa

l Dev

elop

men

t Too

lkit

and

Pro

posa

l Writ

ing

trai

ning

m

ater

ials

to O

RH

Kno

wle

dge

Man

agem

ent S

yste

m (

KM

S)

and

diss

emin

ate

link

to V

RC

s,

VR

HR

Cs,

and

VH

A p

rogr

am

offic

es. D

isse

min

ate

non

VA

st

akeh

olde

r id

eas

to V

RC

s,

VR

HR

Cs,

and

VH

A p

rogr

am

offic

es. S

uppo

rt th

e O

RH

C

omm

unic

atio

ns le

ad w

ith c

onte

nt

for

and

part

icip

atio

n in

edu

catio

n,

diss

emin

atio

n, a

nd e

xpor

tatio

n ef

fort

s. T

rack

con

tent

and

pa

rtic

ipat

ion

supp

ort f

rom

VR

Cs

and

VR

HR

Cs.

Pos

t cal

l for

FY

13 P

ortfo

lio

Con

cept

Pap

ers

to O

RH

KM

S a

nd

OR

H in

tran

et s

ite. S

uppo

rt th

e O

RH

Com

mun

icat

ions

lead

with

co

nten

t for

and

par

ticip

atio

n in

ed

ucat

ion,

dis

sem

inat

ion,

and

ex

port

atio

n ef

fort

s. T

rack

con

tent

an

d pa

rtic

ipat

ion

supp

ort f

rom

V

RC

s an

d V

RH

RC

s.

Sup

port

the

OR

H C

omm

unic

atio

ns

lead

with

con

tent

for

and

part

icip

atio

n in

edu

catio

n,

diss

emin

atio

n, a

nd e

xpor

tatio

n ef

fort

s. T

rack

con

tent

and

pa

rtic

ipat

ion

supp

ort f

rom

VR

Cs

and

VR

HR

Cs.

Ref

ine

the

deve

lope

d ev

alua

tive

crite

ria.

VR

HR

C s

taff

will

cre

ate

a

prop

osal

dev

elop

men

t too

lkit,

in

clud

ing

a pr

opos

al w

ritin

g tr

aini

ng w

orks

hop.

Intr

oduc

e th

e pr

opos

al

deve

lopm

ent t

oolk

it an

d co

nduc

t th

e pr

opos

al w

ritin

g w

orks

hop

at

the

OR

H B

iann

ual M

eetin

g.

Dis

sem

inat

e ca

ll fo

r F

Y13

OR

H

port

folio

con

cept

pap

ers.

Rev

iew

C

once

pt P

aper

s an

d in

vite

ap

prov

ed c

once

pts

to s

ubm

it a

full

prop

osal

(M

ay).

Rev

iew

FY

13 p

ortfo

lio

subm

issi

ons.

Pro

vide

ass

ista

nce

for

cond

ition

ally

app

rove

d pr

opos

al

subm

issi

ons

in o

rder

to m

eet

eval

uativ

e cr

iteria

, inc

ludi

ng

crite

ria fo

r in

nova

tion,

su

stai

nmen

t, an

d ex

pans

ion.

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

15

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

2.1.

1: S

uppo

rt/p

arti

cipa

te in

a b

asel

ine

asse

ssm

ent

of te

le-c

omm

unic

atio

ns in

fras

truc

ture

in r

ural

are

as in

co

llab

orat

ion

wit

h U

.S. F

eder

al C

omm

unic

atio

ns

Com

mis

sion

, U.S

. Dep

artm

ent o

f H

ealt

h an

d H

uman

S

ervi

ces,

Hea

lth

Res

ourc

es a

nd S

ervi

ces

Adm

inis

trat

ion

and

Indi

an H

ealt

h S

ervi

ces,

and

the

Nat

iona

l Rur

al H

ealt

h A

ssoc

iati

on a

nd S

tate

Off

ices

of

Rur

al H

ealt

h, a

s ap

prop

riat

e in

ord

er to

ens

ure

full

tele

heal

th c

apab

ilit

ies

at

all V

HA

rur

al f

acil

itie

s.

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

2.1.

2: D

ocum

ent a

nd m

onit

or e

xist

ing

and

emer

ging

ex

tern

al te

lehe

alth

net

wor

k in

fras

truc

ture

res

ourc

es a

nd

coll

abor

ate

whe

re f

easi

ble.

Tom

Klo

buca

rT

om K

lobu

car

Act

ion

2.1.

3: –

Inv

ento

ry r

ural

Com

mun

ity

-Bas

ed

Out

pati

ent C

lini

cs (

CB

OC

s) a

nd o

utre

ach

clin

ics

as

rega

rdin

g te

lehe

alth

use

, ser

vice

s, tr

aini

ng, e

quip

men

t and

in

fras

truc

ture

nee

ds.

Tom

Klo

buca

rT

om K

lobu

car

Act

ion

2.2.

1: I

dent

ify

prio

rity

are

as o

f ca

re in

rur

al a

nd

high

ly r

ural

are

as th

at c

ould

be

sign

ific

antl

y im

pact

ed b

y in

stit

utin

g ne

w te

lehe

alth

ser

vice

s.

Tom

Klo

buca

rT

om K

lobu

car

Act

ion

2.2.

2: C

onti

nue

to id

enti

fy th

roug

h co

llab

orat

ion

wit

h pr

ivat

e an

d pu

blic

cou

nter

part

s ne

w a

nd in

nova

tive

te

chno

logi

es th

at c

ould

be

adop

ted

to a

ddre

ss r

ural

V

eter

ans

heal

th c

are

need

s.

Byr

on B

air

Byr

on B

air

Act

ion

2.3.

1: C

reat

e a

mul

ti-d

isci

plin

ary

com

mit

tee

whi

ch

incl

udes

OR

H,

VA

Off

ice

of I

nfor

mat

ion

and

Tec

hnol

ogy,

V

HA

Off

ice

of H

ealt

h In

form

atio

n, O

ffic

e of

Tel

ehea

lth

Ser

vice

s an

d ot

her

prog

ram

off

ices

as

appr

opri

ate

to f

ocus

on

leve

ragi

ng H

ealt

h IT

sol

utio

ns to

impr

ove

acce

ss to

car

e fo

r ru

ral V

eter

ans.

Tom

Klo

buca

r

K

atie

Dzi

akK

atie

Dzi

ak

Act

ion

2.3.

2: E

xpan

d he

alth

info

rmat

ion

exch

ange

eff

orts

(V

irtu

al L

ifet

ime

Ele

ctro

nic

Rec

ord)

wit

h st

ate

and

loca

l pa

rtne

rs.

Byr

on B

air

Byr

on B

air

Act

ion

2.4.

1 :

Con

tinu

e to

wor

k w

ith

VH

A O

ffic

e of

T

eleh

ealt

h S

ervi

ces

(OT

S)

to e

nsur

e th

e av

aila

bili

ty o

f te

lem

edic

ine

equi

pmen

t at V

A f

acil

itie

s an

d co

rres

pond

ing

outr

each

cli

nics

that

ser

ve r

ural

and

hig

hly

rura

l Vet

eran

s.

Mar

y B

eth

Sku

pien

S

heila

War

ren

Mar

y B

eth

Sku

pien

Act

ion

2.4.

2: C

onti

nue

to s

uppo

rt a

nd e

valu

ate

dem

onst

rati

on p

roje

cts

of n

ew m

odel

s of

car

e us

ing

tele

med

icin

e m

odal

itie

s.

OR

H V

AC

O, V

RC

, an

d V

RH

RC

sK

atie

Dzi

ak

She

ila W

arre

n

Initi

ativ

e 2.

4: S

uppo

rt e

xist

ing

and

new

te

lehe

alth

initi

ativ

es.

Initi

ativ

e 2.

2 -

Wor

k w

ith p

rivat

e an

d pu

blic

co

unte

rpar

ts to

leve

rage

new

and

exi

stin

g te

chno

logi

es a

ddre

ssin

g pr

iorit

y ar

eas

of

care

for

rura

l and

hig

hly

rura

l Vet

eran

s.

Per

form

GIS

map

ping

of n

atio

n w

ide

tele

com

mun

icat

ions

in

fras

truc

ture

and

res

ulta

nt g

aps

Ass

ess

pote

ntia

l im

pact

of

VH

A/D

oD in

itiat

ive

OS

EH

RA

, the

O

pen

Sou

rce

Ele

ctro

nic

Hea

lth

Rec

ord

Age

nt o

n ru

ral V

eter

ans

Iden

tify

part

icip

atin

g of

fices

and

da

ta s

ourc

es fo

r co

mpi

latio

n of

a

base

line

repo

rt o

f tel

e co

mm

unic

atio

ns in

fras

truc

ture

in

rura

l Am

eric

a

Obt

ain

GIS

map

ping

ser

vice

s fo

r ba

selin

e as

sess

men

t dat

a

Con

duct

rev

iew

of a

vaila

ble

info

rmat

ion

from

VH

A a

nd n

on-

VH

A s

ourc

es to

iden

tify

new

te

lehe

alth

mod

els

of c

are

Usi

ng e

xtan

t VH

A d

ata

sour

ces,

as

sess

diff

eren

ces

in u

rban

and

ru

ral v

eter

ans'

hea

lth s

ervi

ces

need

s

Det

erm

ine

num

ber

and

curr

ent

disp

ositi

on o

f rur

al C

BO

Cs

and

Out

reac

h C

linic

s. C

reat

e m

aste

r lis

t of c

linic

s to

be

inve

ntor

ied.

Stra

tegi

c G

oal T

wo:

Opt

imiz

e th

e us

e of

ava

ilabl

e an

d em

ergi

ng h

ealth

info

rmat

ion

tech

nolo

gies

(Hea

lth IT

) to

impr

ove

acce

ss to

car

e to

Vet

eran

s re

sidi

ng in

rura

l and

hig

hly

rura

l are

as.

Ass

ess

exis

ting

tele

heal

th n

etw

ork

reso

urce

s, in

clud

ing

thos

e cr

eate

d by

sta

te a

nd fe

dera

l rur

al

band

wid

th e

xpan

sion

pro

gram

s.

Pre

sent

rep

ort t

o O

RH

of f

indi

ngs

Ass

ess

exis

ting

stat

e an

d lo

cal n

on-

VH

A te

lem

edic

ine

prog

ram

s in

rur

al

area

s.

Dev

elop

sub

grou

ps to

acc

ompl

ish

task

s.

Pre

sent

find

ings

to V

HA

le

ader

ship

Upd

ate

and

resu

bmit

the

deve

lope

d te

mpl

ate

as a

rep

ort o

f te

chno

logi

es fo

r po

ssib

le u

se in

cl

inic

al p

ilots

Ass

ess

tele

med

icin

e tr

aini

ng n

eed

in r

ural

CB

OC

s an

d ou

trea

ch

clin

ics

and

wor

k w

ith O

TS

to

ensu

re a

vaila

bilit

y of

trai

ning

re

sour

ces

to r

ural

CB

OC

and

ou

trea

ch c

linic

per

sonn

el.

Cre

ate

whi

te p

aper

on

the

stat

e of

cu

rren

t tel

ehea

lth n

etw

ork

infr

astr

uctu

re a

nd o

ppor

tuni

ties

for

colla

bora

tion

with

non

-VH

A

entit

ies

Pre

sent

fina

l com

mitt

ee r

epor

t to

OR

H a

nd V

HA

lead

ersh

ip.

Det

erm

ine

feas

ibili

ty o

f tra

ckin

g te

lehe

alth

use

in C

BO

Cs

and

outr

each

clin

ics

usin

g ex

tant

dat

a so

urce

s. D

eter

min

e ra

nge

of

spec

ialty

car

e se

rvic

es d

eliv

ered

or

capa

ble

of b

eing

del

iver

ed u

sing

te

lem

edic

ine

tech

nolo

gies

.

OR

H p

rogr

am a

naly

sts

will

ov

erse

e ex

pend

iture

s an

d re

port

on

pro

ject

mile

ston

es a

nd

perf

orm

ance

on

a qu

arte

rly b

asis

.

Inve

stig

ate

need

s as

sess

men

t in

form

atio

n fr

om 3

Q F

Y 2

012

and

the

abili

ty o

f ope

n so

urce

rec

ords

ex

chan

ges

and

new

tele

heal

th

mod

els

to im

pact

thos

e ne

eds.

OR

H is

fund

ing

102

stud

ies

eval

uatin

g m

odel

s of

car

e de

liver

y us

ing

tele

med

icin

e m

odal

ities

in

FY

12.

OR

H p

rogr

am a

naly

sts

will

ove

rsee

ex

pend

iture

s an

d re

port

on

proj

ect

mile

ston

es a

nd p

erfo

rman

ce o

n a

quar

terly

bas

is.

OR

H p

rogr

am a

naly

sts

will

ov

erse

e ex

pend

iture

s an

d re

port

on

pro

ject

mile

ston

es a

nd

perf

orm

ance

on

a qu

arte

rly b

asis

.

Ass

ess

infr

astr

uctu

re a

nd

equi

pmen

t nee

ds a

fter

impl

emen

tatio

n of

OT

S te

lehe

alth

ex

pans

ion

and

T21

initi

ativ

es in

ru

ral a

reas

.

Will

col

labo

rate

with

nat

iona

l IT

pr

ogra

m d

irect

or /

Tim

Cro

mw

ell

and

sta

te o

f Uta

h O

ffice

of

Vet

eran

Affa

irs d

irect

or T

erry

S

chow

on

upda

tes

on n

atio

nal

pilo

t pro

gram

s an

d re

port

.

Dev

elop

a te

mpl

ate

to a

llow

the

docu

men

tatio

n of

new

te

chno

logi

es w

hich

can

be

used

in

rura

l hea

lthca

re

Pilo

t the

tem

plat

e w

hich

was

de

velo

ped

to a

llow

the

docu

men

tatio

n of

new

tech

nolo

gies

w

hich

can

be

used

in r

ural

he

alth

care

Sub

mit

the

deve

lope

d te

mpl

ate

as

a re

port

of t

echn

olog

ies

for

poss

ible

use

in c

linic

al p

ilots

Hol

d a

kick

off

mee

ting

to in

trod

uce

com

mitt

ee m

embe

rs a

nd r

evie

w

char

ter.

Fin

aliz

e ch

arte

r.

Will

col

labo

rate

with

nat

iona

l IT

pr

ogra

m d

irect

or /

Tim

Cro

mw

ell

and

sta

te o

f Uta

h O

ffice

of

Vet

eran

Affa

irs d

irect

or T

erry

S

chow

on

upda

tes

on n

atio

nal p

ilot

prog

ram

s an

d re

port

.

Will

col

labo

rate

with

nat

iona

l IT

pr

ogra

m d

irect

or /

Tim

Cro

mw

ell

and

sta

te o

f Uta

h O

ffice

of V

eter

an

Affa

irs d

irect

or T

erry

Sch

ow o

n up

date

s on

nat

iona

l pilo

t pro

gram

s an

d re

port

.

Dev

elop

dra

ft ch

arte

r fo

r co

mm

ittee

; Id

entif

y ap

prop

riate

le

ad fr

om e

ach

VA

pro

gram

offi

ce

to in

vite

to c

omm

ittee

OR

H le

ader

ship

mee

ts q

uart

erly

w

ith O

TS

lead

ersh

ip to

dis

cuss

te

lehe

alth

nee

ds a

nd in

itiat

ives

in

rura

l are

as.

OR

H le

ader

ship

mee

ts q

uart

erly

w

ith O

TS

lead

ersh

ip to

dis

cuss

te

lehe

alth

nee

ds a

nd in

itiat

ives

in

rura

l are

as.

OR

H le

ader

ship

mee

ts q

uart

erly

w

ith O

TS

lead

ersh

ip to

dis

cuss

te

lehe

alth

nee

ds a

nd in

itiat

ives

in

rura

l are

as.

OR

H le

ader

ship

mee

ts q

uart

erly

w

ith O

TS

lead

ersh

ip to

dis

cuss

te

lehe

alth

nee

ds a

nd in

itiat

ives

in

rura

l are

as.

Will

col

labo

rate

with

nat

iona

l IT

pr

ogra

m d

irect

or /

Tim

Cro

mw

ell

and

sta

te o

f Uta

h O

ffice

of

Vet

eran

Affa

irs d

irect

or T

erry

S

chow

on

upda

tes

on n

atio

nal

pilo

t pro

gram

s an

d re

port

.

Initi

ativ

e 2.

1 -

Iden

tific

atio

n of

gap

s in

tele

-co

mm

unic

atio

ns in

fras

truc

ture

, tel

ehea

lth

serv

ices

, equ

ipm

ent i

n ru

ral a

nd h

ighl

y ru

ral

com

mun

ities

.

Initi

ativ

e 2.

3: S

trea

mlin

e ac

cess

to n

ew a

nd

exis

ting

tech

nolo

gica

l pla

tform

s.

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

16

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Initi

ativ

e 3.

1 E

xpan

d A

cces

s to

and

Use

of

VA

stu

dies

and

dat

aA

ctio

n 3.

1.1

: C

onti

nue

to p

rom

ote

the

use

of th

e R

ural

H

ealt

h B

rief

ing

Boo

k an

d R

ural

Hea

lth

Pro

file

con

tain

ing

rura

l Vet

eran

enr

olle

e an

d ut

iliz

atio

n da

ta.

Kat

ie D

ziak

Kat

ie D

ziak

Act

ion

3.1.

2 :

Con

tinu

e to

mon

itor

and

rep

ort q

uart

erly

on

a na

tion

al s

et o

f co

re p

erfo

rman

ce m

easu

res

that

qua

ntif

y ac

cess

and

qua

lity

of

care

del

iver

ed to

rur

al a

nd h

ighl

y ru

ral

Vet

eran

s .

She

ila W

arre

n

Kat

ie D

ziak

She

ila W

arre

n

Act

ion

3.1.

3: C

onti

nue

to d

isse

min

ate

info

rmat

ion

gath

ered

fr

om O

RH

-spo

nsor

ed p

ilot

pro

ject

s, s

tudi

es a

nd p

rogr

ams

to e

xter

nal s

take

hold

ers

thro

ugh

the

new

OR

H w

ebsi

te,

elec

tron

ic n

ewsl

ette

r, f

act s

heet

s, s

ocia

l med

ia,

conf

eren

ces,

pub

lica

tion

s an

d em

ail a

lert

s. T

he O

RH

m

ater

ials

are

dis

trib

uted

ele

ctro

nica

lly

to c

onta

cts

mai

ntai

ned

in a

n ac

cess

dat

abas

e. I

n ad

diti

on, O

RH

sta

ff

wil

l pub

lish

in p

eer-

revi

ewed

jour

nals

and

wil

l est

abli

sh a

pr

esen

ce a

t nat

iona

l rur

al h

ealt

h ca

re a

nd r

esea

rch

mee

ting

s.

OR

H

com

mun

icat

ions

Nan

cy M

aher

K

riste

n W

ing

Act

ion

3.1.

4: R

evie

w a

nd u

tili

ze b

est p

ract

ices

of

com

mun

icat

ion

wit

h ru

ral V

eter

ans

(e.g

., ra

dio,

tow

n ha

ll,

loca

l cle

rgy,

com

mun

ity

orga

niza

tion

s) to

dis

sem

inat

e in

form

atio

n re

gard

ing

OR

H p

rogr

am d

evel

opm

ents

and

im

pact

s.

OR

H

com

mun

icat

ions

Nan

cy M

aher

K

riste

n W

ing

Act

ion

3.2.

1: F

orm

an

ad h

oc c

omm

itte

e co

nsis

ting

of

pers

onne

l fro

m O

RH

and

the

VH

A O

ffic

e of

Res

earc

h an

d D

evel

opm

ent (

OR

D)

that

mee

t per

iodi

call

y fo

r in

form

atio

n ex

chan

ges.

The

se e

xcha

nges

wil

l inf

orm

the

deve

lopm

ent

of im

port

ant r

esea

rch

ques

tion

s re

gard

ing

the

heal

th

disp

arit

ies

and

clin

ical

nee

ds a

mon

g ru

ral V

eter

ans,

as

wel

l as

hea

lth

serv

ice

deli

very

and

cos

t-ef

fect

iven

ess

issu

es in

ru

ral a

reas

.

Nan

cy M

aher

Ser

ena

Chu

A

lan

Wes

t

Pet

er K

abol

i

Pet

er K

abol

i

Act

ion3

.2.2

: Con

tinu

e to

par

tner

wit

h V

A H

ealt

h S

ervi

ces

Res

earc

h an

d D

evel

opm

ent (

HS

R&

D)

rese

arch

ers

for

Col

labo

rati

ve R

esea

rch

to E

nhan

ce a

nd A

dvan

ce

Tra

nsfo

rmat

ion

and

Exc

elle

nce

(CR

EA

TE

) ap

plic

atio

ns

OR

HN

ancy

Mah

er

Cre

ate

and

diss

emin

ate

3 O

RH

fa

ct s

heet

s fo

r m

onth

ly d

istr

ibut

ion.

C

reat

e an

d di

ssem

inat

e a

quar

terly

O

RH

new

slet

ter.

Sen

d em

ail a

lert

s to

sta

keho

lder

s re

gard

ing

new

O

RH

pub

licat

ions

as

need

ed.

Con

tinue

to u

pdat

e O

RH

web

site

.

Hav

e a

conf

eren

ce c

all w

ith O

RD

le

ader

ship

and

rur

al h

ealth

in

vest

igat

ors

to r

evie

w p

riorit

ies

in

rura

l hea

lth. S

peci

fical

ly, r

evie

w

the

Sta

te o

f the

Art

Con

fere

nce

Rec

omm

enda

tions

for

Res

earc

h on

Acc

ess

to c

are.

Dev

elop

a p

lan

for

the

com

ing

year

.

Initi

ativ

e 3.

2: C

olla

bora

te w

ith V

A R

esea

rch

and

Dev

elop

men

tH

ave

a m

eetin

g at

the

Nat

iona

l VA

H

ealth

Ser

vice

s R

esea

rch

and

Dev

elop

men

t mee

ting

(Feb

. 201

2)

incl

udin

g th

e ke

y st

akeh

olde

rs in

V

A r

ural

hea

lth r

esea

rch.

D

eter

min

e w

hat s

houl

d be

don

e ov

er th

e ne

xt tw

o qu

arte

rs a

nd

repo

rt b

ack

to O

RH

.

Cre

ate

and

diss

emin

ate

3 O

RH

fa

ct s

heet

s fo

r m

onth

ly

dist

ribut

ion.

Cre

ate

and

diss

emin

ate

a qu

arte

rly O

RH

ne

wsl

ette

r. S

end

emai

l ale

rts

to

stak

ehol

ders

reg

ardi

ng n

ew O

RH

pu

blic

atio

ns a

s ne

eded

. Con

tinue

to

upd

ate

OR

H w

ebsi

te.

Fin

aliz

e V

SS

C w

eb b

ased

sys

tem

. P

rovi

de tr

aini

ng to

VR

Cs

on h

ow

to u

tiliz

e w

eb b

ased

sys

tem

. C

ontin

ue d

iscu

ssio

ns w

ith O

ffice

of

Info

rmat

ion

and

Tec

hnol

ogy

(OI&

T)

to d

evel

op w

eb-b

ased

sy

stem

. Pro

vide

qua

rter

ly r

epor

t su

mm

ary

to O

RH

lead

ersh

ip.

Orie

nt a

ny n

ew s

taff

to V

SS

C w

eb-

base

d sy

stem

. Pro

vide

qua

rter

ly

repo

rt s

umm

ary

to O

RH

le

ader

ship

. F

inal

ize

OI&

T w

eb

data

base

dev

elop

men

t. P

repa

re to

la

unch

for

FY

13

proj

ects

.

Cre

ate

and

diss

emin

ate

3 O

RH

fa

ct s

heet

s fo

r m

onth

ly

dist

ribut

ion.

Cre

ate

and

diss

emin

ate

a qu

arte

rly O

RH

ne

wsl

ette

r. S

end

emai

l ale

rts

to

stak

ehol

ders

reg

ardi

ng n

ew O

RH

pu

blic

atio

ns a

s ne

eded

. Con

tinue

to

upd

ate

OR

H w

ebsi

te. O

RH

sta

ff w

ill a

ttend

and

hav

e a

boot

h at

the

Nat

iona

l Rur

al H

ealth

Ass

ocia

tion

Ann

ual M

eetin

g in

Den

ver,

C

olor

ado.

Orie

nt a

ny n

ew s

taff

to V

SS

C w

eb-

base

d sy

stem

. P

rovi

de q

uart

erly

re

port

sum

mar

y to

OR

H le

ader

ship

. B

egin

OI&

T w

eb d

atab

ase

deve

lopm

ent.

Orie

nt a

ny n

ew s

taff

to V

SS

C w

eb-

base

d sy

stem

. P

rovi

de q

uart

erly

re

port

sum

mar

y to

OR

H

lead

ersh

ip. C

ontin

ue O

I&T

web

da

taba

se d

evel

opm

ent.

Rev

iew

lite

ratu

re fo

r be

st p

ract

ices

fo

r he

alth

com

mun

icat

ion

with

ol

der

gene

ratio

ns o

f Vet

eran

s

Dev

elop

a w

hite

pap

er o

n to

pic

and

diss

emin

ate

to r

ural

hea

lth te

ams

and

part

ners

.

Con

tinue

to d

isse

min

ate

mat

eria

ls

to p

artn

ers.

Con

tinue

to d

isse

min

ate

mat

eria

ls

to p

artn

ers,

eva

luat

e im

pact

Pro

vide

qua

rter

ly tr

aini

ng

oppo

rtun

ities

for

VR

Cs

and

Pro

gram

Offi

ce p

erso

nnel

. O

rient

ne

w V

RC

sta

ff as

app

licab

le.

Incl

ude

in O

RH

lead

ersh

ip

pres

enta

tions

as

appl

icab

le.

Pro

vide

qua

rter

ly tr

aini

ng

oppo

rtun

ities

for

VR

Cs

and

Pro

gram

Offi

ce p

erso

nnel

. Orie

nt

new

VR

C s

taff

as a

pplic

able

. In

clud

e in

OR

H le

ader

ship

pr

esen

tatio

ns a

s ap

plic

able

.

Pro

vide

qua

rter

ly tr

aini

ng

oppo

rtun

ities

for

VR

Cs

and

Pro

gram

Offi

ce p

erso

nnel

. Orie

nt

new

VR

C s

taff

as a

pplic

able

. In

clud

e in

OR

H le

ader

ship

pr

esen

tatio

ns a

s ap

plic

able

.

Pro

vide

qua

rter

ly tr

aini

ng

oppo

rtun

ities

for

VR

Cs

and

Pro

gram

Offi

ce p

erso

nnel

. O

rient

ne

w V

RC

sta

ff as

app

licab

le.

Incl

ude

in O

RH

lead

ersh

ip

pres

enta

tions

as

appl

icab

le.

Cre

ate

and

diss

emin

ate

3 O

RH

fa

ct s

heet

s fo

r m

onth

ly d

istr

ibut

ion.

C

reat

e an

d di

ssem

inat

e a

quar

terly

O

RH

new

slet

ter.

Sen

d em

ail a

lert

s to

sta

keho

lder

s re

gard

ing

new

O

RH

pub

licat

ions

as

need

ed.

Con

tinue

to u

pdat

e O

RH

web

site

.

Mee

t with

VA

HS

R &

D

inve

stig

ator

s as

req

uest

ed to

di

scus

s O

RH

par

tner

ship

in

CR

EA

TE

app

licat

ions

.

Dep

ende

nt o

n re

port

.D

epen

dent

on

repo

rt.

Mee

t with

VA

HS

R &

D

inve

stig

ator

s as

req

uest

ed to

di

scus

s O

RH

par

tner

ship

in

CR

EA

TE

app

licat

ions

.

Mee

t with

VA

HS

R &

D

inve

stig

ator

s as

req

uest

ed to

di

scus

s O

RH

par

tner

ship

in

CR

EA

TE

app

licat

ions

.

Mee

t with

VA

HS

R &

D

inve

stig

ator

s as

req

uest

ed to

di

scus

s O

RH

par

tner

ship

in

CR

EA

TE

app

licat

ions

.

Stra

tegi

c G

oal T

hree

: Max

imiz

e ut

iliza

tion

of e

xist

ing

and

emer

ging

stu

dies

and

ana

lyse

s to

impr

ove

care

del

iver

ed to

rura

l and

hig

hly

rura

l Vet

eran

s

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

17

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

4.1.

1: T

he V

HA

Em

ploy

ee E

duca

tion

Sys

tem

(E

ES

) w

ill c

ondu

ct a

rur

al h

ealt

h tr

aini

ng/e

duca

tion

nee

ds

asse

ssm

ent t

o he

lp in

form

OR

H o

n ed

ucat

ion/

trai

ning

gap

s in

rur

al h

ealt

h.

EE

S

S

eren

a C

huS

eren

a C

hu

Act

ion

4.1.

2:

In c

olla

bora

tion

wit

h E

ES

, OR

H w

ill d

evel

op

‘Rur

al H

ealt

h E

thic

s’.

EE

S

K

riste

n W

ing

Kris

ten

Win

g

Act

ion

4.1.

3:

Dev

elop

new

dis

tanc

e le

arni

ng r

ural

hea

lth

trai

ning

/edu

cati

onal

mod

ules

bas

ed o

n ne

eds

asse

ssm

ent.

Ser

ena

Chu

P

aul H

offm

anS

eren

a C

hu

Act

ion

4.1.

4: In

col

labo

ratio

n w

ith O

TS

, OR

H w

ill e

xpan

d te

lem

edic

ine

trai

ning

to r

ural

CB

OC

and

out

reac

h cl

inic

pe

rson

nel.

In c

olla

bora

tion

wit

h th

e P

AC

T O

ffic

e, O

RH

w

ill e

xpan

d P

atie

nt A

lign

ed C

are

Tea

ms

( P

AC

T)

trai

ning

to

CB

OC

and

out

reac

h cl

inic

per

sonn

el.

Pau

l Hof

fman

R

HP

I P

aul H

offm

an

Act

ion

4.1.

5: C

onti

nue

expa

nsio

n of

the

use

of d

ista

nce

tech

nolo

gy in

ord

er to

pro

vide

edu

cati

on to

sta

ff a

t C

BO

Cs.

Pau

l Hof

fman

Son

ya S

tarli

ng

Jaso

n Z

ullo

Pau

l Hof

fman

Iden

tify

EE

S s

taff

that

can

ass

ist i

n co

mpl

etin

g th

is a

naly

sis.

Dev

elop

an

actio

n pl

an w

ith

timel

ines

for

com

plet

ing

this

an

alys

is.

Impl

emen

t the

act

ion

plan

and

co

nduc

t the

fron

t end

ana

lysi

s.F

inal

ize

the

fron

t end

ana

lysi

s an

d co

mm

unic

ate

the

resu

lts w

ith

OR

H.

Stra

tegi

c G

oal F

our:

Im

prov

e av

aila

bilit

y of

edu

catio

n an

d tr

aini

ng fo

r VA

and

non

-VA

ser

vice

pro

vide

rs to

rura

l and

hig

hly

rura

l Vet

eran

s.

Dis

cuss

pot

entia

l OR

H p

roje

cts

with

EE

S a

nd d

evel

op a

n ac

tion

plan

for

acco

mpl

ishi

ng th

ese

proj

ects

Beg

in p

rodu

ctio

n of

EE

S p

roje

cts,

w

hich

will

incl

ude

a m

ixtu

re o

f co

nfer

ence

sup

port

, bro

adca

st

prog

ram

s, a

nd e

duca

tion/

mar

ketin

g vi

deos

.

Con

tinue

pro

duct

ion

of E

ES

pr

ojec

ts, w

hich

will

incl

ude

a m

ixtu

re o

f con

fere

nce

supp

ort,

broa

dcas

t pro

gram

s, a

nd

educ

atio

n/m

arke

ting

vide

os.

Com

plet

e th

e pr

oduc

tion

of a

ll E

ES

pro

ject

s.

Con

tinue

to d

evel

op th

e co

nten

t fo

r th

e E

thic

s vi

deo

and

secu

re a

ll th

e fa

culty

that

will

be

invo

lved

in

the

prod

uctio

n of

this

vid

eo.

Fin

aliz

e th

e co

nten

t and

slid

es fo

r th

e E

thic

s vi

deo.

Sec

ure

facu

lty

and

plan

ning

com

mitt

ee

info

rmat

ion

so th

e pr

ogra

m c

an b

e ac

cred

ited.

Film

this

bro

adca

st in

Sal

t Lak

e C

ity. B

road

cast

will

be

repe

ated

ly

aire

d on

EE

S' s

ite.

Rur

al H

ealth

Pro

fess

ions

(R

HP

I)

Inst

itute

will

par

tner

with

VR

HR

C-

ER

.D

evel

op m

odul

es fo

r T

elem

edic

ine

( T

M )

trai

ning

.

Fin

aliz

e m

odul

es fo

r T

M tr

aini

ng.

Sel

ect l

ocat

ions

for

TM

trai

ning

. P

rom

ote

trai

ning

ava

ilabi

lity

and

sche

dule

dat

es.

Impl

emen

t TM

trai

ning

at C

BO

Cs.

Col

lect

pro

gram

/mod

ule

feed

back

.

Clin

ical

Vid

eo-T

eleh

ealth

(C

VT

)-N

euro

logy

Fol

low

-up

Car

e fo

r V

eter

ans

with

Pro

gres

sive

Mul

tiple

S

cler

osis

, Liv

ing

in R

ural

Are

as’

Wor

kgro

up in

Bal

timor

e to

es

tabl

ish

natio

nwid

e si

tes.

E

xpan

d D

ME

to 1

CB

OC

in V

ISN

8.

Est

ablis

h N

orth

Flo

rida'

s te

lere

habi

litat

ion

mod

el a

t the

W

hite

Riv

er J

unct

ion

VA

incl

udin

g st

anda

rdiz

ed c

linic

s, p

roce

sses

an

d m

easu

rem

ent s

yste

ms.

Tel

e-N

euro

will

fina

lize

list o

f pa

tient

s at

eac

h si

te,

verif

y pr

ofile

s, s

ched

ule

and

cond

uct f

irst

TM

vis

its a

t eac

h si

te.

Exp

and

DM

E to

1 C

BO

C in

VIS

N 8

.E

xpan

d F

lorid

a's

tele

reha

bilit

atio

n m

odel

to in

clud

e sp

ecia

lized

focu

s ar

eas

such

as

TB

I, H

BP

C, a

nd

post

sur

gica

l pat

ient

s.

Con

tinue

to c

ondu

ct T

ele-

Neu

ro

visi

ts a

t eac

h si

te.

Rev

iew

the

Tel

e-N

euro

Pt a

nd

Pro

vide

r ev

alua

tions

. E

xpan

d D

ME

to 1

CB

OC

in V

ISN

8.

Initi

tiate

trea

tmen

t of V

eter

ans

with

the

spec

ializ

ed fo

cus

and

begi

n tr

acki

ng o

utco

mes

.

Con

duct

follo

w-u

p w

orkg

roup

for

'Clin

ical

Vid

eo-T

eleh

ealth

(C

VT

)-N

euro

logy

Fol

low

-up

Car

e fo

r V

eter

ans

with

Pro

gres

sive

Mul

tiple

S

cler

osis

, Liv

ing

in R

ural

Are

as’.

Col

labo

rate

with

GIS

team

to m

ap

patie

nts

at e

ach

site

nat

ionw

ide.

E

xpan

d D

ME

to 1

CB

OC

in V

ISN

8. C

ontin

ue tr

eatm

ent o

f spe

cial

ized

fo

cus

area

s an

d tr

acki

ng o

f ou

tcom

es. I

nclu

de tr

endi

ng d

ata

and

expa

nsio

n of

num

bers

of

patie

nts

serv

ed.

Stra

tegi

c G

oal F

our C

ontin

ued

Nex

t Pag

e

Initi

ativ

e 4.

1: E

xpan

d th

e us

e of

dis

tanc

e le

arni

ng te

chno

logi

es a

nd o

ther

mod

aliti

es

for

rura

l edu

catio

n pr

ogra

m d

eliv

ery

to

prov

ide

targ

eted

trai

ning

to a

ddre

ss s

peci

fic

need

s of

rur

al p

rovi

ders

.

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

18

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

4.2.

1: C

onti

nue

and

expa

nd th

e R

ural

Hea

lth

Tra

inin

g P

rogr

am (

RH

TP

). T

he R

HT

P is

dir

ecte

d at

m

edic

al s

tude

nts,

nur

se p

ract

ione

rs, a

nd o

ther

all

ied

heal

th

prof

essi

onal

s. O

AA

wil

l col

labo

rate

as

need

ed r

egar

ding

af

fili

atio

n re

lati

onsh

ips

and

poli

cies

gov

erni

ng tr

aine

es in

ac

cred

ited

pro

gram

s.

Pau

l Hof

fman

Son

ya S

tarli

ng

Pen

elop

e M

arkl

e

Pau

l Hof

fman

Act

ion

4.2.

2: O

RH

wil

l col

labo

rate

wit

h O

ffic

e of

A

cade

mic

Aff

ilia

tion

s (O

AA

) in

dev

elop

ing

a ne

w V

A

Tra

inin

g In

itia

tive

dir

ecte

d at

rur

al V

A i

nter

disc

ipli

nary

te

ams,

suc

h as

thos

e at

rur

al C

BO

CS

and

Ext

ensi

on

Cli

nics

, hub

sit

es f

or r

ural

tele

heal

th s

ervi

ces,

or

HB

PC

te

ams

cari

ng f

or r

ural

Vet

eran

s.

OR

H V

AC

O O

AA

Nan

cy M

aher

Act

ion

4.2.

3: D

evel

op a

nd im

plem

ent a

n ed

ucat

ion

prog

ram

on d

iagn

osin

g di

agno

stic

pro

cedu

res

that

wil

l req

uire

ph

ysic

ians

to c

ompl

ete

pre-

read

ings

and

kno

wle

dge

asse

ssm

ents

, vie

w in

stru

ctio

nal v

ideo

s, p

ract

ice

usin

g pr

oced

ure-

spec

ific

sim

ulat

ion

equi

pmen

t, an

d un

derg

o a

full

ski

ll a

sses

smen

t usi

ng c

urre

nt p

ract

ice

stan

dard

s an

d ev

iden

ce b

ased

cri

teri

a un

der

the

eval

uati

on o

f an

ap

prop

riat

e m

edic

al p

eer.

Pro

vide

a tr

aini

ng m

odel

that

co

uld

be a

ppli

ed a

t all

VA

MC

s se

rvin

g ru

ral p

opul

atio

ns.

Al W

est

Al W

est

Act

ion

4.2.

4: T

he T

ogus

VA

MC

and

the

VR

HR

C -

Eas

tern

R

egio

n w

ill a

ctiv

ely

part

icip

ate

in th

e ‘H

RS

A T

eleh

ealt

h R

esou

rce

Cen

ter

Gra

nt P

rogr

am: C

FD

A 9

3.21

1, N

orth

east

T

eleh

ealt

h R

esou

rce

Cen

ter’

Son

ya S

tarli

ng

Pen

elop

e M

arkl

eS

onya

Sta

rling

Initi

ativ

e 4.

2: D

evel

op n

ew e

duca

tion

reso

urce

s fo

r he

alth

-car

e pr

ofes

sion

als

VR

HR

C-E

R s

taff

part

icip

atio

n in

T

eleh

ealth

Adv

isor

y C

omm

ittee

m

eetin

gs. S

eek

to d

evel

op a

nd

man

age

colla

bora

tive

trai

ning

pr

ojec

ts w

ith N

ET

RIC

team

.

VR

HR

C-E

R s

taff

part

icip

atio

n in

T

eleh

ealth

Adv

isor

y C

omm

ittee

m

eetin

gs. S

eek

to d

evel

op a

nd

man

age

colla

bora

tive

trai

ning

pr

ojec

ts w

ith N

ET

RIC

team

.

Fin

aliz

e fir

st r

otat

ion

of A

RN

P, P

T,

and

3 m

edic

al s

tude

nts.

R

ecru

it ne

xt P

T s

tude

nt a

t Nor

th

Flo

rida/

Sou

th G

eorg

ia V

eter

ans

Hea

lth c

are

syst

em (

NF

/SG

VH

S).

E

xpan

d th

e R

HT

P w

ith a

co

llabo

ratio

n m

eetin

g w

ith D

r. L

ori

Dav

is a

nd D

r. H

ugh

Myr

ick

for

Pub

lic P

sych

iatr

y an

d T

ele-

Men

tal

Hea

lth.

Tel

epha

rmac

y P

roje

ct-M

aine

VA

:In

itiat

e an

d es

tabl

ish

Tel

epha

rmac

y M

edic

atio

n R

econ

cilia

tion

Clin

ics

Pro

ject

at

VA

Mai

ne in

acc

orda

nce

with

OT

S

Con

ditio

ns o

f Par

ticip

atio

n an

d lo

cal p

olic

y. E

stab

lish

form

at in

R

ES

ITR

AC

K to

rec

ord

Pha

rmac

y R

esid

ent e

xper

ienc

e. C

ertif

y P

harm

acy

Res

iden

ts (

2) a

s O

TS

-ap

prov

ed C

VT

pro

vide

rs. O

rient

P

harm

acy

Stu

dent

s (6

th y

ear)

to

proj

ect.

Orie

nt a

nd tr

ain

CB

OC

st

aff.

Dev

elop

ano

nym

ous

patie

nt

satis

fact

ion

surv

ey. I

nitia

te

Pha

rmac

y R

esid

ent T

elep

harm

acy

Med

icat

ion

Rec

onci

liatio

n cl

inic

vi

sits

for

CB

OC

pat

ient

s D

ecem

ber

2011

.

Pla

ce P

T s

tude

nt a

t NF

/SG

VH

S.

Est

ablis

h re

latio

nshi

p w

ith o

ther

sc

hool

s fo

r A

RN

P a

nd P

T s

tude

nts.

Tel

epha

rmac

y P

roje

ct-M

aine

VA

:C

ontin

ue P

harm

acy

Res

iden

t T

elep

harm

acy

Med

icat

ion

Rec

onci

liatio

n cl

inic

vis

its fo

r C

BO

C p

atie

nts

with

ong

oing

rev

iew

of

pro

cess

es o

f ser

vice

del

iver

y.

Pha

rmac

y st

uden

ts (

6th

year

) ob

serv

e cl

inic

as

adva

nced

pr

actic

e ph

arm

acy

CV

T

expe

rienc

e. M

ake

adju

stm

ents

to

oper

atio

n of

Tel

epha

rmac

y M

edic

atio

n R

econ

cilia

tion

Clin

ics,

if

need

ed.

Fin

aliz

e ro

tatio

n of

PT

and

med

ical

st

uden

ts.

Tel

epha

rmac

y P

roje

ct-M

aine

VA

:D

evel

op a

sta

ff sa

tisfa

ctio

n su

rvey

an

d ob

tain

nec

essa

ry lo

cal

appr

oval

s to

adm

inis

ter.

Con

tinue

Pha

rmac

y R

esid

ent

Tel

epha

rmac

y M

edic

atio

n R

econ

cilia

tion

clin

ic v

isits

for

CB

OC

pat

ient

s w

ith o

ngoi

ng

revi

ew o

f pro

cess

es o

f ser

vice

de

liver

y. P

harm

acy

stud

ents

(6t

h ye

ar)

obse

rve

clin

ic a

s ad

vanc

ed

prac

tice

phar

mac

y C

VT

ex

perie

nce.

Mak

e ad

just

men

ts to

op

erat

ion

of T

elep

harm

acy

Med

icat

ion

Rec

onci

liatio

n C

linic

s,

if ne

eded

.

Rev

iew

stu

dent

and

pre

cept

or

eval

uatio

n fo

rms.

A

ttend

and

dis

trib

ute

recr

uitm

ent

pack

ets

at s

tude

nt o

rient

atio

n da

y.

Tel

epha

rmac

y P

roje

ct-M

aine

VA

:C

ontin

ue P

harm

acy

Res

iden

t T

elep

harm

acy

Med

icat

ion

Rec

onci

liatio

n cl

inic

vis

its fo

r C

BO

C p

atie

nts

with

ong

oing

re

view

of p

roce

sses

of s

ervi

ce

deliv

ery.

Pha

rmac

y st

uden

ts (

6th

year

) ob

serv

e cl

inic

as

adva

nced

pr

actic

e ph

arm

acy

CV

T

expe

rienc

e.

Adm

inis

ter

staf

f sat

isfa

ctio

n su

rvey

.S

umm

ariz

e pa

tient

sat

isfa

ctio

n su

rvey

info

rmat

ion.

Eva

luat

e pi

lot a

nd p

rovi

de

prog

ram

rec

omm

enda

tions

Con

tinue

mee

tings

bet

wee

n O

RH

te

am a

nd O

AA

team

. D

evel

op, r

evie

w a

nd a

ppro

ve

Req

uest

for

Pro

posa

ls (

RF

P)

Dis

trib

ute

RF

P a

nnou

ncem

ent.

Fie

ld w

ill s

end

in L

OIs

to O

RH

and

O

AA

. Fie

ld w

ill d

evel

op p

ropo

sals

. O

RH

and

OA

A w

ill m

eet a

s ne

eded

.

Ful

l pro

posa

ls d

ue. P

ropo

sals

are

re

view

ed b

y O

AA

rev

iew

team

. O

RH

and

OA

A w

ill m

eet a

s ne

eded

.

App

lican

ts a

re n

otifi

ed o

f rev

iew

re

sults

. Pro

gram

beg

ins

Fal

l of

A

cade

mic

Yea

r 20

12-2

013.

Acq

uire

pre

-inte

rven

tion

mea

sure

s of

pat

ient

wai

t tim

es a

nd d

elay

ed

care

, and

cou

nts

of m

edic

al s

taff

qual

ified

to p

erfo

rm p

roce

dure

s.

Pur

chas

e si

mul

ator

s an

d "t

rain

the

trai

ners

" to

put

them

into

use

, the

n st

art t

rain

ing

med

ical

sta

ff w

ith

them

.

Con

tinue

trai

ning

sta

ff an

d co

llect

ing

data

.C

ontin

ue s

taff

trai

ning

, and

beg

in

follo

w-u

p da

ta c

olle

ctio

n.C

ompl

ete

data

col

lect

ion

and

anal

ysis

, and

writ

e fin

al r

epor

t.

HR

SA

aw

arde

d gr

ant f

undi

ng fo

r N

ew E

ngla

nd T

eleh

ealth

Res

ourc

e C

ente

r (N

ET

RC

) P

roje

ct o

n 9/

1/20

11 H

RS

A G

rant

#

G22

RH

2269

9

VR

HR

C-E

R s

taff

part

icip

atio

n in

T

eleh

ealth

Adv

isor

y C

omm

ittee

m

eetin

gs. S

eek

to d

evel

op a

nd

man

age

colla

bora

tive

trai

ning

pr

ojec

ts w

ith N

ET

RC

team

.

VR

HR

C-E

R s

taff

part

icip

atio

n in

T

eleh

ealth

Adv

isor

y C

omm

ittee

m

eetin

gs. S

eek

to d

evel

op a

nd

man

age

colla

bora

tive

trai

ning

pr

ojec

ts w

ith N

ET

RC

team

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

19

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

5.1.

1:

Mai

ntai

n ex

isti

ng c

olla

bora

tion

s w

ith

the

Off

ice

of G

eria

tric

s an

d E

xten

ded

Car

e, th

e O

ffic

e of

M

enta

l Hea

lth

Ser

vice

, the

VA

Hom

eles

s O

ffic

e, a

nd th

e W

omen

Vet

eran

s H

ealt

h S

trat

egic

Hea

lth

Car

e G

roup

by

clos

ely

mon

itor

ing

the

perf

orm

ance

of

exis

ting

co

llab

orat

ive

proj

ects

and

by

expa

ndin

g/m

aint

aini

ng

succ

essf

ul p

rogr

ams

if f

undi

ng a

llow

s.

OR

H V

AC

OS

eren

a C

hu

Chr

istin

a W

hite

Act

ion

5.1.

2: C

ondu

ct a

n as

sess

men

t of

rura

l out

reac

h ef

fort

s an

d id

enti

fy e

ffor

ts th

at c

ould

be

join

tly

coor

dina

ted

wit

h lo

cal f

acil

ity’

s M

y H

ealt

heV

et (

MH

V)

Coo

rdin

ator

to

allo

w f

or im

med

iate

in-p

erso

n au

then

tica

tion

dur

ing

an

outr

each

eve

nt

Kris

ten

Win

gK

riste

n W

ing

Act

ion

5.1.

3:

Iden

tify

and

eng

age

othe

r V

A p

rogr

am

offi

ces

that

impa

ct r

ural

hea

lth

for

poss

ible

col

labo

rati

ons.

O

RH

VA

CO

Ser

ena

Chu

N

ancy

Mah

er K

riste

n W

ing

Act

ion

5.2.

1: I

nven

tory

and

ass

ess

effe

ctiv

enes

s of

cur

rent

O

RH

–fu

nded

out

reac

h ac

tivi

ties

usi

ng c

rite

ria

deve

lope

d by

OR

H le

ader

ship

.

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

5.2.

2: P

arti

cipa

te a

s a

mem

ber

of th

e N

atio

nal

Vet

eran

s O

utre

ach

(NV

O)

Off

ice

outr

each

wor

kgro

ups

to

prov

ide

repr

esen

tati

on f

or O

RH

, the

VR

C’s

, and

V

RH

RC

’s; a

nd to

sha

re in

form

atio

n ab

out t

he o

utre

ach

need

s of

rur

al V

eter

ans

and

OR

H-s

uppo

rted

out

reac

h in

itia

tive

s.

Kris

ten

Win

gK

riste

n W

ing

Act

ion

5.2.

3: U

tili

ze th

e ne

w (

FY

12)

NV

O O

utre

ach

Dat

abas

e an

d O

utre

ach

guid

e in

ord

er to

iden

tify

VA

ou

trea

ch p

rogr

am a

nd p

artn

ers

curr

entl

y co

nduc

ting

ou

trea

ch (

such

as

OE

F/O

IF o

utre

ach)

, Yel

low

Rib

bon

even

ts, e

tc.)

in r

ural

are

as a

nd c

olla

bora

te (

whe

re p

ossi

ble

and

appr

opri

ate)

; to

guid

e th

e pl

anni

ng a

nd im

plem

enta

tion

of

OR

H –

spo

nsor

ed o

utre

ach

init

iati

ves,

and

to e

valu

ate

and

anal

yze

the

effe

ctiv

enes

s of

out

reac

h ef

fort

s.

Kris

ten

Win

gK

riste

n W

ing

Initi

ativ

e 5.

2: C

ontin

ue to

par

tner

with

va

rious

ent

ities

with

in th

e ru

ral h

ealth

co

mm

unity

to e

stab

lish

or b

uild

upo

n ex

istin

g ou

trea

ch n

etw

orks

for

rura

l V

eter

ans.

Stra

tegi

c G

oal F

ive:

Enh

ance

exi

stin

g an

d im

plem

ent n

ew s

trat

egie

s to

impr

ove

colla

bora

tions

and

incr

ease

ser

vice

opt

ions

for r

ural

and

hig

hly

rura

l Vet

eran

s.

Fol

low

-up

with

VR

HR

Cs

and

VR

Cs

to id

entif

y re

mai

ning

gap

s in

M

HV

par

tner

ship

s.

Con

tact

VR

HR

Cs

and

VR

Cs

to

begi

n bu

ildin

g an

inve

ntor

y of

sc

hedu

led

Out

reac

h ev

ents

, di

ssem

inat

e lis

t of M

HV

C

oord

inat

ors

to V

RH

RC

s an

d V

RC

s.

Par

ticip

ate

in a

MH

V C

oord

inat

or

mon

thly

Poi

nt-o

f-C

onta

ct (

PO

C)

call

to in

form

the

MH

V

Coo

rdin

ator

s ab

out R

ural

Hea

lth

Out

reac

h ef

fort

s.

Con

duct

web

inar

to e

duca

te

VR

HR

Cs

and

VR

Cs

abou

t the

In-

Per

son

Aut

hent

icat

ion

(IP

A)

Pro

cess

and

Sec

ure

Mes

sagi

ng.

FY

12 O

RH

fund

ing

of s

usta

ined

H

ome

Bas

ed P

rimar

y C

are

(HB

PC

)

and

E R

AN

GE

pro

ject

s w

ill b

e di

sbur

sed.

FY

12 O

RH

fund

ing

of

new

pro

ject

s di

rect

ed b

y th

e O

ffice

of

Wom

en's

Hea

lth w

ill b

egin

. O

RH

pro

gram

ana

lyst

s w

ill m

onito

r ex

pend

iture

s an

d re

port

qua

rter

ly

on p

erfo

rman

ce m

easu

res.

OR

H p

rogr

am a

naly

sts

will

mon

itor

expe

nditu

res

and

repo

rt q

uart

erly

on

per

form

ance

mea

sure

s.

OR

H p

rogr

am a

naly

sts

will

mon

itor

expe

nditu

res

and

repo

rt q

uart

erly

on

per

form

ance

mea

sure

s.

OR

H p

rogr

am a

naly

sts

will

mon

itor

expe

nditu

res

and

repo

rt q

uart

erly

on

per

form

ance

mea

sure

s.

1. P

artic

ipat

e in

Nat

iona

l Vet

eran

s O

utre

ach

Offi

ce w

orkg

roup

co

nfer

ence

cal

ls.

2. P

artic

ipat

e in

m

onth

ly P

hysi

cal M

edic

ine

and

Reh

abili

tatio

n S

ervi

ce A

dvis

ory

Boa

rd c

onfe

renc

e ca

lls. 3

. Mee

t qu

arte

rly w

ith th

e O

ffice

of T

ribal

G

over

nmen

t Rel

atio

ns.

1. P

artic

ipat

e in

Nat

iona

l Vet

eran

s O

utre

ach

Offi

ce w

orkg

roup

co

nfer

ence

cal

ls.

2. P

artic

ipat

e in

m

onth

ly P

hysi

cal M

edic

ine

and

Reh

abili

tatio

n S

ervi

ce A

dvis

ory

Boa

rd c

onfe

renc

e ca

lls. 3

. Mee

t qu

arte

rly w

ith th

e O

ffice

of T

ribal

G

over

nmen

t Rel

atio

ns.

1. P

artic

ipat

e in

Nat

iona

l Vet

eran

s O

utre

ach

Offi

ce w

orkg

roup

co

nfer

ence

cal

ls.

2. P

artic

ipat

e in

m

onth

ly P

hysi

cal M

edic

ine

and

Reh

abili

tatio

n S

ervi

ce A

dvis

ory

Boa

rd c

onfe

renc

e ca

lls. 3

. Mee

t qu

arte

rly w

ith th

e O

ffice

of T

ribal

G

over

nmen

t Rel

atio

ns.

1. P

artic

ipat

e in

Nat

iona

l Vet

eran

s O

utre

ach

Offi

ce w

orkg

roup

co

nfer

ence

cal

ls.

2. P

artic

ipat

e in

m

onth

ly P

hysi

cal M

edic

ine

and

Reh

abili

tatio

n S

ervi

ce A

dvis

ory

Boa

rd c

onfe

renc

e ca

lls. 3

. Mee

t qu

arte

rly w

ith th

e O

ffice

of T

ribal

G

over

nmen

t Rel

atio

ns.

Sup

port

the

VR

Cs

and

VIS

Ns

with

th

eir

actio

n pl

ans

for

rura

l ou

trea

ch w

ith c

omm

unity

par

tner

s,

usin

g be

st p

ract

ices

doc

umen

ted

and

Out

reac

h T

oolk

it de

velo

ped

by

WR

.

Initi

ate

mee

ting

with

VR

Cs

to

defin

e th

eir

outr

each

act

ivity

act

ion

plan

s w

ithin

thei

r V

ISN

. Doc

umen

t ac

tion

plan

s an

d tim

elin

e fo

r in

itiat

ion.

Beg

in p

opul

atin

g th

e da

shbo

ard

mon

thly

with

met

rics.

Beg

in

docu

men

tatio

n of

inve

ntor

y of

pa

rtne

rs. I

nitia

te w

orkg

roup

to

iden

tify

best

pra

ctic

es a

nd b

egin

do

cum

enta

tion

of s

ame.

VR

HR

C-

WR

will

hos

t the

OR

H m

eetin

g,

them

e of

whi

ch is

col

labo

ratio

ns

with

rur

al c

omm

uniti

es. E

duca

tion

prov

ided

to a

ll V

RC

s an

d ot

hers

at

tend

ing

this

con

fere

nce.

Iden

tify

OR

H c

riter

ia fo

r de

term

inin

g ef

fect

iven

ess

of

outr

each

act

iviti

es v

ia th

orou

gh

revi

ew o

f pro

pose

d pr

ogra

m g

oals

an

d de

liver

able

s. D

evel

op d

ata

gath

erin

g to

ol a

nd d

ashb

oard

on

OR

H w

ebsi

te fo

r re

port

ing.

Tes

t da

shbo

ard

by id

entif

ying

pro

gram

le

ads

and

educ

atin

g th

em o

n th

e re

port

/pur

pose

. col

lect

and

co

mpi

le a

list

of e

ntiti

es th

at a

re

pres

entin

g w

orki

ng w

ith V

A in

rur

al

loca

tions

to s

uppo

rt o

utre

ach

to

Vet

eran

s w

ithin

thei

r co

mm

unity

.

Par

ticip

ate

in O

utre

ach

Wor

kgro

up

conf

eren

ce c

alls

. P

artic

ipat

e in

Out

reac

h W

orkg

roup

co

nfer

ence

cal

lsP

artic

ipat

e in

Out

reac

h W

orkg

roup

co

nfer

ence

cal

lsP

artic

ipat

e in

Out

reac

h W

orkg

roup

co

nfer

ence

cal

ls

Whe

n da

taba

se is

rel

ease

d,

cond

uct a

web

inar

to in

trod

uce

VR

HR

Cs

and

VR

Cs

to th

e N

VO

O

utre

ach

Dat

abas

e an

d su

ppor

t its

im

plem

enta

tion

Ana

lyze

use

of N

VO

Out

reac

h D

atab

ase

by V

RH

RC

s/V

RC

s, v

erify

th

at o

utre

ach

even

ts id

entif

ied

in

Act

ion

Item

2.2

.3 h

ave

been

en

tere

d, id

entif

y pl

anne

d ou

trea

ch

even

ts in

rur

al a

reas

and

sha

re

info

rmat

ion

with

VR

HR

Cs/

VR

Cs

Iden

tify

plan

ned

outr

each

eve

nts

in r

ural

are

as a

nd s

hare

in

form

atio

n w

ith V

RH

RC

s/V

RC

s

Iden

tify

plan

ned

outr

each

eve

nts

in r

ural

are

as a

nd s

hare

in

form

atio

n w

ith V

RH

RC

s/V

RC

s

Initi

ativ

e 5.

1: C

ontin

ue e

xist

ing

and

begi

n ne

w c

olla

bora

tions

with

VA

pro

gram

offi

ces.

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

20

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

5.2.

4: I

dent

ify

addi

tion

al r

ural

are

as o

f th

e co

untr

y to

targ

et in

rur

al V

eter

an o

utre

ach

effo

rts

to e

nsur

e th

at a

ll

rura

l Vet

eran

s ha

ve b

een

cont

acte

d re

gard

ing

thei

r be

nefi

ts

and

new

loca

l ser

vice

s.

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

5.2.

5: I

dent

ify

Sta

te a

nd lo

cal o

rgan

izat

ions

in r

ural

co

mm

unit

ies

for

outr

each

par

tner

ship

s an

d co

llab

orat

e w

here

fea

sibl

e.

Byr

on B

air

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

5.2.

6: F

acil

itat

e pa

rtne

rshi

ps b

etw

een

rura

l CB

OC

s (a

nd o

utre

ach

clin

ic p

erso

nnel

) w

ith

com

mun

ity

heal

th

enti

ties

by

help

ing

to s

trea

mli

ne p

roce

ss f

or c

ontr

acti

ng.

Byr

on B

air

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

5.2.

7: T

o im

prov

e co

mm

unic

atio

ns b

etw

een

OR

H

and

its

part

ners

, fur

ther

dev

elop

out

reac

h co

ntac

ts d

atab

ase

incl

udin

g in

divi

dual

s fr

om S

tate

Off

ices

of

Rur

al H

ealt

h,

Hea

lth

Res

earc

h S

ervi

ce A

dmin

istr

atio

n (H

RS

A)

Off

ice

of

Rur

al H

ealt

h P

olic

y, a

nd r

ural

hea

lth

rese

arch

ers.

OR

H

com

mun

icat

ions

Kris

ten

Win

g

Initi

ativ

e 5.

3: E

xpan

d an

d de

velo

p pu

blic

-pu

blic

col

labo

ratio

ns.

Act

ion

5.3.

1: E

stab

lish

ong

oing

liai

son

wit

h S

trat

egic

A

ctio

n gr

oups

rel

evan

t to

rura

l iss

ues

that

are

par

t of

the

DO

D/V

A I

nteg

rate

d M

enta

l Hea

lth

Str

ateg

y (I

MH

S).

The

IM

HS

cen

ters

on

a co

ordi

nate

d pu

blic

hea

lth

mod

el to

im

prov

e th

e ac

cess

, qua

lity

, eff

ecti

vene

ss, a

nd e

ffic

ienc

y of

m

enta

l hea

lth

serv

ices

. Rec

ipie

nts

of th

ese

serv

ices

incl

ude

acti

ve d

uty

serv

ice

mem

bers

, Nat

iona

l Gua

rd a

nd R

eser

ve

Com

pone

nt m

embe

rs, V

eter

ans,

and

thei

r fa

mil

ies.

Mar

y B

eth

Sku

pien

She

ila W

arre

nM

ary

Bet

h S

kupi

en

Act

ion

5.3.

2: E

stab

lish

and

for

mal

ize

rela

tion

ship

wit

h th

e S

ubst

ance

Abu

se a

nd M

enta

l Hea

lth

Ser

vice

s A

dmin

istr

atio

n (

SA

MH

SA

) fo

r in

form

atio

n sh

arin

g an

d pr

ovid

er tr

aini

ng.

Mar

y B

eth

Sku

pien

She

ila W

arre

nM

ary

Bet

h S

kupi

en

Act

ion

5.3.

3: E

stab

lish

rel

atio

nshi

p w

ith

US

Dep

artm

ent o

f A

gric

ultu

re (

US

DA

) co

oper

ativ

e ex

tens

ion

for

outr

each

to

rura

l Vet

eran

car

egiv

ers.

Mar

y B

eth

Sku

pien

She

ila W

arre

nM

ary

Bet

h S

kupi

en

Act

ion

5.3.

4: P

arti

cipa

te in

the

new

ly e

stab

lish

ed W

hite

H

ouse

Rur

al C

ounc

il t

hat w

ill c

ulm

inat

e in

a R

ural

Sum

mi t

in W

ashi

ngto

n, D

C.

Mar

y B

eth

Sku

pien

She

ila W

arre

nM

ary

Bet

h S

kupi

en

Act

ion

Item

5.4

.1: C

olla

bora

te w

ith th

e N

atio

nal R

ural

H

ealth

Ass

ocia

tion

(NR

HA

) to

ass

ist i

n th

e pl

anni

ng o

f the

ir an

nual

mee

ting

incl

udin

g or

gani

zatio

n of

wor

ksho

ps,

spea

kers

and

topi

cs o

f int

eres

t.

Nan

cy D

aile

yN

ancy

Dai

ley

Act

ion

Item

5.4

.2: O

rgan

ize

regi

onal

virt

ual m

eetin

gs w

ith

priv

ate

sect

ors

prov

ider

s an

d O

RH

sta

ff to

gai

n in

sigh

t on

he

alth

car

e ne

eds

of r

ural

Vet

eran

s .

Col

lette

Alv

arez

Col

lette

Alv

arez

Det

erm

ine

cont

act a

t SA

MH

SA

an

d m

eet w

ith in

divi

dual

in fi

rst

quar

ter

FY

12. D

evel

op p

artn

er

stra

tegy

for

prov

ider

trai

ning

.

US

DA

rep

rese

ntat

ive

notif

ied

of

repr

esen

tativ

e fo

r th

e V

RH

AC

. O

RH

Dire

ctor

will

be

wor

king

cl

osel

y w

ith h

e an

d hi

s co

unte

rpar

ts o

n ru

ral

issu

es/c

once

rns

and

oppo

rtun

ities

.

Mee

t on

quar

terly

bas

is if

req

uire

d.M

eet o

n qu

arte

rly b

asis

if r

equi

red.

Eva

luat

e if

actio

n pl

an h

as b

een

met

and

det

erm

ine

new

act

iviti

es

for

FY

13.

Mee

t on

quar

terly

bas

is if

req

uire

d.

Rep

ort l

esso

ns le

arne

d an

d em

ergi

ng s

trat

egie

s fo

r fu

rthe

r ex

port

atio

n of

rur

al c

olla

bora

tion

tool

kit.

Rep

ort l

esso

ns le

arne

d an

d em

ergi

ng s

trat

egie

s fo

r fu

rthe

r ex

port

atio

n of

rur

al c

olla

bora

tion

tool

kit

Fin

al r

epor

t on

less

ons

lear

ned

and

emer

ging

str

ateg

ies

from

ex

port

atio

n of

rur

al c

olla

bora

tion

tool

kit

and

defin

e ne

xt s

teps

for

natio

nal e

xpor

tatio

n

Use

too

l kit

to h

elp

VA

site

s

iden

tify

key

rura

l par

tner

s fo

r

outr

each

, par

tner

ship

and

co

llabo

rativ

e ef

fort

s by

VA

sta

tions

Rep

ort l

esso

ns le

arne

d fr

om u

sing

th

e to

ol k

it to

iden

tify

rura

l par

tner

s fo

r ou

trea

ch, p

artn

ersh

ips,

and

co

llabo

rativ

e ef

fort

s

Rep

ort l

esso

ns le

arne

d fr

om u

sing

th

e to

ol k

it to

iden

tify

rura

l par

tner

s fo

r ou

trea

ch, p

artn

ersh

ips,

and

co

llabo

rativ

e ef

fort

s

Pro

vide

a fi

nal r

epor

t on

less

ons

lear

ned

from

usi

ng th

e to

ol k

it to

id

entif

y ru

ral p

artn

ers

for

outr

each

, pa

rtne

rshi

ps, a

nd c

olla

bora

tive

effo

rts

Mon

itor

cont

ract

ing

proc

esse

s in

id

entif

ied

site

s an

d re

port

less

ons

lear

ned

Fin

al r

epor

t on

mon

itor

cont

ract

ing

proc

esse

s in

iden

tifie

d si

tes

Rev

iew

OR

H C

onta

cts

Dat

abas

e fo

r ex

istin

g ou

trea

ch p

artn

ers,

id

entif

y ga

ps in

col

labo

ratio

ns,

rese

arch

add

ition

al c

onta

cts

and

add

thei

r in

form

atio

n to

Con

tact

s D

atab

ase

Dis

sem

inat

e a

list o

f pla

nned

VA

ou

trea

ch e

vent

s to

out

reac

h co

ntac

ts, i

nqui

re a

bout

op

port

uniti

es to

col

labo

rate

on

outr

each

with

con

tact

s.

Dis

sem

inat

e a

list o

f pla

nned

VA

ou

trea

ch e

vent

s to

out

reac

h co

ntac

ts, i

nqui

re a

bout

op

port

uniti

es to

col

labo

rate

on

outr

each

with

con

tact

s.

Dis

sem

inat

e a

list o

f pla

nned

VA

ou

trea

ch e

vent

s to

out

reac

h co

ntac

ts, i

nqui

re a

bout

op

port

uniti

es to

col

labo

rate

on

outr

each

with

con

tact

s.

Con

tinui

ng v

irtua

l mee

tings

with

H

uman

a an

d C

ary

Med

ical

Cen

ter

on a

mon

thly

bas

is to

gai

n in

sigh

t fr

om p

rivat

e se

ctor

pro

vide

rs o

n he

alth

car

e ne

eds

of r

ural

V

eter

ans

Con

tinue

mee

ting

mon

thly

with

H

uman

a an

d C

ary

Med

ical

Cen

ter.

Con

tinue

mee

ting

mon

thly

with

H

uman

a an

d C

ary

Med

ical

Cen

ter.

Atte

nd p

lann

ing

mee

ting

Upd

ate

from

IMH

S in

firs

t qua

rter

. D

iscu

ss o

ngoi

ng p

artn

ersh

ips

in

this

are

a. M

eet w

ith K

aren

M

alen

bran

che

and

staf

f to

disc

uss

VA

/DO

D p

riorit

ies

and

OR

H

invo

lvem

ent i

n th

e pr

oces

s.

Mon

itor

prog

ress

and

act

ion

step

s af

ter

initi

al m

eetin

g qu

arte

rly.

Mon

itor

prog

ress

and

act

ion

step

s af

ter

initi

al m

eetin

g qu

arte

rly..

Eva

luat

e if

actio

n pl

an h

as b

een

met

and

det

erm

ine

new

act

iviti

es

for

FY

13.

Atte

nd n

atio

nal m

eetin

gP

rovi

de fi

nal r

epor

t and

nex

t ste

ps

Act

ive

mem

ber

of th

e P

resi

dent

's

Rur

al C

ounc

il Q

ualit

y of

Life

W

orkg

roup

. Mee

ts 2

tim

es p

er

mon

th. F

ollo

w u

p ac

tion

plan

s w

ill

be m

onito

red

Mee

t on

a m

onth

ly b

asis

as

requ

ired

Mee

t virt

ually

on

a m

onth

ly b

asis

an

d ev

alua

te if

act

ion

plan

has

be

en m

et a

nd d

eter

min

e ne

w

activ

ities

for

FY

13.

Initi

ativ

e 5.

4: In

stitu

tiona

lize

publ

ic-p

rivat

e co

llabo

ratio

ns.

Mee

t on

a m

onth

ly b

asis

and

ev

alua

te th

e V

A O

RH

OR

H p

lan

of

actio

n fo

r th

e W

H R

ural

Cou

ncil

activ

ities

. Rem

ain

activ

e on

this

co

unci

l.

Eva

luat

e if

actio

n pl

an h

as b

een

met

and

det

erm

ine

new

act

iviti

es

for

FY

13.

Mee

t on

quar

terly

bas

is if

req

uire

d.

Mon

itor

cont

ract

ing

proc

esse

s in

id

entif

ied

site

s an

d re

port

less

ons

lear

ned

Impl

emen

t pla

nnin

g ag

enda

Mee

t on

a m

onth

ly b

asis

as

requ

ired

Mon

itor

cont

ract

ing

proc

esse

s in

id

entif

ied

site

s an

d re

port

less

ons

lear

ned

Iden

tify

6 ne

w s

ites

for

test

ing

of

rura

l col

labo

ratio

n to

ol k

it

Off

ice

of R

ural

Hea

lth

– F

Y 2

010-

2014

Str

ateg

ic P

lan

Ref

resh

21

App

endi

x A

Tab

le o

f Act

ion

Item

s, Pe

rson

(s) R

espo

nsib

le, Q

uart

erly

Mile

ston

es

Init

iati

ves

Act

ion

Item

sP

erso

n o

r O

rgan

izat

ion

R

esp

on

sib

le

Act

ion

Item

PO

C

FY

201

2 M

ilest

on

es1s

t Q

uar

ter

(Oct

-Dec

)F

Y 2

012

Mile

sto

nes

3rd

Qu

arte

r (A

pr-

Jun

)F

Y 2

012

Mile

sto

nes

2nd

Qu

arte

r (J

an-M

ar)

FY

201

2 M

ilest

on

es4t

h Q

uar

ter

(Ju

l-S

ep)

Act

ion

6.1.

1: I

ncre

ase

use

of th

e S

tude

nt E

duca

tion

al

Enr

ollm

ent P

lan

(SE

EP

) an

d V

A L

earn

ing

Opp

ortu

niti

es

Res

iden

cy (

VA

LO

R)

prog

ram

s in

are

as d

esig

nate

d ru

ral

and

high

ly r

ural

. VH

A H

ealt

hcar

e R

ecru

itm

ent a

nd

Ret

enti

on O

ffic

e (H

RR

O),

who

is r

espo

nsib

le f

or

adm

inis

teri

ng th

ese

prog

ram

s, w

ill e

arm

ark

fund

ing

spec

ific

ally

for

use

in f

acil

itie

s de

sign

ated

rur

al a

nd h

ighl

y-ru

ral.

VH

A P

lace

men

t Ser

vice

s w

ill a

lso

deve

lop

an a

war

d to

be

pres

ente

d to

VA

LO

R s

tude

nts

upon

gra

duat

ion.

HR

RO

Ant

hony

Ach

ampo

ng

Act

ion

6.1.

2: I

ncre

ase

pres

ence

at c

olle

ges

and

univ

ersi

ties

w

ith

clos

e pr

oxim

ity

to r

ural

VA

hea

lth

care

fac

ilit

ies.

H

RR

O w

ill d

evel

op a

war

ds/r

ecog

niti

on p

rogr

ams

for

pres

enta

tion

to s

tude

nts

com

mit

ted

to r

ural

pra

ctic

e at

co

mm

ence

men

t cer

emon

ies;

iden

tify

and

att

end

even

ts in

ru

ral c

omm

unit

ies

and

upco

min

g ru

ral h

ealt

h co

nfer

ence

s,

incl

udin

g th

e N

atio

nal R

ural

Hea

lth

Con

fere

nce

in M

ay

2012

.

HR

RO

Ant

hony

Ach

ampo

ng

Act

ion

6.1.

3: H

RR

O M

arke

ting

and

Pla

cem

ent S

ervi

ces

wil

l dev

elop

rur

al c

omm

unit

y aw

aren

ess

cam

paig

n to

be

roll

ed o

ut r

ural

loca

tion

s id

enti

fied

by

HR

RO

to h

elp

deve

lop

rura

l pro

vide

r w

orkf

orce

. HR

RO

wil

l ext

end

mar

keti

ng s

cope

to in

clud

e ad

diti

onal

dem

ogra

phic

s gr

oups

(hig

h sc

hool

stu

dent

s, f

amil

ies)

wit

h a

vest

ed in

tere

st in

ru

ral p

ract

ice.

HR

RO

A

ntho

ny A

cham

pong

Act

ion

6.2.

1: O

RH

will

fos

ter

ongo

ing

dial

ogue

bet

wee

n V

HA

Pla

cem

ent R

ecru

itmen

t Con

sulta

nts

in H

RR

O a

nd

VIS

N R

ural

Con

sulta

nts

(VR

Cs)

and

HR

and

form

a

wor

kgro

up to

iden

tify

top

occu

patio

nal p

riorit

ies,

cha

lleng

es

and

oppo

rtun

ities

for

recr

uitm

ent a

nd r

eten

tion

at r

ural

and

hi

ghly

rur

al V

A h

ealth

car

e fa

cilit

ies

in o

rder

to d

evel

op a

ru

ral h

ealth

wor

kfor

ce s

trat

egy.

HR

RO

, VR

Cs

Ant

hony

A

cham

pong

Ant

hony

Ach

ampo

ng

Act

ion

6.2.

2: C

ondu

ct a

join

t nat

iona

l rur

al h

ealt

h w

orkf

orce

stu

dy w

ith

Hea

lth

Res

ourc

es S

ervi

ce

Adm

inis

trat

ion

–Off

ice

of R

ural

Hea

lth

Pol

icy

(HR

SA

-O

RH

P )

to e

xam

ine

shar

ed w

orkf

orce

str

ateg

ies

and

spec

ific

nee

ds in

ord

er to

gai

n ev

iden

ce o

f ex

isti

ng a

d ho

c m

odel

s an

d su

ppor

t nee

ded

for

join

t con

trac

ting

of

prov

ider

s.

Mar

y B

eth

Sku

pien

Mar

y B

eth

Sku

pien

Act

ion

6.2.

3: E

valu

ate

regi

onal

and

sta

te m

odel

s of

rur

al

rete

ntio

n st

rate

gies

.C

entr

al R

egio

n -

VR

HR

CM

ary

Cha

rlton

Wor

k w

ith lo

cal a

nd n

atio

nal

expe

rts

to d

evel

op a

n in

vent

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Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 24

Appendix B

FY 12 Veterans Rural Health Resource Center (VRHRC) Projects

Western Region (WR)

1. Does co-management of veterans’ health through VA and non-VA care improve outcomes? This study will be the first to document the extent to which Veterans use VA care in combination with Medicare and VA contract care, for both rural and urban Veterans. It will also be the first study to compare VAMC and CBOC utilization between rural and urban patients. Finally, this study will evaluate the effect of dual use (VA and non VA care) on patient health outcomes.

2. Model Development, Population Comparison and Programmatic Information for Native Veterans. Year two of a 2 year study that will: 1) Model factors affecting service utilization and healthcare trends among Native populations including, but not limited to, the impact of traumatic brain injury, age/period of service, and gender; 2) Document methodological issues in procedures and definitions for utilizing the VA Medical SAS Datasets for Native-focused analyses; 3) Create GIS maps of the Native veteran population characteristics, service options and co-morbidities; 4) Collect, systematize, and disseminate Native-specific VA programmatic information provided by each VISN.

3. ORH Collaborative Training Model for Community Agencies – This is an initiative to provide training to community agencies operating in rural areas with the aim of helping them to understand the services and benefits available to Veterans.

4. Rural Native Veteran Telehealth Collaborative Education and Consultation Services – This is year two of a 3 year project to establish a collaborative National Native Telehealth Training and Consultative Service to aid in the dissemination and replication tele-mental health clinics targeted at rural Native veterans.

5. Rural Native Veterans Promising Programs Initiative - This project will develop and evaluate a process for implementing promising programs that are responsive to specific cultural and health challenges of rural Native Veterans.

6. Rural Veteran Outreach Program – This training program involves multiple community leaders in a rural community and facilitating the initiation and solidification of collaborative relationships between the community at large and the local VAs in supporting their Veterans. The goal is to VA's presence in rural communities by enlisting existing community agencies and leaders, as well as informal leaders, to outreach to Veterans.

7. Rural Women Veterans Demographic and Service Needs -This project is dedicated to understanding population demographics, healthcare utilization, and perceived service gaps from the perspective of the rural female Veteran. This study will be focused on the use of outpatient care by women Veterans.

8. Strengthening Existing VA Community Partnerships in Rural Areas - This project aims to systematically build community partnerships that form through natural operational processes into formal VA/rural community partnerships and to help VA staff engaged in these natural partnerships to reframe their role to include the concept of being a champion in forming these partnerships. 

9. Using Community Hotlines for Rural Needs Assessment - This project will be conducted in collaboration with staff from the National Caregiver Hotline, located at the Canandaigua VA Medical Center in Canandaigua, NY. The project has the several objectives: 1). Estimate the frequency that rural caregivers utilize the caregiver hotline and identify their reasons for calling; 2). Compare urban and rural

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 25

caregivers in terms of caregiving needs as recorded by the caregiver hotline, 3). Examine local follow-up to caregiver queries to determine outcomes and identify barriers to addressing rural caregivers' needs.

10. Using Rural Veterans’ Perspectives on Access Issues and Satisfaction with VA Healthcare to Improve VA Patient Care ‐ The objective of this project is to summarize Veteran input on their healthcare

access issues and healthcare experiences and to distribute that information to: 1). Appropriate VA staff in VISNs and patient services, 2). Rural community healthcare specialists, and 3). Professionals interested in rural health.

11. Collaboration between the National State Office of Veterans Affairs and ORH for outreach to non enrolled Veterans – The purpose of this project is to facilitate development of a relational data base that can be used to help rural veterans obtain VA benefits within the state where they live.

 

Central Region (CR)

12. Tele-mental Health Care of OEF/OIF /OND Veterans at Western Illinois University- Macomb Campus – Year two of a 2 year project to assess and address the mental health needs of OEF/OIF student veterans attending a rural University.

13. Virtual Team Based Care for Rural Veterans with HIV: A Model for the Generalist-Specialist Interface in the Rural Patient-Centered Medical Home – Year two of a 2 year project to pilot the development and evaluation of “virtual HIV care teams” capable of providing accessible, high quality, comprehensive care for rural veterans with HIV.

14. The Implementation and Process Evaluation of a Home-Based Stroke Tele-Rehabilitation (SteleR) Program – This project will systematically evaluate the implementation fidelity and other factors of a home-based stroke tele-rehabilitation program (SteleR) into clinical care at the Roudebush and Iowa City VAMCs.

15. Mobile Teleretinal Imaging for Rural Veterans Served by Community Based Outpatient Clinics – The ORH funded Mobile Teleretinal Imaging Project (MTRIP) at the Iowa City VAMC is up and running, and in the course of 6 weeks has screened 119 patients (a rate of nearly 1000 Veterans per year) at CBOCs serving rural veterans. In year two of a 2 year project, the program will be evaluated in terms of patient satisfaction, cost savings and cost avoidance as well as a return on investment analysis.

16. Pilot Intervention to Improve Annual Colorectal Cancer Screening Rates Among Average Risk Veterans and in Veterans with Diabetes – This project will determine the feasibility and effectiveness of incorporating a colorectal cancer education and screening intervention into a diabetes case management program in order to significantly increase the rate of screening in this at-risk population.

17. Tailored Tobacco Quitline for Rural Veterans - The project is designed to help increase access to tobacco cessation services among rural veterans and to develop more effective treatment services that better address comorbid issues commonly experienced by rural smokers. The objectives are: 1). Study the feasibility of an individually-tailored telephone intervention for rural smokers, 2). Examine the impact of the intervention on tobacco use outcomes, and 3). Evaluate the effect of the intervention on issues commonly experienced by rural smokers including depressive symptoms, alcohol use, and weight gain.

18. Adapting Quality Improvement Tools for Patient Self Management by Rural Veterans- The purpose of this project is to develop and evaluate patient centered tools to facilitate symptom recognition and patient-provider communication among rural veterans to support timely treatment adjustment and avoid unnecessary travel to clinic visits and/or hospitalizations.

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 26

19. Evaluating the Introduction of the First Official VA Blog: VAntage Point and Implications for the Rural Health Community - This project is part of a larger collaborative effort in FY12 to address the issue of access as it relates to rural Veteran outreach and post-deployment transition.

20. Mixed Methods Evaluation of Case Management and Home Telehealth (CM/HT) Programs for Rural Veterans -This project will study the effectiveness of interactive voice response (IVR) technology compared with the older, landline dependent home tele-monitoring equipment. It will also evaluate the content of the communication between case managers and their rural Veterans. Many of those who conducted evaluations of Case Management/Home Telehealth interventions, while finding the interventions effective, call for closer evaluation of the frequency and content of communication between case manager and patient.

21. Targeted Outreach to Rural Veterans: Qualitative Message Testing Using Marketing Techniques -This project will allow for the synthesis of existing data with a specific focus on issues related to rural Veteran access to VA services and care, followed by a collaborative effort to develop VA outreach messages directed at specific populations (e.g., Veteran-students on a rural university campus, rural women Veterans, rural OEF/OIF Reserve and National Guard (R/NG) service members, and rural Veterans who are not students, women, or R/NG). The project will include testing messages through a process of qualitative marketing practices.

22. Primary Investigation of Patterns of Dual Healthcare System Use in Rural Veterans - The objective of this project is to characterize Veterans (both rural and non-rural) who are dual users—i.e., who choose to access both VA and non-VA healthcare services—and their perceptions of dual use in terms of satisfaction, care coordination, and their role in facilitating information exchange.

Eastern Region (ER)

23. Clinical Video Telehealth (CVT)-Neurology for Follow-Up Care of Veterans with Progressive Multiple Sclerosis Living in Rural Areas - VRHRC-ER staff and the Multiple Sclerosis Center of Excellence-East (MSCoE-East) are collaborating on a multi-site demonstration project to exhibit the effectiveness of Clinical Video Telehealth (CVT) for the neurological follow-up of rural Veterans who are disabled by the symptoms of progressive Multiple Sclerosis.

24. CVT- Rehabilitation (PT/RT) for long term stabilization/ improvement in function for Patients with Multiple Sclerosis living in rural areas - This study is being undertaken to determine the benefit of long-term exercise participation with initially begun as a therapeutic rehabilitation program, directed by a licensed physical therapist, and then progressed to a wellness program, directed by a certified / licensed recreational therapist. The uniqueness of this study is that the rehabilitation program and wellness program will be provided through distance technology, i.e., tele-video units, with transmission from clinic to individuals' homes.

25. CVT-Rural Caregiver Assistance Program - A rehabilitation clinical professional (nurse or physical therapist) will provide caregiver assistance including: (1) problem-solving skills development; (2) resource education; and (3) supportive problem solving via videophone technology to a caregiver of a rural Veteran in a demonstration project designed to improve caregiver self –efficacy and reduce strain and burden.

26. Delivery of Primary Care to Veterans with Spinal Cord Injury (SCI/D) by CVT to home or Community-based outpatient clinic (CBOC): Expanding Telehealth Services to SCI Rural Veterans –This one year demonstration will determine the feasibility of home telehealth and CVT- primary care delivered to the closest CBOC for the treatment of intercurrent acute illness and other urgent situations that occur in a disabled SCI/D population. This aspect of the study will be primarily descriptive (qualitative)

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 27

and will allow us to focus on the effectiveness of the delivery system for particular illnesses and situations in subsequent studies. We have specifically selected patients suffering from ALS, progressive MS and SCI who are at high risk for having these events.

27. Rural Telehealth Veteran Independence Initiative – This program will provide distance assessment and management for highly rural Veterans at risk for reduction in functional independence due to traumatic brain injury (TBI), high frequency/high complexity diagnoses, and home safety/fall risk.

28. Public Psychiatry Fellowship Program – This is a collaborative training program between the Tuscaloosa VAMC (TVAMC) and the University of Alabama School of Medicine (UASOM) Tuscaloosa Campus. The program includes two tracks: (1) Family Medicine and (2) Psychiatry, with clinical rotations and didactics for each located at the TVAMC (25% of time), a state public clinic, and the UASOM. The fellowship is a one year full-time training program for psychiatrists and family physicians who have completed an accredited psychiatric and family medicine residency program, respectively, and who plan to devote their careers to working with high risk populations in the public sector in a rural area. The project aim is to train physicians to be more competent in delivering mental health services in rural areas that rely on public funds. In addition, the project’s objective is to recruit and retain high caliber physicians to serve as leaders in the provision of mental health services in the public sector of Rural Alabama, including the VA setting.

29. Rural Health Training Program for Medical, Nursing and Associated Health Professions Students - The sustainment of the 2010 Rural Health Training Program (RHTP) will be continued at North Florida/South Georgia Veterans Health System (NF/SGVHS) and expand to a National Training Program with collaboration and support from the Office of Academic Affiliations (OAA).

30. Telepharmacy – Brown Bag Clinics for Rural Maine CBOCs -The purpose of this project is to provide access for patients to pharmacy Brown Bag Medication Clinics via Clinical Video Telehealth (CVT) at the rural CBOCs in Rumford, Calais, Caribou and Lincoln.

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 28

Appendix C

FY2012 ORH-Sponsored VISN Projects

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

1 Tele & Models of Care ACT Chronic Pain Treatment/Bangor CBOC2 Geriatrics HBPC Western New York2 Geriatrics HBPC - Indian Health Service Collaboration -Mohawk2 Geriatrics HBPC at Rome, NY2 Mental Health Behavioral Health Care Line - Watertown2 Mental Health E-Range2 Geriatrics HBPC Pennsylvania Connection2 Mental Health Behavioral Health Care Line - Rome2 Mental Health Behavioral Health Care Line - Tompkins/Cortland2 Specialty Care Space and Staff for Physical Therapy at Ft. Drum3 Tele & Models of Care Riverhead CBOC - Expansion of 5 integrated programs3 Geriatrics HBPC/Harris/Monticello CBOC and Community Collaboration4 Tele & Models of Care Expansion of Home Telehealth 4 Access & Quality Rural Mobile Clinic 4 Mental Health E Range 4 Access & Quality OEF/OIF Outreach Clinic4 Training & Education Virtual Collaboration5 Tele & Models of Care Rural Health Initiative - PT/OT to selected CBOCs5 Women Veterans Women's Health, Education and Training in Rural Areas, Mental Behavioral Health5 Tele & Models of Care Lifestyle Intervention for Veterans (LIVe)5 Homelessness Rural Homeless and Homeless Prevention Services Extension5 Mental Health MHICHM Range for Eastern Shore5 Tele & Models of Care Community Coaching6 Collaboration & Outreach Effective Rural Health Communications and Low Health Literacy Program6 CBOC Staunton, Wytheville and Lynchburg CBOC6 CBOC Rutherfordton CBOC6 CBOC Emporia CBOC6 CBOC Edenton/Elizabeth City CBOC (Albermarle CBOC)6 CBOC Greenbrier County CBOC6 CBOC Robeson County CBOC6 Geriatrics HBPC Expansion to Greenbriar6 Geriatrics HBPC Expansion to Robeson CBOC6 Geriatrics HBPC Franklin CBOC6 Women Veterans Women's Health Training: Providers and Nursing Staff Mini Residencies6 Tele & Models of Care Telemental Health to Rural Areas7 Tele & Models of Care New Project-Access & Quality (Statesboro)-VISN 7 5097 CBOC Blairsville CBOC7 Mental Health Rural Telemental Health Initiative

7 Collaboration & Outreach Alabama Veterans Rural Health Initiative and Long Term Evaluation Assessing Rural Need7 Access & Quality Community Outreach Clinic Milledgeville, GA7 Geriatrics Jasper HBPC7 Geriatrics HBPC Selma Outreach Clinic and Athens CBOC

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 29

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

7 Tele & Models of Care Enhancing Services for Rural Veterans- A novel approach using VA-PACE Partnership7 Geriatrics HBPC Conway SC7 Geriatrics Selma HBPC and Podiatry Clinic7 Geriatrics HBPC Milledgeville7 Geriatrics Oakwood HBPC Rural Health Team7 Mental Health Imp MH/BH - 508 SUD and PTSD7 Geriatrics Health Watch for Heroes7 Tele & Models of Care Tuscaloosa Rural Mobile Clinic7 Tele & Models of Care Telehealth Expansion7 Mental Health MICHM E-Range7 Geriatrics Orangeburg HBPC7 Tele & Models of Care Rural HT8 Access & Quality Waycross Outreach Clinic8 CBOC Palatka Rural CBOC8 CBOC Marianna CBOC8 CBOC St. Mary's CBOC8 Tele & Models of Care Rural Veterans Tele=Rehabilitation Initiative Phase III8 Access & Quality Taylor County Outreach Clinic8 Geriatrics HBPC CBOC and Community Collaboration8 Access & Quality Comerio Rural Clinic8 Access & Quality Utuado Rural Clinic8 Access & Quality Vieques Rural Clinic8 Access & Quality St. John Outreach Clinic9 Training & Education Rural Health Professions Institute9 Geriatrics HBPC Community Collaboration - Norton CBOC9 Specialty Care Rural CBOC Physical Therapy Clinics9 Access & Quality Gallipolis Rural Outreach Clinic9 Mental Health Community Based Mental Health Services for Veterans living in Rural Areas9 Access & Quality Rural Outreach Clinics9 Specialty Care Clarksville Teleretinal Screening and Image Reading9 Specialty Care Rural CBOC Radiology Services9 Access & Quality Rural Transportation Coordinator9 Specialty Care Rural CBOC Occupational Therapy Clinics

10 Geriatrics VISN 10 HBPC and CCHT Expansion 10 Mental Health CBOC Mental Health Service Expansion10 Tele & Models of Care Care Coordination Store and Forward Telehealth10 Tele & Models of Care Clinical Pharmacists Expansion10 Specialty Care Optometry and Podiatry in CBOCs10 Tele & Models of Care Video Consultation Services10 Access & Quality Wilmington Outreach Clinic10 Access & Quality Georgetown Outreach Clinic10 Access & Quality Cincinnati Mobile Unit Outreach10 Women Veterans Women Diagnostic Coordinator

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 30

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

11 CBOC Peru, Indiana CBOC

11 Collaboration & Outreach Farm Initiative for Illinois11 CBOC Cadillac CBOC (Saginaw VAMC)11 CBOC Badaxe CBOC (Saginaw VAMC)11 Access & Quality RH Transportation Program

11 Tele & Models of Care Improving Chronic Disease Management in Rural CBOC Clinics: The Care Partner Program11 Access & Quality Transportation11 Tele & Models of Care Telehealth12 Tele & Models of Care Telemedicine in the Northern and Central Markets12 Geriatrics HBPC 12 Geriatrics HBPC -LaSalle CBOC12 Specialty Care Providing opthalmological and ENT Services Locally at Oscar Johnson VAMC12 Access & Quality Outreach Clinic Manistique, Michigan12 Mental Health Improve Mental Health - Establish E-Range at Hancock CBOC12 Mental Health MICHM E- RANGE Manistique12 CBOC Expand Manteno CBOC12 Specialty Care Expand LaSalle CBOC12 Access & Quality Transportation12 Specialty Care Implementation of Audiology Services at Wisconsin Rapids Outpatient Clinic12 CBOC Sault Saint Marie CBOC Lease 12 CBOC Hancock CBOC15 Geriatrics Marion VAMC HBPC Expansion15 CBOC Carbondale CBOC15 CBOC Harrisburg CBOC15 Geriatrics Wichita HBPC15 CBOC Washington/Sullivan CBOC15 CBOC Sedalia CBOC15 Tele & Models of Care Expansion of CCHT for patient centered alternatives to Institutional Care15 Mental Health MICHM Range15 CBOC Sikeston CBOC15 Tele & Models of Care Care Coordination Home Telehealth sustainment15 Tele & Models of Care CCHT Expansion Eastern Kansas15 Access & Quality John J. Pershing Sleep Study Lab15 Tele & Models of Care Marion VAMC Tele-Pharmacy15 Mental Health Collaborative Discharge Planning for Veterans Returning to Rural Areas16 CBOC VISN 16 Rural CBOC sustainment - Fort Polk16 CBOC VISN 16 Rural CBOC sustainment - Vinita16 CBOC VISN 16 Rural CBOC sustainment - Natchitoches16 CBOC VISN 16 Rural CBOC sustainment - Bogalusa16 CBOC VISN 16 Rural CBOC sustainment - Jay16 CBOC VISN 16 Rural CBOC sustainment - Franklin16 CBOC VISN 16 Rural CBOC sustainment - Russellville

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 31

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

16 CBOC VISN 16 Rural CBOC sustainment - Conway16 CBOC VISN 16 Rural CBOC sustainment - Ozark16 Geriatrics HBPC Expansion for Vinita and Hartshorne CBOC16 Geriatrics Rural Native American Veteran Outreach HBPC16 Tele & Models of Care Improving Cancer Care for Rural patients with Malignancy16 Mental Health MIRECC Clergy-Mental Health Partnership to Improve Care for Rural Veterans 16 Mental Health MHICM E-RANGE Muskogee16 Tele & Models of Care Biloxi Rural Access and Home tele-health Expansion16 Specialty Care Improving Access to Sleep Medicine Care Using Telehealth

17 CBOC Expansion and Enhancement of Medical Care provided in rural CBOCs - South New Braunfels

17 Mental Health Tele-Psychiatry within Central Texas Veterans Health Care System Project Expansion17 Specialty Care Tele-Rehabilitation Clinic - Amputee and TBI Polytrauma17 Specialty Care VISN 17 Teleretinal Imaging Program Improvement Project17 Mental Health MHICM E-range

17 CBOC Expansion and Enhancement of Medical Care provided in rural CBOCs - South Del Rio

17 CBOC Expansion and Enhancement of Medical Care provided in rural CBOCs - South Beeville

17 CBOC Expansion and Enhancement of Medical Care provided in rural CBOCs - South Uvalde

17 CBOC Expansion and Enhancement of Medical Care provided in rural CBOCs - South Seguin17 Specialty Care North Texas Teleretinal Program 17 Specialty Care Texas Valley Coastal Bend Teleretinal Imaging Program 17 Women Veterans South Texas Mobile Mammography Unit17 Tele & Models of Care Rural Telehealth Support and Expansion17 Mental Health Central TX Telemental Health Expansion17 Specialty Care South Texas Teleretinal Program Expansion at Victoria and Kerrville18 Homelessness Homeless Grant and per diem Program for rural Veterans18 Tele & Models of Care Telehealth Expansion18 Tele & Models of Care Telemedicine Expansion18 Geriatrics Albuquerque VA HBPC/IHS Rural Health Sustainment18 Tele & Models of Care Telemedicine Expansion18 Tele & Models of Care Compensation and Pension18 CBOC Payson/Buckeye CBOC18 CBOC Show Low & Globe CBOC18 Tele & Models of Care Pharmacy Disease Management Services in CBOC18 Mental Health Enhance Mental health Services for Rural Veterans at the NAVAHCS CBOCs

18 Mental HealthEnhance Mental health services and PTSD outreach for rural Veterans on the Navajo/Hopi Nation

18 Access & Quality Mobile Health Clinic18 Mental Health Mental Health Services at Hobbes, CBOC18 CBOC Hobbs CBOC lease18 CBOC Fort Stockton CBOC lease

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 32

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

19 Access & Quality Primary Care for Rural Vets (PCTOC)19 Access & Quality Primary Care for Rural Veterans: Telehealth Outreach Clinic Expansion Initiatives19 Access & Quality Mobile Telehealth Clinic 19 Tele & Models of Care Primary Care Telehealth For Rural Veterans19 Collaboration & Outreach Cheyenne CCHT (Patient Education)19 Access & Quality Rawlins PCTOC 19 Access & Quality Burlington Telehealth Outreach clinic19 Specialty Care General Telehealth Specialty Services19 Mental Health MHICM E-RANGE Cheyenne19 Access & Quality AMB: Salida Primary Care Telephone Outreach Clinic19 Specialty Care Prosthetic Treatment Center Mobile Lab 19 Access & Quality Primary Care for Rural Vets (PCTOC)19 Access & Quality Primary Care Telehealth Outreach Clinics19 Specialty Care Tele-Pain Management19 Specialty Care Tele-Specialty – Sheridan VAMC

19 Specialty Care Extended Education and Wellness Strategies for Veterans in Rural Communities (Tele-Move)19 Specialty Care Cheyenne Specialty (Telehealth)

19 Specialty CareEnhancement of PTSD treatment in the transition from residential care to rural outpatient settings

19 Specialty Care Tele-Endocrine19 Collaboration & Outreach Partnership and Enhancement of the Casper Based Mobile Veterans Center19 Specialty Care Cardiology outreach clinics in Cheyenne and Grand Jct VAMCs19 Specialty Care Tele-Dementia 19 Collaboration & Outreach Mild Traumatic Brain Injury / Posttraumatic Stress Disorder Psychoeducation 19 Specialty Care Tele-Dermatology20 Tele & Models of Care VISN 20 Rural Teledermatology Project

20 Geriatrics Sustainment of Portland VAMC HBPC rural Health Grand Ronde, Newport, North Coast20 CBOC South Sound CBOC20 Access & Quality Rural Health Community Partnerships - Spokane20 Access & Quality Newport Outreach Clinic20 CBOC North Coast Community Based Outpatient Clinic20 Access & Quality Dalles Outreach Clinic20 Geriatrics HBPC Caldwell ID CBOC20 Geriatrics HBPC : Indian Health Service Collaboration Warm Springs Tribe

20 Collaboration & OutreachBuilding Collaboration in Rural Alaska with Tribal Organizations for Increased access to care and services utilizing the VA Tribal Consultative Process

20 Geriatrics Sustainment Grants Pass Satellite HBPC team 20 Tele & Models of Care Rural Sleep program20 Access & Quality Primary Care Telehealth Outreach Clinics20 Tele & Models of Care Remote Telemedicine Amputee Clinic20 Geriatrics HBPC - Mtn Home Outreach Clinic20 Geriatrics HBPC - Boise20 Mental Health MHICM E-RANGE White City

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 33

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

20 Access & Quality Partnering with Primary Care Providers

20 Tele & Models of CareSouthern Oregon Rehabilitation Center & Clinic Telehealth Patient Consultants/Telehealth Subspecialty Clinic

20 Specialty Care Contract Speech and Language Pathology Services

20 Tele & Models of Care VA Southern Oregon Rehabilitation Center & Clinics Home Telehealth Care Manager20 Specialty Care Horses to Heroes21 CBOC Eureka CBOC transition to VA staffed model21 Access & Quality Pacific Western Insular Area Veteran Travel21 CBOC Lake County CBOC21 CBOC Expansion of Yuba City Outpatient Clinic21 Geriatrics HBPC Indian Health Service Collaboration21 CBOC Diamond View CBOC21 Collaboration & Outreach Thrive Expansion: THRIVE Everywhere/THRIVE OEF/OIF21 Tele & Models of Care NCHCS CCHT Expansion21 Geriatrics HBPC Eureka21 Tele & Models of Care Primary Care Telemedicine Outreach21 Geriatrics HBPC Expansion: CBOC and Community Collaboration21 Access & Quality Saipan Outreach Clinic/Rural Health Coordinator PIHSC21 Geriatrics HBPC to Guam21 Access & Quality Yreka Outreach Clinic21 Access & Quality Winnemucca Outreach Clinic

21 Mental Health Community Based Mental Health Services for Veterans living in Rural Areas: Honolulu, HI21 Collaboration & Outreach The Health Resource Initiative for Veterans Everywhere -Online21 Access & Quality Central California Transportation Program 21 Collaboration & Outreach Rural Health Initiatives Project Coordinator21 Tele & Models of Care San Francisco Telepharmacy Pathway21 Tele & Models of Care RN Care Coordination at Ukiah CBOC21 Tele & Models of Care Telehealth Care Coordination at Clearlake CBOC21 Tele & Models of Care PACT Clinical Pharmacist at Clearlake CBOC21 Collaboration & Outreach Identifying and Overcoming Barriers to Care for Rural Veterans21 Collaboration & Outreach Rural Health Initiative Project Coordinator21 Access & Quality Transportation to Yreka Outreach Clinic21 Tele & Models of Care Anticoagulation Pharmacist to Monitor Patients on Warfarin at the Ukiah CBOC21 Specialty Care Telehealth closing the Teledermatology loop at Clearlake CBOC21 Specialty Care Telehealth Closing the Teledermatology loop at Ukiah CBOC21 Collaboration & Outreach Enhancing Patient Health Education at Rural Sites21 Specialty Care Management of Nail Care in High and Moderate Risk Veterans at Clearlake CBOC21 Specialty Care Management of Nail Care in High and Moderate Risk Veterans at Ukiah CBOC21 Specialty Care Horses to Heroes22 Access & Quality Expansion ORH Strategic Plan22 Access & Quality Sustainment-ORH Strategic Plan22 Tele & Models of Care Designing Veteran Centric Care

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 34

Appendix BFY2012 ORH-Sponsored VISN Projects

VISN/ PO Category Proposal name

23 CBOC Decorah, IA CBOC23 CBOC Sterling, IL CBOC 23 CBOC Ottumwa, IA23 Geriatrics Rural Expansion of HBPC23 Geriatrics HBPC Expansion at Alexandria CBOC23 Tele & Models of Care Minneapolis Office of Rural Co management23 Geriatrics Wagner Streamlined Model HBPC23 Geriatrics HBPC Mille Lacs Band of Ojibwe23 Tele & Models of Care CCHT-SCI, TBI and Wound

1, 19, 20 Mental Health Mental Health Rural Pilots20/OHMS Mental Health Oregon Rural Mental Health Implementation

7 & 8 Training & Education Rural Health Training InitiativeChaplain Service Collaboration & Outreach Educating Rural Clergy to Recognize & Respond to Veterans Health Care NeedsGEC/19 Geriatrics Providing Rural Veterans Access to Proactive Dementia Care GEC/19 Tele & Models of Care Veteran Centric Healthcare Model-Geriatrics and Extended CareGEC/19 Geriatrics Fighting immobility in rural Veterans with Exercise and TechnologyGEC/22 Training & Education Geriatric Scholars ProgramGEC/8 Geriatrics A Lifeline for Stroke Caregivers: Addressing Rural Health DisparitiesOAA Training & Education Rural Health Training

Tele & Models of Care VHA National Teleradiology Program Rural Support and Expansion Proposal

1,6,15,18, 19 Access & Quality Project ARCH

Office of Rural Health – FY 2010-2014 Strategic Plan Refresh 35