• Georgia’s critical access hospitals: Financial performance and process improvement

      Mase, William; Apenteng, Bettye; Carhuff, Lisa; Hanna, Mark; Boakye, Kwabena; Kimsey, Linda; Opoku, Samuel; Owens, Charles; Tedders, Stuart; Whaley, Patricia; et al. (2017)
      Background: Georgia’s Critical Access Hospitals (CAH) are in crisis. Within the last 2 years, four CAHs have closed their doors due to failed financial and operational performance. Evidence points to the risk that several more are on the brink of closure. CAH closures have far-reaching impact on residents. Negative impacts include the extra distance that patients must travel to seek care, the displacement of health professionals and the unravelling of the entire fabric of the communities these hospitals serve. We hope to help participants understand the financial and operational challenges of CAHs, and to identify realistic strategies to enhance the resilience of these hospitals. Methods: The Georgia Southern team worked with a cohort of CAHs across the state of Georgia to identify financial and operational best practices. Year 1 of this project focused on data collection, analysis and benchmarking. Year 2 is currently focused on performance improvement through Lean Six Sigma. Results: CAHs face financial constraints due to factors such as low volume, declining market share, unfavorable payer mix, challenges relating to collections, and difficulties in recruiting providers. CAHs in Georgia performed more poorly on the financial indicators assessed, in comparison to respective national medians. Many CAHs in our cohort are better organized to deal with crises – utilizing strong executive and bureaucratic structures – than to pursue ongoing improvement through employee empowerment and a process focus. Conclusions: Improvements in the operational and financial management practices of Georgia’s CAHs may significantly improve performance. Evidence-based strategies for operational and financial improvement are vital to sustainability. Opportunities exist for collaboration between public health systems and rural hospitals, including CAHs in assuring healthcare access for rural populations.
    • A preliminary examination of elevated blood lead levels in a rural Georgia county

      Rustin, Christopher; Sun, Yu; Calhoun, Chris; Kuriatnyk, Christy; Georgia Southern University, Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Children in Flint, Michigan were exposed to lead at unsafe levels in drinking water bringing renewed interest and national attention to an old public health problem. In Georgia, thousands of children are exposed annually to lead at unsafe levels primarily from paint in homes built before 1978. With lead poisoning typically viewed as an urban problem, rural areas are often considered lower-risk in light of similar lead poisoning risk factors, albeit on a smaller scale. The purpose of this preliminary study was to examine the prevalence of elevated blood lead levels in children <6 years of age tested in rural Ben Hill County, Georgia, a county designated as lower risk. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to state and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children who were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL). This is approximately 3.5 and 2.4 times higher, respectively, when compared to national (2.5%) and state (3.64%) percentages of children exposed to lead ≥5ug/dL. Analysis also indicated low screening rates, which limits interpretation of population prevalence. Conclusions: Lead poisoning is often viewed as an urban, inner-city problem due to a higher percentage of older homes clustered together, exposing more children, compared to rural areas with homes geographically dispersed. While these data are preliminary and more analysis is planned to understand the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.