Each state was asked to respond to the following question:
Please provide information about cross-state collaborations you may be working on related to the Flex Program.
The Alabama Flex Program is administered through the State Office of Rural Health (SORH) in collaboration with the Alabama Hospital Association (AlaHA). Co-directors in both agencies work together to provide leadership, management and guidance to the program, which serves the four CAHs and 27 other rural providers across the state. The Flex Program recognizes all SHIP-eligible hospitals as participants and invites all hospitals to all activities, provided the hospitals are willing to share requisite data. Both co-directors collaborate with the Alabama Quality Assurance Foundation, the quality improvement organization (QIO) for Alabama, to promote the objectives of all programs and to ensure duplication of effort is avoided. Collaboration also exists within Region B with other state Flex Programs, as well as with the Flex Monitoring Team (FMT). Areas of mutual interest and concern are shared, multiplying the effect of positive activities and reducing the damage of negative events.View Alabama's State Flex Profile >
Since 2013, AzFlex has worked with the Bureau of EMS and Trauma System on implementing a state-wide trauma performance improvement initiative focused on:
- Reducing Level III/IV Emergency Department dwell times to Level I Trauma Centers
- Reducing transfers after admissions
- Reducing deaths outside of trauma centers
- Increasing trauma billing efficiency
IArizona’s Trauma Level I Centers have taken turns to host in-person meetings for trauma program managers around the state. These meetings address the Arizona trauma plan priorities of continuing the performance improvement efforts, strengthening injury prevention, supporting utilization of the trauma registry and providing necessary resources on trauma billing.View Arizona's State Flex Profile >
Telligen is the quality improvement organization (QIO) for Colorado, Illinois and Iowa for quality improvement, value-based purchasing program support and technical assistance. Telligen has been a supporter of the CAH program and has invited CRHC and CAHs to participate on their cross-state hospital quality reporting/improvement update webinars. These webinars allow participants to share best practices and discuss barriers from providers.
CRHC is continuing as an operating partner with Healthy Transitions Colorado, a statewide initiative which is working to link best practices and resources about care transitions and readmissions efforts across the state.View Colorado's State Flex Profile >
The Flex Program Coordinator is participating in the planning committees for the Northwest Rural Health Conference in Seattle, Washington as well as the Western Region Flex Conference in Hawaii.View Idaho's State Flex Profile >
Through the Illinois Flex Program, ICAHN is working with Wyoming, Nebraska, North Dakota and California to collaborate on best practices for emergency department transfer communications (EDTC), as well as working on an Emergency Department Consumer Assessment of Healthcare Providers and Services (ED CAHPS) project with North Dakota.View Illinois's State Flex Profile >
With help from Stratis Health, a monthly emergency department transfer communication (EDTC) data collection tool has been created. With the creation of this tool, a newly developed import function allows the data collected in the tool to be transferred into a multi-state benchmarking system designed for small rural hospitals to compare selected measures with other similar hospitals. Kansas CAHs can compare data and share best practices not only among themselves but with CAHs in all participating states. Additionally, the Kansas Flex Program is able to gather the aggregated EDTC data using the benchmarking system report function to compile and complete the required quarterly reports to the Federal Office of Rural Health Policy. Both the tool and the import function support reporting of EDTC data on a monthly basis. A series of workshops is underway to train CAHs on EDTC data measures and reporting with the monthly data collection tool and benchmarking system.View Kansas's State Flex Profile >
Collaboration occurs within the region of New England through the NEPI Network. This ongoing collaboration has allowed Maine CAHs to benefit from regional offerings, such as IHI programming, while simultaneously providing the Flex Programs with shared learning opportunities. NEPI activities are measured through process measures primarily with anticipated outcomes to include a greater number of professionally certified staff at Maine CAHs as well as increased quality scores for CAHs. The Quality Improvement Organization (QIO) and Rural Veterans Health Access Program (RVHAP) grants will measure activity per those particular grant requirements. Anticipated outcomes for the QIO project include improvement in emergency department transfer communication (EDTC) at participating hospitals. Anticipated outcomes for RVHAP include improved care coordination for rural Veterans regardless of where they receive their care.View Maine's State Flex Profile >
Massachusetts has a long-standing New England Rural Hospital Performance Improvement Network which is a collaboration between the New England Rural Health RoundTable and the Flex Programs in Maine, Massachusetts, New Hampshire and Vermont. Through this network, Massachusetts contracts with the Institute for Healthcare Improvement (IHI) and offer an array of quality improvement certifications in order to help build QI capacity at small and rural hospitals.
QI certification offerings include Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Health Risk Management (CPHRM), Certified Professional in Patient Safety (CPPS), Certification in Infection Control (CIC) with the addition this year of Trauma Nurse Core Course (TNCC) and Pharmacy Antibiotic Stewardship certification. Massachusetts is also exploring adding Emergency Nursing Pediatric Course (ENPC) certification training and Healthstream programming focused on developing and retaining first year nurses. Massachusetts has also supported the offering of the Rural Trauma Team Development Course (RTTDC) designed by the Rural Trauma Committee of the American College of Surgeons Committee on Trauma via NEPI and otherwise.View Massachusetts's State Flex Profile >
Minnesota has begun meeting in person or by phone from time to time with other Flex Programs in the upper Midwest, crossing borders of National Organization of State Offices of Rural Health (NOSORH) regions. The Flex Coordinators from Minnesota, Wisconsin, North Dakota, South Dakota, Iowa, Nebraska and Kansas have agreed to meet from time to time to share challenges and success stories. All are Midwest states with a high number of CAHs.View Minnesota's State Flex Profile >
Several of the CAH networks include member hospitals from bordering states. These CAHs participate in all network activities.View Nebraska's State Flex Profile >
For the past 15 years, the Nevada Flex Program has collaborated with our colleagues in Arizona, California, Hawaii, New Mexico, Utah and other western states to support CEO and CFO participation in the Western Region Flex Conference.View Nevada's State Flex Profile >
The New Hampshire Flex Program is a member of the New England Performance Improvement Network (NEPI). NEPI brings together the Flex Programs in New Hampshire, Vermont, Maine and Massachusetts to collaborate on shared support of New England CAHls. The support has focused on QI and operational improvements by providing online-based educational opportunities.View New Hampshire's State Flex Profile >
New Mexico and Arizona have had discussions about collaboration, but have not yet developed a project.View New Mexico's State Flex Profile >
The North Dakota CAH Quality Network, in partnership with the Illinois Critical Access Hospital Network (ICAHN) is working to facilitate the development of a cohort of four North Dakota CAHs and seven Illinois CAHs on the Emergency Department Hospital Assessment of Healthcare Providers & Systems (EDCAHPS).View North Dakota's State Flex Profile >
The Pennsylvania Flex Program has most recently had cross-state collaboration with HCI, which hosted a meeting of HCI users that included hospitals and organizations from Pennsylvania, New York, Maryland and the District of Columbia. The organizations shared their best practices and how the use the population health data and best practices in their communities. In the past, Pennsylvania has collaborated with the New York State Office of Rural Health in holding a joint meeting of CAHs.View Pennsylvania's State Flex Profile >
The South Carolina Flex Program works closely with the South Carolina Hospital Association and Carolinas Center for Medical Excellence on an informal basis. Many quality programs overlap for the hospitals so these entities meet on a semi-regular basis to check-in on hospital and/or project status(es). Network activities are supported by another South Carolina Hospital Association collaboration, AccessHealth South Carolina. EMS activities are made possible by work with the South Carolina Department of Health and Environmental Control's Office of EMS and Trauma, four Regional EMS Offices, South Carolina EMS Association and the Joint Committee on Rural Emergency Care (JCREC). SCORH also actively participates in the South Carolina Heart Care Alliance, bringing together ST-segment elevation myocardial infarction (STEMI), stroke, sudden cardiac arrest and heart failure care under one umbrella group.View South Carolina's State Flex Profile >
As a follow-up activity for the 2015 Flex Reverse Site Visit, the Flex Coordinators from Kansas, Minnesota, North Dakota, South Dakota and Wisconsin developed a collaborative. Since that meeting, this group has met at national meetings and through conference calls to share successes and challenges in implementing work plans.View South Dakota's State Flex Profile >
Vermont continues to work with Flex and State Office of Rural Health (SORH) program staff from neighboring states on the New England Performance Improvement (NEPI) initiative through the New England Rural Health RoundTable. Through NEPI, rural hospital leaders and staff have access to a wide range of discounted or free online courses and webinars through the Institute for Healthcare Improvement (IHI), as well as certifications in Patient Safety, Healthcare Quality, Healthcare Risk Management, Infection and Disease Control and Trauma Nursing.View Vermont's State Flex Profile >
The Flex Program is working with their Quality Innovation Network (QIN), Association for Professionals in Infection Control and Epidemiology (APIC) and the Department of Health Healthcare Acquired Infection Section to develop a new Infection Preventionist (IP) training and professional development program designed specifically for CAHs. Collaborative work with Rural Quality Improvement Technical Assistance (RQITA) provides support for the Medicare Beneficiary Quality Improvement Project (MBQIP) and other QI activities. Washington Flex is currently in an eight-month long, in-depth TA program with RQITA to better serve the state's CAHs.
Within the Washington State Department of Health Office of Rural Health there is collaboration among the federal Small Rural Hospital Improvement Grant Program (SHIP), State Office of Rural Health (SORH), the Stroke Program, Workforce and J1 Visa program, EMS and Trauma services.View Washington's State Flex Profile >
The West Virginia Flex program and the Kentucky Flex Program will be working on a collaborative project with the Appalachian Regional Healthcare hospitals in the two states to improve reporting of the Medicare Beneficiary Quality Improvement Project (MBQIP) and emergency department transfer communication (EDTC) data.View West Virginia's State Flex Profile >
The Wyoming Flex office has worked with Montana, Idaho, Alaska, Hawaii, Arizona, Illinois and California. It is currently working with Arkansas, with plans to continue to work in collaboration with states.View Wyoming's State Flex Profile >