Mary Imogene Bassett Hospital

THE NORTHEAST CENTER FOR AGRICULTURAL HEALTH-RENEWAL

THE NORTHEAST CENTER FOR AGRICULTURAL HEALTH

ADVANCED NURSING EDUCATION- NURSE PRACTITIONER RESIDENCY FELLOWSHIP PROGRAM

SOCIAL MARKETING OF ROLLOVER PROTECTION: A MULTISTATE EXPANSION

NURSE, EDUCATION, PRACTICE, QUALITY AND RETENTION - REGISTERED NURSES IN PRIMARY CARE

IMPLEMENTING ROPS PROGRAMS: KEY FACTORS IN OSH EVIDENCE-BASED PRACTICE ADOPTION

GIVING SAFETY A COMPETITIVE ADVANTAGE: INCREASING PFD USE AMONG LOBSTER FISHERMEN

ANE - NURSE PRACTITIONER RESIDENCY PROGRAM

RURAL INNOVATIVE MULTI-SECTORAL PREVENTIVE APPROACHES COMMUNITY TRIAL FOR POPULATION HEALTH IMPROVEMENT (RURAL IMPACT FOR POPULATION HEALTH IMPROVEMENT) - MEMBERS OF RURAL COMMUNITIES OFTEN FACE DIFFICULTIES IN ACCESSING DIABETES PREVENTION SERVICES, AN OUTCOME OF MULTI-LEVEL SYSTEM PROCESSES THAT PERPETUATE URBAN BIASES IN THE PROVISION, PRODUCTION AND CONSUMPTION OF HEALTH PROMOTION AND DISEASE PREVENTION SERVICES. EFFECTIVE APPROACHES TO IMPROVING ACCESS REMAIN ELUSIVE BECAUSE THERE IS A FUNDAMENTAL MISMATCH BETWEEN CONVENTIONAL POPULATION HEALTH IMPROVEMENT APPROACHES AND THE WAY IN WHICH A COMMUNITY SYSTEM COORDINATES ITSELF TO MAKE DECISIONS. CONVENTIONAL APPROACHES USUALLY INVOLVE A TOP-DOWN STRATEGY THAT STANDARDIZES SOLUTIONS AND COMMANDS ALIGNMENT AMONG ALL AGENTS WITHIN THE POPULATION HEALTH IMPROVEMENT SYSTEMS WITHOUT CONSIDERING THE UNIQUE CONSTRAINTS WITHIN RURAL COMMUNITIES. COMMUNITY SYSTEMS ARE MESSY, DYNAMIC, AND REQUIRE RESILIENCE TO ADDRESS AN ARRAY OF CHALLENGES WITHIN A NESTED HETERARCHICAL LANDSCAPE. REQUIRING ALIGNMENT WITH STATIC STANDARDS DOES NOT ALLOW COMMUNITIES TO COORDINATE THEMSELVES THROUGH SELF-ORGANIZATION AND TRIAL-AND-ERROR LEARNING. THE PURPOSE OF THIS TWO-PHASE PROPOSAL IS TO TEST THE OVERALL HYPOTHESIS THAT HEALTH PROMOTION STRATEGIES NEED TO FIT THE SYSTEM STRUCTURE IN WHICH THEY ARE OPERATING IN ORDER TO IMPROVE POPULATION-LEVEL OUTCOMES. THE FIRST PHASE OF THE PROPOSAL IS AN OBSERVATIONAL STUDY TO UNDERSTAND HOW COMMUNITIES AND CLINICS ARE CURRENTLY COORDINATED TO MAKE DECISIONS ABOUT SERVICE PROVISION AND PRODUCTION. IN THE SECOND PHASE WE WILL IMPLEMENT A 2 BY 2 FACTORIAL CLUSTER RANDOMIZED TRIAL ASSIGNING 10 COMMUNITIES TO COMMUNITY-DRIVEN OR STANDARD PRACTICE AND 18 HEALTH CARE CLINICS TO CLINIC-ENGAGED OR STANDARD PRACTICES TO TEST ALTERNATIVE RULES FOR COMMUNITY- AND CLINIC-LEVEL DECISION-MAKING AND SYSTEM COORDINATION PROCESSES. WE WILL LEVERAGE PARTNERSHIPS WITH OUR RURAL HEALTH NETWORKS-MULTI-SECTOR COUNTY-LEVEL COALITIONS WHOSE MISSION IS TO IMPROVE THE HEALTH OF RURAL POPULATIONS—TO ACCOMPLISH THE FOLLOWING THREE MULTI-LEVEL AIMS: 1) INVESTIGATE THE EXISTING COMMUNITY- AND CLINIC-LEVEL SYSTEM STRUCTURE RULES (POLICIES, PRACTICES, NORMS) THAT LEAD TO THE PROVISION, PRODUCTION AND CONSUMPTION OF DIABETES SCREENING AND PREVENTION SERVICES BOTH WITHIN THE COMMUNITY SYSTEM AND THE CORRESPONDING LOCAL HEALTHCARE SYSTEM; 2) EXAMINE THE CHANGE IN DIABETES PREVENTION SYSTEM STRUCTURE OVER TIME AS A RESULT OF MANIPULATING THE COMMUNITY AND CLINIC COORDINATION SYSTEMS TO ENHANCE SELF-ORGANIZATION AND LEARNING; AND 3) DETERMINE THE RELATIVE IMPACT OF COMMUNITY AND CLINIC COORDINATION PROCESSES ON OPPORTUNITIES TO ACCESS DIABETES SCREENING AND PREVENTION SERVICES AS MEASURED THROUGH SURVEYS, FOCUS GROUPS AND ASSET MAPPING, AND ON THE CHANGE IN SCREENING RATES AS MEASURED BY THE ELECTRONIC HEALTH RECORD (EHR) AND SURVEYS.

PUTTING ROPS RESEARCH INTO PRACTICE: PAVING THE WAY FOR A NATIONAL PROGRAM

TELEHEALTH NETWORK GRANT PROGRAM

IN THE WHEELHOUSE: EMPOWERING FISHERMEN THROUGH COMMUNITY PARTNERSHIPS TO IMPROVE HEALTH AND SAFETY

NURSE EDUCATION PRACTICE, QUALITY AND RETENTION

NURSE, EDUCATION, PRACTICE, QUALITY AND RETENTION - REGISTERED NURSES IN PRIMARY CARE

RURAL HIT NETWORK PROGRAM

CHILDREN'S ORAL HEALTHCARE ACCESS PROGRAM

SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT

RURAL HEALTH NETWORK DEVELOPMENT PROGRAM

TELEMEDICINE GRANT

AGRICULTURE, FORESTRY AND FISHING (AGFF) EMPOWER: ENGAGING MEDICAL STAFF AND PATIENTS IN OCCUPATIONAL HEALTH AND WELLNESS WITH ELECTRONIC RESOURCES - THE OVERARCHING GOAL OF THIS PROPOSAL IS TO IMPROVE HEALTH AMONG AGRICULTURE, FORESTRY AND FISHING (AGFF) WORKERS BY EMPOWERING PATIENTS AND CLINICIANS TO BETTER ADDRESS OCCUPATIONAL HEALTH ISSUES WITH CUSTOMIZED RESOURCES. THIS RESOURCE GRANT WILL BE USED TO UPDATE AND EXPAND THE FARMWORKER CLINICAL CARE RESOURCE FOR OCCUPATIONAL HEALTH, ALSO KNOWN AS THE FARMWORKER CLINICIANS MANUAL WEBSITE, TO THE “AGFF EMPOWER” (ENGAGING MEDICAL STAFF AND PATIENTS IN OCCUPATIONAL HEALTH AND WELLNESS WITH ELECTRONIC RESOURCES) WEB RESOURCE. THIS RESOURCE WILL ENHANCE CLINICIANS’ ABILITIES TO COMMUNICATE, RECOGNIZE OCCUPATIONAL INJURIES AND ILLNESSES, AND TREAT THEIR PATIENTS WHO WORK IN THE AGRICULTURE, FORESTRY, AND FISHING INDUSTRIES AND IMPROVE HEALTH LITERACY AND PERSONAL HEALTH ADVOCACY AMONG AGRICULTURE, FORESTRY, AND FISHING WORKERS. WORKERS IN AGRICULTURE, FORESTRY AND FISHING LARGELY LIVE IN RURAL COMMUNITIES, OFTEN LACK ADEQUATE MEDICAL AND HEALTH RESOURCES AND HAVE LOWER SOCIOECONOMIC STATUS (SES). OVER HALF OF PHYSICIANS WHO WORK IN RURAL SETTINGS ARE EXPECTED TO RETIRE WITHIN THE NEXT TEN YEARS. REGARDLESS OF BEING TRAINED IN THE U.S. OR ABROAD, MEDICAL EDUCATION IS MOSTLY BASED IN METROPOLITAN OR URBAN AREAS, WHICH LESSENS THE EXPERIENCE AND CULTURAL KNOWLEDGE OF RURAL PLACES, INCLUDING THE ROLE OF WORK. OVER THE COURSE OF ALL FOUR YEARS OF MEDICAL SCHOOL, STUDENTS RECEIVE LESS THAN A SINGLE DAY OF INSTRUCTION ON OCCUPATIONAL MEDICINE, WITH ONE THIRD REPORTING HAVING NO CURRICULUM ON OCCUPATIONAL MEDICINE, LET ALONE AGRICULTURAL (WHICH ENCOMPASSES FORESTRY AND FISHING) HEALTH AND SAFETY. THIS REVISED RESOURCE WILL SERVE CLINICIANS AND AGFF WORKERS IN THE NORTHEASTERN UNITED STATES (TWELVE STATE REGION FROM MAINE TO WEST VIRGINIA). EXPANDING THE RESOURCE TO BETTER SERVE WORKERS, INCLUDING THOSE EMPLOYED IN THE FORESTRY AND COMMERCIAL FISHING INDUSTRIES, DIRECTLY RELATES TO THE HEALTHY PEOPLE 2030 OBJECTIVES OF DECREASING THE PROPORTION OF ADULTS WHO REPORT POOR COMMUNICATION WITH THEIR HEALTH CARE PROVIDER (HC/HIT-02) AND INCREASING THE HEALTH LITERACY OF THE POPULATION (HC/HIT-R01). THIS RESOURCE WILL BE DEVELOPED AND DISSEMINATED BY A TEAM WITH EXTENSIVE EXPERTISE IN OCCUPATIONAL MEDICINE AND OCCUPATIONAL HEALTH RESEARCH, WEB DESIGN AND DEVELOPMENT, HEALTH LITERACY, AND INFORMATION SCIENCE. THE RESOURCE DEVELOPMENT STRATEGY WILL HAVE SEVEN PHASES 1) REVIEW OF THE EXISTING FARMWORKER CLINICIANS MANUAL (FCM) WEBSITE, 2) IDENTIFICATION OF UP TO DATE INFORMATION AND RESOURCES, 3) DEVELOPMENT OF ASSETS NOT AVAILABLE ELSEWHERE (VIDEO/PHOTOGRAPHY), 4) ESTABLISHMENT OF WEB DEVELOPMENT PARTNER, 5) EXECUTION OF WEBSITE REDESIGN, 6) DISSEMINATION OF THE NEW AGFF EMPOWER WEBSITE, AND 7) CONTINUOUS EVALUATION AND MAINTENANCE.

CHILDREN'S HEALTH INSURANCE PROGRAM OUTREACH AND ENROLLMENT GRANT

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

THE IMPACT OF HAI ON TYPICAL AND ATYPICAL CHILD DEVELOPMENT AND HEALTH

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

THE RURAL WORKSITE WEIGHT MANAGEMENT PROJECT

DOCUMENTING THE TRUE COST OF OCCUPATIONAL INJURY BURDEN IN AGRICULTURE: A MIXED METHODS EFFORT TO IMPROVE INJURY SURVEILLANCE METHODS

U.S. DAIRY FARMING IS CHANGING RAPIDLY -- FEWER FARMS ARE PRODUCING A LARGER SHARE OF THE NATION'S MILK, FARMS ARE GETTING BIGGER, AND FARMERS ARE OPERATING WITHIN INCREASINGLY CONCENTRATED AND COMPLEX MARKETS. WHILE THESE CHANGES ARE OFTEN DISCUSSED IN TERMS OF EFFICIENCY AND PRODUCTIVITY, MUCH LESS ATTENTION HAS BEEN GIVEN TO WHAT THEY MEAN FOR THE PEOPLE AND COMMUNITIES LIVING THROUGH THEM. FOR MANY FARMERS, FARMING IS NOT SIMPLY A JOB; IT IS TIED TO FAMILY HISTORY, IDENTITY, COMMUNITY, AND A SENSE OF RESPONSIBILITY FOR CARRYING THE FARM FORWARD. WHEN THE ECONOMIC AND SOCIAL CONDITIONS THEY OPERATE WITHIN DRASTICALLY CHANGE, THE CONSEQUENCES CAN THEREFORE EXTEND WELL BEYOND THE FARM BUSINESS -- AFFECTING FARMER WELLBEING, FAMILY LIFE, COMMUNITY INSTITUTIONS, AND, PLAUSIBLY,THE FUTURE VIABILITY THE FARM AND RURAL VITALITY.OUR PRELIMINARY CDC/NIOSH-FUNDED RESEARCH IN UPSTATE NEW YORK-- WHICH LAID THE FOUNDATIONS FOR THIS SEED PROJECT --HAS HIGHLIGHTED JUST HOW PERSONAL THESE STRUCTURAL CHANGES CAN BECOME. REFLECTING ON THE LOSS OF A FARM THAT HAD BEEN IN HIS FAMILY FOR 12 GENERATIONS, ONE FARMER TOLD US: ...THE SENSE OF GUILT AND SHAME WILL NEVER LEAVE ME... I COULDN'T KEEP THINGS GOING... THE DAY THE COWS WERE TAKEN WAS THE WORST DAY OF MY LIFE. ANOTHER FARMER DESCRIBED THE WIDER COMMUNITY IMPACTS: ...WE USED TO HAVE NEIGHBORS WE COULD CALL... NOW THE FARMS ARE GONE, AND SO ARE THE PEOPLE... THE FEED MILL SHUT DOWN AND THE VET MOVED AWAY.SUCHACCOUNTS HIGHLIGHT HOW AGRICULTURAL RESTRUCTURING CAN BE EXPERIENCED NOT ONLY AS ECONOMIC CHANGE, BUT AS A PROFOUND PERSONAL, SOCIAL, AND COMMUNITY RUPTURE. THIS SEED PROJECT WILL EXTEND THAT WORK ACROSS PENNSYLVANIA, WISCONSIN, AND TEXAS, EXAMINING THE WIDER SOCIAL COSTS OF AGRICULTURAL RESTRUCTURING, WITH A PARTICULAR FOCUS ON FARMER MENTAL HEALTH, IDENTITY, FARM VIABILITY, AND RURAL COMMUNITY WELLBEING.WE WILL CONDUCT APPROXIMATELY 75 INTERVIEWS WITH DAIRY FARMERS, FARM FAMILY MEMBERS, AND KEY AGRICULTURAL STAKEHOLDERS ACROSS PENNSYLVANIA, WISCONSIN, AND TEXAS --THREE STATES THAT REPRESENT VERY DIFFERENT DAIRY SYSTEMS AND LEVELS OF INDUSTRY CONSOLIDATION. BY COMPARING FARMERS' EXPERIENCES ACROSS THESE SETTINGS, THE STUDY WILL EXAMINE HOW ISSUES SUCH AS MARKET VOLATILITY, PRICING SYSTEMS, COOPERATIVE AND PROCESSOR POWER, DEBT, CHANGING FARM STRUCTURES, AND COMMUNITY DECLINE SHAPE FARMERS' EVERYDAY LIVES AND DECISION-MAKING. FINDINGS WILL BE DEVELOPED IN PARTNERSHIP WITH A MULTI-STATE ADVISORY BOARD AND SHARED THROUGH STAKEHOLDER WORKSHOPS, SCIENTIFIC PUBLICATIONS, A TECHNICAL WHITE PAPER, AND A POLICY BRIEF.ULTIMATELY, THE PROJECT AIMS TO PROVIDE A STRONGER EVIDENCE BASE FOR UNDERSTANDING HOW LARGE STRUCTURAL CHANGES IN AGRICULTURE AFFECT PEOPLE AND RURAL COMMUNITIES --AND TO IDENTIFY PRACTICAL AND POLICY-RELEVANT WAYS OF SUPPORTING FARMER WELLBEING, FARM VIABILITY, AND THE LONG-TERM RESILIENCE OF RURAL AMERICA.

GENERATING STRUCTURAL AND FINANCIAL SUPPORT FOR TRACTOR RETROFITTING INITIATIVES

ARRA - EQUIPMENT TO ENHANCE TRAINING FOR HEALTH PROFESSIONALS

ASSESSMENTS OF SLEEP DEPRIVATION AND ASSOCIATED HEALTH AND COGNITIVE IMPACTS IN COMMERCIAL FISHERMEN

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT

THE RELATIONSHIP BETWEEN PETS AND MULTIPLE CHILD HEALTH INDICATORS

HEALTHCARE ACCESS

RURAL HEALTH CLINIC VACCINE CONFIDENCE PROGRAM

AFFORDABLE CARE ACT (ACA) GRANTS FOR SCHOOL-BASED HEALTH CENTERS CAPITAL PROGRAM

TELEHEALTH NETWORK GRANT PROGRAM

THE IFISH INNOVATION EXCHANGE HUB

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

SCHOOL-BASED HEALTH CENTERS CAPITAL PROGRAM

RURAL HEALTH NETWORK DEVELOPMENT PLANNING GRANT PROGRAM

RURAL HEALTH NETWORK DEVELOPMENT PLANNING GRANT PROGRAM

NURSE EDUCATION PRACTICE QUALITY RETENTION- REGISTERED NURSE IN PRIMARY CARE COVID

CHILDREN'S ORAL HEALTHCARE ACCESS PROGRAM

RURAL HEALTH CLINIC VACCINE CONFIDENCE PROGRAM

SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT

ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES