The necessity of improving rural health in the American West is an urgent and complex, but surmountable challenge. Individuals and communities in rural areas comprise a frequently underserved population, with historical issues and emerging crises. At the same time, the rural health domain also serves as the wellspring for novel technologies, innovative solutions, and resourceful enterprises worth emulating.

The Healthier Rural West Summit, which takes place on March 19-21, 2019 in Salt Lake City, Utah, is an effort to Convene key stakeholders, Connect thought and opinion leaders with practitioners and community members, Communicate nascent issues and lessons learned, foster Collaboration, and secure Commitments from relevant parties throughout the Rural West.

This Resource Guide is intended to: serve as a pre-reading primer for conference attendees; highlight the vital contributions of individuals and organizations whose efforts have been shown to be effective in improving rural health; serve as a repository and clearinghouse for useful tools; and to disseminate actionable information on both looming challenges and time-tested solutions.

Given the gravity of the health challenges facing those of us who call the Rural West home, transitioning from crisis to well-being will require significant mutual effort. “In these times, if ‘I’ is replaced with ‘We’, even illness becomes wellness.” We can only work towards a healthier Rural West together; thank you for joining us!

About this guide

This guide is intended to be more descriptive than prescriptive, more participatory than proprietary. It is hoped that this guide can help foster novel, cross-cutting initiatives. As such, a broad scope has been maintained, oriented along Healthier Rural West Summit focal areas in the initial chapter, complemented with key rural health tools, followed by audience-specific resources. Conference attendees are encouraged to reflect on their experience and expertise while reading this guide, and to capitalize upon the fresh ideas and new opportunities that arise. We look forward to working with you going forward.

Acronyms

CBOs	Community-Based Organizations
CDC	Centers for Disease Control and Prevention
CDMS	Chronic Disease Management Systems
CHNA	Community Health Needs Assessment
CHW	Community Health Worker
CMS	Center for Medicare & Medicaid Services
CPSTF	Community Preventive Services Task Force
EHR	Electronic Health Records
FAQs	Frequently Asked Questions
FCC	Federal Communications Commission
FORHP	Federal Office of Rural Health Policy
HCPs	Health Care Providers
HHS	United States Department of Health and Human Services
HIE	Health Information Exchange
HIT	Health Information Technology
HRH	Human Resources for Health
HRSA	Health Resources & Services Administration
HSOs	Health Service Organizations
HWAI	Health Workforce Advocacy Initiative
i2b2	Informatics for Integrating Biology & the Bedside
iHRIS	Human Resources Information Solutions
IT	Information Technology
LHDs	Local Health Departments
NACCHO	National Association of County and City Health Officials
NCSL	National Conference of State Legislatures
NIMH	National Institute of Mental Health
NORC	National Opinion Research Center
NOSORH	National Organization of State Offices of Rural Health
ONC	Office of the National Coordinator for Health Information Technology
ORH	Office of Rural Health
PCA	Primary Care Association
PCPs	Primary Care Providers
PHRs	Personal Health Records
QPP	Quality Payment Program
RHC	Rural Health Clinic
RHIhub	Rural Health Information Hub
RHLR	Rural Health Leadership Radio
SARRAH	Services for Australian Rural and Remote Allied Health
SDOH	Social Determinants of Health
SORH	State Office of Rural Health
USAID	United States Agency for International Development
USDA	United States Department of Agriculture
VA	United States Department of Veterans Affairs
WHO	World Health Organization
WWAMI	The Washington, Wyoming, Alaska, Montana, Idaho Rural Health Research Center at the University of Washington

Summit Focus-Area Resources

Technological Tools

The Health Information Technology Toolkit for Critical Access and Small Hospitals can be used for implementing a comprehensive HIT or EHR system, for acquiring individual applications, or for overhauling existing systems.

The Rural Health Information Technology Network Development program’s electronic Health Information Exchange toolkit offers key guidelines and requirements for rural health networks and organizations to consider when engaging in the exchange of health information or when joining an HIE organization.

The Rural Health Information Hub’s Health Information Technology Model involves the use of technology to improve care, and includes tools and technologies relating to Electronic Health Records (EHR), patient registries and Chronic Disease Management Systems (CDMS), Telehealth, HIE, prescription assistance programs, electronic resource directories, patient portals, Personal Health Records (PHRs), etc. RHIhub also curates a complete inventory of Rural Health Information Technology Workforce Curriculum Resources.

The Office of the National Coordinator for Health Information Technology (ONC) has a dedicated resource page for critical access hospitals and small rural hospitals, listing benefits of health IT in rural settings, and shares information on overcoming barriers to health IT adoption and implementation.

The Healthcare Information and Management Systems Society maintains Rural Health IT Resources and Rural Health IT Whitepapers pages.

The Intermountain Gardner Transformation Center, a home for multiple institutes seeking to transform care delivery, includes the Intermountain Healthcare Leadership Institute, the Intermountain Healthcare Delivery Institute, the Homer Warner Center for Informatics Research, and Clinical Programs.

The National Rural Health Association’s Health Information Technology Resources page includes official policy papers on rural health IT, telehealth reimbursement, telehealth provider credentialing, and geographic restrictions for Medicare telehealth reimbursement.

The University of Queensland Centre for Online Health rural and remote research projects include initiatives on telehealth services for rural/remote dementia care among indigenous peoples, secondary telehealth-delivered psychiatric consultancy services, connecting rural schools to allied health professionals specializing in speech language pathology/physiotherapy/occupational therapy, and enabling better access to specialist care in rural regions through the use of telehealth in rural hospitals/general practices/residential aged care facilities.

Analytics/Informatics

RHIhub hosts three Rural Data Visualizations, including the Rural Data Explorer – an interactive map for exploring county-level data on issues that impact rural health, including rural demographics, health disparities, the health workforce, and other topics, a Chart Gallery illustrating key issues related to rural health at the national level and for all 50 states (including rural demographics, healthcare access, health status, social determinants of health, and more), and Maps on topics related to rural healthcare provision and access, as well as rural population health and demographics.

The National Rural Health Resource Center’s Population Health Portal includes a ‘Put Data to Use’ tool that provides users the ability to extract data from multiple federal, publicly available datasets to use for population health planning, and includes data from Hospital Compare from the Center for Medicare & Medicaid Services, Medicare data from the Dartmouth Atlas of Health Care, county health rankings, and the US Census Bureau.

A 2015 webinar (video, slides) on ‘Using Data Analytics to Manage Population Health Services’ in the rural setting, funded by HHS/HRSA under the Information Services to Rural Hospital Flexibility Program, covers the use of data analytics to manage population health services, and is coupled with a Guide for Rural Hospitals to Identify Populations and Shift to Population Health.

The use of informatics within the Informatics for Integrating Biology & the Bedside (i2b2) model has been studied for utility in bootstrapping rural health analytics and learning networks, promoting communication and research initiatives by providing the infrastructure necessary for sharing data and insights across a group of healthcare and research partners.

Telehealth / eMedicine

HHS/HRSA’s Rural Health IT Toolbox included a TeleHealth module that provides an overview of telehealth with an emphasis on its application in a rural setting.

The Northwest Regional Telehealth Resource Center, funded by the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, maintains a Telehealth Tool Kits inventory available for use as guidelines in network development.

The Great Plains Telehealth Resource & Assistance Center’s Telehealth Start-Up and Resource Guide provides an overview and framework for implementing telehealth in critical access hospitals and rural areas, as well as pointing readers to reliable and informative resources for learning about telehealth and the organizations that support the use of telehealth in various ways.

ONC publishes a guidebook of the federal resources currently available for rural providers interested in achieving meaningful use of health IT.

Cross-Sector Collaboration

The National Cooperative of Health Networks Association hosts a Rural Health Networks literature review with references to literature including discussions of numerous rural health network categories (both common and uncommon), benefits of collaboration, barriers to the formation of networks, and studies on what makes some networks more effective than others.

RHIhub’s Rural Health Networks and Coalitions Toolkit provides resources, strategies, and examples to communities who are considering developing a new or expanding an existing health network or coalition. Their Rural Health Promotion and Disease Prevention Toolkit also includes a module on Partnerships and Coalitions.

The Rural Health Initiative published six Network Guides with modules on Network Communications, Network Leadership, Network Strategy and Structure, and Sustainability (among others).

The National Rural Health Resource Center maintains a Collaboration Building Resource Library that provides frameworks as rural health organizations consider their next steps in developing key relationships for achieving improved outcomes in rural health. Their tools and presentations can also help organizational and community leaders build the skills needed to initiate, foster and strengthen collaboratives or partnerships.

The Intersector Project created a curated list of ten notable resources on cross-sector collaboration in rural areas as part of its guide on the diagnosis, design, implementation, and assessment of successful cross-sector collaborations.

The Washington State Hospital Association created a Community Engagement Toolkit for Rural Hospitals that endeavors to help rural hospital administrators leverage their hospital’s strengths and resources to engage in a community dialogue about health and form sustainable community partnerships.

The National Association of County & City Health Officials (NACCHO) published a guidebook entitled Mobilizing Community Partnerships in Rural Communities: Strategies and Techniques, which describes how rural communities can develop and maintain partnerships, provides stories from the field, and consolidates lessons learned to identify essential elements of partnerships that healthcare providers, community-based organizations (CBOs), and LHDs can translate into focused solutions for their rural communities.

The University of California San Francisco Family Health Outcomes Project generated a Community Collaborative Toolkit to guide communities in creating or improving their own needle-moving collaboratives, and includes case studies on rural health networks.

Central Queensland Rural Health has compiled numerous toolboxes and resource guides relating to cross-sector collaboration under their Resources for Governance site.

Facilities / Health Infrastructure

The FCC’s Rural Health Care Program, which includes the new Healthcare Connect Fund, provides funding to eligible health care providers (HCPs) for telecommunications and broadband services necessary for the provision of health care. The goal of the program is to improve the quality of health care available to patients in rural communities by ensuring that eligible HCPs have access to telecommunications and broadband services.

The National Network for Rural and Frontier Capacity publishes a Leading Change Toolkit: Best Practices in Technical Assistance for Rural and Frontier Health-Care Organizations in an Era of Transformation, which was developed for State Offices of Rural Health (SORHs) and their partners, non-profit organizations, government agencies and other entities dedicated to building the capacity of rural and frontier Health Service Organizations (HSOs). The toolkit includes resources and best practices to develop or enhance technical assistance and consultation offerings.

The USDA’s Rural Development Community Facilities Infrastructure Toolkit is a guide to help organizations and community leaders better understand the complex process that is required to successfully develop and construct a new facility (including healthcare facilities). This Toolkit outlines the major capacity, credit, and logistical challenges that particularly confront America’s small towns and rural areas.

The Rural Health Information hub’s Rural Transportation Toolkit compiles promising models and resources to support organizations implementing transportation programs in rural communities across the United States.

The State Offices of Rural Health program is a federal-state partnership to help rural communities and organizations identify and resolve issues and build rural health infrastructure. The program provides funding for an institutional framework that links small rural communities with state and federal resources to develop long-term solutions to rural health problems.

The USDA National Agricultural Library published the Capital Assistance Funding: A Rural Health Resource Guide, an online reference designed to help hospitals, clinics, community health centers, and other rural health providers learn more about various funding options to meet their capital needs.

The Virginia Rural Health Association hosts a Rural Health Infrastructure presentation compiled by the Eastern Virginia Medical School.

The National Association of County and City Health Officials maintains a Public Health Infrastructure and Systems program that includes tools to build local health department infrastructure and systems.

Social Determinants

The National Organization of State Offices of Rural Health, in collaboration with the Association of State and Territorial Health Officials (ASTHO), produced Social Determinants of Health: A Quick Reference Guide for State Offices of Rural Health and State and Territorial Health Officials. The guide offers an overview of social determinants of health, highlighting the key relationships between health status and the social issues of housing, transportation, education, and food insecurity. The guide also provides targeted resources and state examples to help readers learn more and act on these significant drivers of health status, outcomes, and costs.

The Rural Health Information hub’s Rural Community Health Toolkit provides rural communities with the information, resources, and materials they need to develop a community health program in a rural community.

The Community Health Association of Mountain/Plains States (CHAMPS), in collaboration with the Colorado Community Health Network (CCHN) developed a Rural Social Determinants of Health Game Toolkit, a resource designed to introduce health center and Primary Care Association (PCA) staff to the social, cultural, economic, environmental, and other factors that impact the health of rural patients

The Center for Health Care Strategies published a brief entitled Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations, reviews key considerations for organizations seeking to use SDOH data to improve patient care, including: (1) selecting and implementing SDOH assessment tools; (2) collecting patient-level information related to SDOH; (3) creating workflows to track and address patient needs; and (4) identifying community resources and tracking referrals.

Portland State University’s Social Determinants of Health Initiative curates a list of useful links related to SDOH, including a Rural Communities sub category.

Sociodemographic Sub-Populations

The North Carolina Rural Health Research and Policy Analysis Center of the University of North Carolina at Chapel Hill published a Working Paper entitled ‘Race and Place: Urban-Rural Differences in Health for Racial and Ethnic Minorities’.

The National Rural Health Association published an Issue Paper on Racial and Ethnic Health Disparities.

The Rural Veterans Health Care Atlas, produced by the Office of Rural Health’s GeoSpatial Outcomes Division, is a comprehensive resource for rural and veteran stakeholders (including, but not limited to, researchers, planners, policy decision makers, as well as clinicians and patient care teams) to enhance health care delivery to rural veterans, enrollees and patients.

RHIhub curates Topic pages on Rural Tribal Health, People with Disabilities, Minorities, Hispanics and Latinos, African Americans, Asian and Pacific Islanders, and American Indians, Alaska Natives, and Native Hawaiians.

The National Rural Health Association publishes a Policy Brief on Elder Health in Rural America.

Environmental Health

The National Academy of Sciences convened a workshop and published a book-length Summary Report on Rebuilding the Unity of Health and the Environment in Rural America, which highlights problems of the rural environment extending beyond natural factors such as the quality of the water and the air, to include the built environment in terms of human inputs—the buildings placed on the land, the kind of farming performed and the chemicals that are applied to the land, and the types of industries that are built in rural America. These problems coalesce as a number of health care issues specific to the rural environment, particularly those relating to the widening gap in health care services between rural and urban populations.

The Indian Health Service created an Environmental Health Toolkit, which provides a set of resources for helping care providers assess and strengthen their Environmental Health programs and services in order to support a comprehensive, integrated approach to environmental health.

The New Mexico Department of Health – Environmental Health Epidemiology Bureau compiled a Community Environmental Health Assessment Toolbox to better integrate analysis of environmental conditions and causal agents with community health assessments.

Alaska Community Action on Toxics publishes an Environmental Health Care Toolkit to increase the understanding of environmental contaminants found in rural areas that affect human health. The toolkit provides facts about contaminants that may be present in the environment, known or suspected symptoms, and their human health effects.

Montana’s Rural Nurse Environmental Health Education Project was the subject of a doctoral dissertation at Montana State University, recommending a re-emphasis on environmental health in the scope of responsibilities and competencies for rural primary care practitioners.

The West Virginia Rural Health Research Center published a report on Environmental Workforce Characteristics in the Rural Public Health Sector analyzing the environmental workforce characteristics of the rural public health sector to inform policy relative to the coordination of rural environmental health services.

The Otsego County Conservation Association in Upstate New York published a briefing paper on Environmental Impacts on Rural Health, describing common environmental problems in rural areas and how these issues are associated with rural health. The paper highlights environmental health challenges in rural areas that can be addressed with improved education, strategic planning, and policy reform.

Health Workforce

The Washington, Wyoming, Alaska, Montana, Idaho Rural Health Research Center (WWAMI) at the University of Washington produced a Policy Brief Series entitled Data and Issues for Policymakers in: Washington, Wyoming, Alaska, Montana, Idaho describing characteristics of the rural health care workforce and factors affecting the delivery of health care in rural areas, with issues on The Rural Health Workforce: Challenges and Opportunities, The Rural Health Workforce in the WWAMI States: By the Numbers, Building and Maintaining the Rural Health Workforce: Resources and Strategies, What is Rural in the WWAMI States? Why Definitions Matter, and Health Workforce Assessment: Tools for Policymakers and Planners.

The National Rural Health Resource Center’s Workforce Resource Library curates a list of resources including information related to recruitment and retention activities, long-term workforce solution infrastructure, employee satisfaction and data related to health care workforce supply and demand.

The Health Workforce Advocacy Initiative, part of the Global Health Workforce Alliance, contributes to a range of global, regional, and national-level human resources for health (HRH) initiatives. In HWAI’s Guiding Principles for National Health Workforce Strategies, prioritization of an equitable distribution of health workers in the HRH planning process is fundamental, and includes an emphasis on developing and expanding cadres most likely to practice in rural areas and focusing resources on improving health infrastructure in rural areas.

The Center for Medicare & Medicaid Services’ Rural Health Strategy includes a ‘Recruiting, Training, and Retaining the Workforce’ theme.

RHIhub’s Rural Healthcare Workforce topic area examines policy, economics, planning challenges, and issues related to rural health workforce, including: supply and demand; distribution of the workforce; characteristics of the rural healthcare workforce; licensure, certification, and scope of practice issues; and programs and policies that can be used to improve the rural healthcare workforce. Additional RHIhub topic guides on Recruitment and Retention for Rural Health Facilities and Education and Training of the Rural Healthcare Workforce are also hosted by RHIhub. Finally, RHIhub’s Rural Oral Health Toolkit includes a module on the rural oral health workforce model.

The National Organization of State Offices of Rural Health (NOSORH) generated a Toolkit for Recruitment and Retention of Primary Care Physicians in Rural Areas with modules on the role of state offices of rural health in the recruitment and retention of primary care providers (PCP), the need for recruitment and retention in rural areas, and federal/state/additional resources.

USAID’s CapacityPlus human resources for health strengthening project, in conjunction with WHO’s Department for Health Systems Policies and Workforce, developed an open source tool to cost various rural/underserved health worker interventions and develop retention strategies to be implemented at the district, regional, or national level, entitled iHRIS Retain.

WHO published a set of Global Policy Recommendations on Increasing access to health workers in remote and rural areas through improved retention, which includes a comprehensive set of strategies to help countries encourage health workers to live and work in remote and rural areas. These include refining the ways students are selected and educated, as well as creating better working and living conditions.

The North Carolina Institute of Medicine Rural Health Task Force produced a presentation on Rural Health Workforce Challenges and Strategies with themes including: health professional supply in rural areas has remained stagnant; the gap between well supplied and not well supplied continues to grow; how can we address these challenges?; training workers in rural areas; pay incentives to work in rural areas; recruiting workers who grew up rural areas; and changing practice models in rural areas.

Mental Health / Substance Abuse

RHIhub hosts a topic guide on Rural Mental Health that focuses on mental health in rural areas and helps health and human services providers in their efforts to develop, maintain, and expand mental health services in rural communities. It also highlights challenges and important issues in mental healthcare delivery, such as workforce shortages, access issues, anonymity, stigma, integration of mental health services into primary care, and suicide prevention. RHIhub’s Substance Abuse in Rural Areas topic guide covers the effect of substance abuse on rural communities, broadly. Their Rural Response to the Opioid Crisis topic guide catalogs activities underway to address the opioid crisis in rural communities at the national, state, and local levels across the country. Their Rural Prevention and Treatment of Substance Use Disorder Toolkit provides evidence-based examples, promising models, program best practices, and resources that can be used to implement substance use disorder prevention and treatment programs.

The Western Interstate Commission for Higher Education (WICHE), in collaboration with the Suicide Prevention Resource Center (SPRC) produced a Suicide Prevention Toolkit: A Guide for Primary Care Providers and Medical Practice Managers, containing information and tools to implement state of the art suicide prevention practices and overcome the hurdles suicide prevention work faces in primary care practices. WICHE also hosts a presentation on Rural Mental Health: Challenges and Opportunities Caring for the Country.

The National Institute of Mental Health (NIMH) Office of Rural Mental Health Research, which coordinates research activities related to the mental health of residents of rural areas, convened a workshop to review relevant research issues in the provision of culturally appropriate e-mental healthcare, resulting in the publication of a study and recommendations on Using e-Health to Enable Culturally Appropriate Mental Healthcare in Rural Areas.

NOSORH conducted a webinar on the Rural Mental Health & Substance Abuse Toolkit, with a presentation on the project’s goals, activities, and findings, including models for communities.

A systematic review of evaluations of web-based mental health programs, entitled Internet‐based mental health programs: A powerful tool in the rural medical kit, describes and reviews the findings from evaluation studies of two web‐based applications focused on evidence‐based information about depression for consumers and automated cognitive behavioral therapy.

The Canadian Collaborative Mental Health Initiative published a toolkit on Establishing collaborative initiatives between mental health and primary care services for rural and isolated populations to encourage greater collaboration among primary health care professionals, mental health care professionals, consumers, families, and community organizations in addressing the primary mental health care needs of individuals living in rural and isolated regions.

Central Queensland Rural Health conducted an examination of current research and ‘grey’ literature around mental health and wellbeing in rural and remote areas to identify potential strategies, preventative measures, and activities local communities can put in place to assist the local population to cope with mental health stressors. The resulting Community Mental Health Tool-kit: Literature Review Project Final Report is hosted here.

Planning/Policy

RHIhub’s Rural Community Health Toolkit provides rural communities with the information, resources, and materials they need to develop a community health program in a rural community. The Toolkit includes modules on creating, developing, implementing, evaluating, and planning programs, as well as disseminating best practices. RHIhub also curates a Rural Health Policy Resources topic area, with additional resources on Legislation and regulations, and Policy. Finally, their Rural Services Integration Toolkit identifies evidence-based and promising models and resources that will benefit rural communities seeking to implement services integration programs.

The National Conference of State Legislatures published the Improving Rural Health: State Policy Options report, which provides an overview of state policies and investments in five key areas: achieving greater access to health care services and overcoming distance, health workforce, long-term services and supports, behavioral health capacity, and prevention and wellness.

The Federal Office of Rural Health Policy is awarding $2.2m to 22 awardees for the 2019 Rural Health Network Development Planning Program. The program is a one-year, community-driven program designed to assist in the planning and development of an integrated health care network at the local level. The Network Planning program is open and receiving applications up until November 30, 2018, with a technical assistance webinar here.

Maryland’s State Office of Rural Health examined existing county health plans, Community Health Needs Assessments, State Health Improvement Process (SHIP) data, results from a state appointed study on Maryland’s Eastern Shore, and feedback from citizens and health care professionals in each of Maryland’s rural counties to understand the state of rural health. Their resulting Rural Health Plan includes recommendations across three categories: policy, systems, and individuals.

The Federal Office of Rural Health Policy prepares regular Policy Update announcements focusing on the impact regulations may have on rural communities.

The Center for Medicare & Medicaid Services (CMS) published its Rural Health Strategy in 2018, elaborating five objectives to improve health care in rural America: apply a rural lens to CMS programs and policies, improve access to care through provider engagement and support, advance telehealth and telemedicine, empower patients in rural communities to make decisions about their health care, and leverage partnerships to achieve the goals of the CMS Rural Health Strategy. These five objectives are aligned across eight themes: improving reimbursement; adapting and improving quality measures and reporting; improving access to services and providers; improving service delivery and payment models; engaging consumers; recruiting, training, and retaining the workforce; leveraging partnerships/resources; and improving affordability and accessibility of insurance options.

A systematic literature review, describing the development and application of a rural health framework to guide evidence-based rural health program, policy, and service planning – focusing on health promotion, chronic disease prevention and population health – was conducted by the Haldimand-Norfolk Health Unit in rural Ontario. The published paper is entitled Development of a Rural Health Framework: Implications for Program Service Planning and Delivery.

Economics

RHIhub hosts an Economic Impact Analysis Tool that estimates the economic impact of grant program investments on the local economy. These calculations help rural program grantees assess performance and advocate for resources that contribute to program sustainability and improved healthcare for rural populations.

The Alabama Office of Primary Care & Rural Health hosts a rural health resource guide, curating Economic Impact Studies, demographic and health statistics and policy information, in service of resource development and technical support to expand access to primary care, dental, and mental health services in rural communities.

In Rural Public Health Infrastructure: A Literature Review, sections on the various funding streams available to strengthen public health infrastructure in rural communities and Models for Practice are detailed.

The Healthcare Value Hub published a research brief entitled Improving Healthcare Value in Rural America, which provides an overview of the unique challenges faced by rural populations and providers, identifies initiatives with limited utility in rural settings, and highlights promising strategies to improve healthcare value in rural America.

North Dakota’s Public Broadcasting System state network – Prairie Public Television – produced a documentary under a grant from USDA Rural Development entitled Life Support: The Economics and Politics of Rural Health Care. The documentary examines the innovative steps communities in North Dakota are taking to ensure that the rural population receives health care, even when it entails some very nontraditional approaches.

The National Rural Health Resource Center curates a page on hospital economic impact, including financial strategies, financial modeling tools, capital project guides/toolkits/resource lists, econometric models, and publications.

The National Center for Rural Health Works has compiled an interactive Economic Impact Tool, with impact models responsive to policy-relevant questions. Economic impact tools and templates are available relating to hospitals, physicians, nursing homes and rural clinics, ancillary services, medical schools and residencies, and community, government, and health policy.

NOSORH’s Engaging State Offices of Rural Health & Rural Health Clinics in Value-Based Care Toolkit, provides resources for SORHs and RHCs to assess their current capacity for taking on value-based care work, information on the initiatives happening around the country, and examples of states tackling these issues with and for their RHCs.

Health Equity

The National Academy of Sciences published Achieving Rural Health Equity and Well-Being: Proceedings of a Workshop, exploring the impacts of economic, demographic, and social issues in rural communities and discussing asset-based approaches to addressing associated challenges. The Proceedings synthesize the discussions held at the workshop, highlights the speakers’ perspectives on rural health equity and well-being, and provides an overview of showcased initiatives and approaches to meeting the particular challenges and opportunities in improving health in rural communities.

The National Rural Health Association convenes the Health Equity Council and Conference (formerly the Rural Multiracial and Multicultural Health Council and Conference) to highlight issues related to rural and underserved LGBTQ, veteran and homeless populations in addition to the multiracial and multicultural populations the council has advocated on behalf of for years.

The HHS / Agency for Healthcare Research and Quality, in their Innovations Exchange series focused on health care disparities experienced by racial, ethnic, and socioeconomic groups and specific priority populations in the U.S., included an issue on Health Care Innovations for Rural Populations, featuring a selection of content that can help address disparities in rural health care.

The American Hospital Association compiled Equity of Care: A Toolkit for Eliminating Health Care Disparities as a guide to help accelerate the elimination of health care disparities and ensure hospital leadership reflect the communities they serve.

The Association of American Medical Colleges published a brief entitled Health Disparities Affect Millions in Rural U.S. Communities, cataloging rural health disparities deeply rooted in economic, social, racial, ethnic, geographic, and health workforce factors.

CDC’s Office of the Associate Director for Policy produces POLARIS, its portal for navigating policy-relevant tools, trainings, and resources. On the POLARIS rural health topic page, population health policies to address health disparities in rural areas are outlined via rural health policy briefs and featured resources.

Wiley publishes a textbook entitled Rural Populations and Health: Determinants, Disparities, and Solutions, which provides an overview of the critical issues surrounding rural health and offers a theoretical and evidence-based rationale for rectifying rural health disparities in the United States. Chapter 4 is entitled The Depth of Rural Health Disparities in America: The ABCDEs.

Audience-Specific Resources

Providers/Practitioners

RHIhub hosts a series of guides on Care Management Reimbursement Strategies for Rural Providers, developed by the NORC Walsh Center for Rural Health Analysis with support from the Federal Office of Rural Health Policy.

CMS published a series of FAQs on Care Management Services in Rural Health Clinics and Federally Qualified Health Centers, with information on transitional care management, chronic care management, general behavioral health integration, and the psychiatric collaborative care model.

SARRAH hosts a comprehensive Transition Toolkit to Remote and Rural Practice designed to support allied health professionals with establishing a practice in a rural or remote setting. The resource bridges the gap between training and becoming a rurally-based allied health service provider. The toolkit supports allied health service providers through: extending university training; developing an understanding of local orientation processes; assisting with maintaining a long-term presence in rural communities; and outlining the benefits of making the transition to remote and rural practice.

Minnesota’s Office of Rural Health and Primary Care created the Community Health Worker (CHW) Toolkit, with modules on CHW program planning and stakeholder engagement; CHW emerging scope of practice/roles and responsibilities; Education and workplace training opportunities; Hiring and onboarding practices; Financial sustainability of a CHW position; and, Return on investment and evaluation of CHW program outcomes.

Dartmouth’s Handbook for Rural Health Care Ethics: A Practical Guide for Professionals is designed to be a useful resource for clinicians and administrators of rural health care facilities, in recognition of the unique nature of rural health care and the need for a thoughtful, practical discussion of rural health care ethics. It is complemented by their Critical Access Hospital Ethics Committee Resource Guide.

The 3RNet – the National Rural Recruitment and Retention Network – connects health professionals searching for jobs in rural or underserved areas with health care facilities. Their For Healthcare Professionals section includes tools for job searches, as well as information on loan repayment programs, health professional shortage areas, and J1 visas.

NCSL published a research brief entitled Meeting the Primary Care Needs of Rural America: Examining the Role of Non-Physician Providers, addressing the use of expanded scopes of practice for non-physician primary care providers – such as physician assistants and nurse practitioners – to improve access to primary care services in rural areas.

Academia

The Rural Health Research Gateway hosts the Dissemination of Rural Health Research toolkit, which aims to assist researchers with reaching their target audiences by developing appropriate, timely, accessible, and applicable products. The toolkit includes a description of multiple modes of dissemination including discussion of the purpose of each product, which mode is appropriate given the topic and audience, and how to develop the product. RHRG produced Disseminating Rural Health Research to Community, State and National Audiences: A Communications Toolkit for Health Researchers, designed to facilitate the dissemination and use of rural health services research. The toolkit is a resource for researchers to enhance communication and dissemination efforts. It includes approaches for both developing various research‐related documents and disseminating research results. RHRG also hosts a Listserv for Rural Health Research, which provides easy, timely access to all of the research and findings of the eight FORHP-funded Rural Health Research Centers.

RHIhub hosts a topic area on Conducting Rural Health Research, Needs Assessment, and Program Evaluation that identifies the similarities and differences among rural health research, assessment, and evaluation; discusses common methods, such as surveys and focus groups; provides contacts within the field of rural health research; addresses the importance of community-based participatory research to rural communities; looks at the community health needs assessment (CHNA) requirements for nonprofit hospitals and public health; and examines the importance of building the evidence-base so interventions conducted in rural areas have the maximum possible impact.

The University of Nebraska Medical Center – Center for Clinical & Translational Research curates a list of toolkits for community engaged research, with research databases, evidence-based practice and comparative effectiveness research resources, multicultural resources, and network resources – including disease-centered, practice-based research, and rural-specific networks.

The Interior Health Research Department publishes a biannual Rural Health Research eNewsletter (most recent issue here), to inform rural communities, current/future health and research partners and knowledge users about rural health research activities.

The University of Illinois at Chicago hosts a Rural Health Research Guide, with useful resources for rural health care professionals and researchers. The guide includes sections on databases and resources, clinical tools, drug information, books, dictionaries and directories, and associations and organizations.

Government

The Federal Office of Rural Health Policy hosts a Resource Guide for New Applicants & Grantees that details resources for government grantees and applicants across 25 topic areas, from access to health care services and aging populations to wellness and prevention and workforce development, recruitment, and retention.

The National Organization of State Offices of Rural Health maintains the SORH Toolkit, a resource guide for State Offices of Rural Health.

The National Advisory Committee on Rural Health and Human Services curates a list of publications, reports, recommendations, and resource papers.

RHIhub’s online library Organizations Topic Area lists Federal Agencies and Councils Addressing Rural Health, Federal Advisory Bodies and Committees, State and Regional Agencies and Organizations, State Offices of Rural Health, State Rural Health Associations, and congressional coalitions, caucuses, and committees addressing rural health.

The USDA’s National Agricultural Library Rural Information Center includes a Rural Public Health topic area providing resource information on public health topics for rural communities and healthcare providers.

CMS’s Rural Health Resources page compiles links to CMS resources such as its Rural Health Clinics Center, Federally Qualified Health Centers, and Quality Payment Program (QPP), along with resources from HHS and other partners and stakeholders.

The Rural Proofing for Health Toolkit was created to provide a source of information and good practice about the issues surrounding health service delivery in rural areas. It is intended to act as a reference for health commissioners, supporting them to develop and maintain a better understanding of the issues surrounding the commissioning and delivery of health services in rural areas.

NGOs

RHIhub’s Rural Community Health Toolkit Funders of Rural Programs module includes a subsection on Foundations and Charitable Organizations, and notes that RHIhub information specialists can conduct custom funding searches for NGOs. RHIhub also catalogs numerous non-governmental rural health-focused organizations within their online library Organizations topic area, including National Rural Organizations with an Interest in Health, and State Rural Health Associations (most of whom are NGOs).

The Washington State Department of Health curates a list of private foundation/NGO funders of rural health initiatives under its Private Grants page, many of whom provide grants to NGOs.

It should be noted that two of the 50 State Offices of Rural Health are themselves non-governmental organizations: the Colorado Rural Health Center, and the South Carolina Office of Rural Health.

3RNet’s For Employers section includes tools for listing NGO and non-profit organization rural health jobs. 3RNet’s organizational membership body includes state-based non-profit organizations who help connect physicians and health professionals with job opportunities in rural and underserved communities.

The Guide to Community Preventive Services (commonly known as The Community Guide) is a collection of evidence-based findings of the Community Preventive Services Task Force (CPSTF). It is a resource to help non-profits, community-based organizations, and others select interventions to improve health and prevent disease. The Community Guide’s Rural Setting filter lists 226 systematic reviews, 14 tools, 24 ‘in action stories’, and 35 resources.

Patients / Community-Members

The University of British Columbia Centre for Rural Health Research developed the Community Toolkit for Sustainable Rural Maternity Care – a graphic representation of the steps necessary to implement rural maternity care at a community level, by stakeholders. The toolkit was created in response to requests by non-practitioner community members who recognized the importance of local maternity care and wanted to spur community-level action; it may serve as a template for analogous health issue-specific campaigns by community members.

The National Rural Health Resource Center’s Resource Library features webinars, presentations, articles and toolkits developed by trusted industry leaders to guide and support rural health stakeholders. The Resource Library hosts a search engine, as well as portals, topics, and spotlights.

The Harold P. Freeman Patient Navigation Institute curates a resources topic area, with modules on Communication Resources, Legal Resources, Financial Navigation Resources, Outreach Navigation Resources, Diagnostic Navigation Resources, Treatment Navigation Resources, and Survivorship, Rehabilitation and Supportive Care Navigation Resources for patient navigators, as well as a training program for community-members desirous to become qualified as patient navigators.

The University of Arkansas for Medical Science – Center for Health Literacy includes a resource guide for patients, including an Online Health Info page.

The CDC has a number of patient / community-member resources, including Plain Language Materials & Resources and a Plain Language Thesaurus.

Additional Resources

Multimedia and Factsheets

Rural Health Leadership Radio is a weekly podcast featuring leaders working in rural health; leaders of hospitals, clinics, networks, companies and communities. RHLR’s mission is to provide a forum to have conversations with rural health leaders to discuss and share ideas about what is working, what is not working, lessons learned, success stories, strategies, things to avoid, and anything else the rural health community wants to talk and hear about.

RHIhub’s Online Library allows for the sorting of resources by type, and includes nearly 200 video or multimedia entries, including presentation slides, webinars, video workshops, recorded congressional programming, and more.

Stanford School of Medicine hosts a Rural Health Fact Sheet series, with issues on Rural California, Rural Healthcare in the Digital Age, VA Office of Rural Health (ORH): Mission, Strategy and Focus, Health Status and Health Behaviors, Healthcare Disparities & Barriers to Healthcare, and Hospice Services in Rural Communities.

The Health Resources & Services Administration’s Data Warehouse allows for the generation of factsheets by individual county, congressional district, state/territory, HHS region, or nation, for the past five fiscal years.

The University of North Dakota School of Medicine & Health Sciences, in their publications & maps topic areas, curates a set of Rural Health Factsheets dating from 2003 to the present.

Phillip Polakoff was interviewed on the Future Hindsight podcast, discussing rural health, healthcare policies, opportunities for reform, and healthcare as a right.

Produced by

Resource Guide: Healthier Rural West Summit

Table of Contents

Introduction