Rural Health

The Title V legislation requires the state, as part of its Application, to carry out a statewide Needs Assessment every five years that identifies the need for preventive and primary care services for pregnant women, mothers and infants up to age one; children and adolescents; and children with special health care needs up to age 26. The University of Arizona College of Public Health is collaborating with Arizona Department of Health Services (ADHS) to contribute the qualitative components of the Title V needs assessment, including focus groups, community forums and dissemination of results to community partners. Our approach involves (i) participation at state-wide meetings; (ii) conduct of focus groups with selected communities not traditionally heard including African American, Hispanic, Refugees, LGBTQ, Farm Workers, Families with Children with Special Health Care Needs and Youth; (iii) facilitation of community forums with community members and providers to get feedback on preliminary findings; and (iv) dissemination of results to community partners. Results will feed into priority setting for Title V programming for the next five years 2020 – 2025.  This project is funded by the Arizona Department of Health Services (ADHS).

ADHS18-185671 Derksen (PI) 11/01/2017 – 10/31/2022 SAMHSA First Responders Comprehensive Addiction and Recovery Act cooperative agreement awarded to ADHS, ADHS-CRH Interagency Services Agreement (ISA) to develop a statewide, comprehensive first responder opioid/naloxone education program. Find more information at: SAMHSA-ADHS- AzCRH First Responder Grant.

H95RH00102 Derksen (PI) 09/01/2013 – 06/30/2021 HRSA and State funding of the Arizona State Office of Rural Health. AzSORH is a clearinghouse for information & innovation for rural health services. Find more information at: AzSORH.

Abstract not available. 

H3HRH00032 Barraza (PI) 06/01/2016 – 05/31/2019 HRSA Small Rural Hospital Improvement Program (AzSHIP) supports quality and performance improvement in 14 critical access hospitals (CAHs). Find more information at: AzSHIP.

H54RH00030 Derksen (PI) 09/01/2015 – 08/31/2019 Health Resources & Services Administration (HRSA). Medicare Rural Hospital Flexibility Program (AzFlex) - supports quality, operational and performance improvement in Arizona’s 14 critical access hospitals (CAHs) and their 17 affiliated Rural Health Clinics. Find more information at: AzFlex.

All activities conducted by the contractor will be implemented through community-based participatory methods supportive of building both professional and organizational capacity. A participatory model will be used that incorporates evaluation as part of program design, actively involves staff and program participants, and continuously incorporates evaluation into program implementation. Maia Ingram, MPH, Co-Director of the Prevention Research Center, will serve as the Principal Investigator or lead staff member for the MEZCOPH and will work on the contract with a ORA in providing evaluation services to the Mariposa Community Health Center (MCHC) in the evaluation of the Coordinated Community Care Model, a collaboration between MCHC and the Rio Rico Fire Department Activities Include: 1)     Review communication protocol and revise as needed 2)     Monitor and update CCCM Logic Model 3)     Conduct process evaluation with a focus on barriers, successes and recommendations in the expansion of the CCCM to other fire departments in the. region 4)     Oversee outcome evaluation of CHW and CCCM services related to chronic disease indicators using EMR 5)     Participate in project meetings.

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The quality of irrigation water drawn from surface water sources can vary greatly. This is particularly true for waters that are subject to intermittent contamination events such as runoff or direct entry of livestock upstream of use. Such pollution in irrigation systems increases the risk of food crop contamination. A single sample does not adequately characterize the risk potential present in large irrigation systems often utilized in the Southwestern US. This project aimed to define optimal monitoring strategies for irrigation water quality and develop guidelines for the irrigation of food crops. Following the analysis of 1,367 samples for Escherichia coli and physical and environmental parameters, the following key irrigation water collection approaches are suggested: 1) Explore up to 600m upstream to ensure no major contamination or outfalls exists; 2) Sample before noon; 3) Collect samples at any point across the canal where safe access is available; 4) Collect samples at the surface of the water; and 5) Composite five samples and perform a single E. coli assay. These recommendations consider the entirety of our data as well as sampling costs, personnel effort, and scientific knowledge of water quality characterization in the Southwest region. These guidelines will better characterize risks from microbial pathogen contamination in irrigation waters and aid in risk reduction practices for agricultural water.

Service: This project includes the development, implementation, data analysis, and reporting of a Tribal Needs Assessment for the Arizona Tribal Public Health Emergency Preparedness Programs.

A Review of the Public Behavioral Health System in Rural Arizona

This project is a small/pilot project program with the Southern California NIOSH Education and Research Center. This project was funded by University of California, Los Angeles (UCLA) through the CDC and NIOSH. For this project, I am serving as Ms. Sugeng's primary sponsor.

Developed research methodology to conduct a language services assessment, based on Joint Commission and CMS standards, conducted at a Critical Access Hospital that serves a U.S.-Mexico border community in southern Arizona. Focus Group conducted at AZ-CAH (May 2011). Provider survey created for pilot (Dec 2011). Kevin Driesen was a contributor on this project but has since left the University of Arizona. 

This center involves innovative and current models of research, service, and training within Arizona, and is part of a national network of Prevention Research Centers funded by the CDC. There is focused research in 4 border counties but the PRC community action board reflects statewide (including tribal) issues. This research project, Unidos: Linking Individuals’ to Social Determinant and Community Health Services will result in a model intervention to improve overall health and quality of life among predominantly Mexican-origin Latinos in Arizona. Principal Investigator: Scott CarvajalDeputy Director: Maia Ingram

This AHEC funded needs and assets assessment was completed in April 2010 and provided to the AHEC Health Sciences Advisory Committee and to the Regional Center for Border Health.

This contract provides the opportunity for our College to develop and implement a strong service learning program as well as to carry out research on the outcomes and impact of service learning on faculty, students, and communities.  It is presently supporting four service learning courses, one community policy practicum and 5 internships annually.   We are collecting information from the students regarding the impact of the course on their future career plans. Samantha Sabo was a contributor on this project but has since left the University of Arizona.

Dissertation research will measure corporate social responsibility (CSR) impact on proximal health and safety of migrant farmworkers employed in one socially responsible agribusiness located in Sonora, Mexico; and explore distal relationships of CSR on selected social determinants of health (SDH) among migrant farmworker households migrating from Chiapas to the Sonora study farm.  A community-based participatory research approach will engage agribusiness owners, health/social service providers, and farmworker stakeholders.  PIMSA will support two critical phases of research; (1) Key informant interviews to synthesize emerging and competing discourse and policies concerning the role of CSR on SDH and how this information is circulated, and understood by stakeholders and; (2) Retrospective case-control study to compare acute and chronic health indicators, including work-related illness and injury among regularly returning farm workers (cases) to those who do not regularly return to the same farm (controls). Study farm employee medical records for years 2004-2009 will be reviewed.  Case employees are expected to have less acute and chronic health issues and decreased work-related illness/injury compared to controls.  Budget will cover travel, per diem, and lodging.

This grant provides funds for some rural health research and evaluation activities. The following were conducted in 2012 and some are continuing into 2013.Each activitie is identified as research, service, or training. RESEARCH: Conducted an Investigation of Rural Women's Health Literacy Levels and Preferred Sources of Health Information - IRB approval was secured early in 2012, data was collected from 350 subjects between February and May 2012, data analysis was conducted from August to December 2012, and data analysis is still ongoing. RESEARCH: Evaluation of the impact of the MEZCOP Arizona Rural Health Professions Program's rurally-based week-long, intensive service-learning courses on public health graduate students subsequent career plans and choices related to rural practice. Planning of this research project began in November 2012, and the IRB application will be submitted by the end of February 2013. The project will survey all MEZCOPH current students and alumni who have participated in any of the rural or underserved area Service-Learning Institutes since they began in 2008. The purpose of the survey will be to determine if the goal of the Rural Health Professions Program - to increase the numbers of public health students who practice in rural and underserved communities in the state of Arizona - is being achieved. SERVICE: Conducted two Community Conversations on Health Care - one in Marana and one in Ajo - to collect community health needs assessment data, and document the findings through a report for each event provided to the community and published on the Center for Rural Health Website. This research project will continue throughout 2013. SERVICE: Performed additional collection, analysis, and publication on the Center for Rural Health Website of existing health-related data resources for the border counties of Cochise, Santa Cruz and Yuma in the in the "Arizona Border Region Data Resources and Virtual Library." This project will continue throughout 2013. SERVICE: Planned and conducted a community needs assessment project for Mohave County Health Department and Kingman Regional Medical Center in Kingmam, Lak Havasu, and Bullhead City. Reports documenting findings were prepared for each site and delivered to the Mohave County Health Department. Project is still ongoing. TRAINING: Provided Community Health Needs Assessment skills training to selected staff of the Mohave and Navajo County Health Departments. Training for others is planned for 2013.