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UA Awarded $1.5M Grant to Improve Rural Hospitals

The Rural Trauma Team Development Course is one of many AzFlex-supported training programs for Critical Access Hospital staff, local fire departments and EMS.

The Rural Trauma Team Development Course is one of many AzFlex-supported training programs for Critical Access Hospital staff, local fire departments and EMS.

The Mel and Enid Zuckerman College of Public Health's Center for Rural Health will use the funding to provide training and information to 14 Critical Access Hospitals, 21 Rural Health Clinics, and a statewide network of primary care, trauma and EMS workers.

The Center for Rural Health, or CRH, at the University of Arizona Mel and Enid Zuckerman College of Public Health has been awarded a three-year, $1.5 million grant by the Health Resources and Services Administration to support the Arizona Medicare Rural Hospital Flexibility Program. AzFlex provides quality, operational and performance improvement in Arizona’s rural hospitals and affiliated outpatient services.

Arizona’s 14 Critical Access Hospitals and 21 Rural Health Clinics play crucial roles in assuring access to quality health care, improving population health outcomes and contributing to a community’s overall economic health and development. The AzFlex program provides technical assistance, training and information resources for Arizona’s Critical Access Hospitals, Rural Health Clinics and a statewide network of rural primary care, trauma and emergency medical services providers.

The AzFlex work plan for the next three years has four program areas: quality improvement; financial and operational improvement; population health management and EMS integration; and Critical Access Hospital designation in Arizona.

"The Center for Rural Health is ideally suited to carry out this important work in Arizona’s rural communities," said Dr. Daniel Derksen, director of the CRH and principal investigator for the grant.

The CRH also houses the Navigator Consortium, the Small Rural Hospital Improvement Program and the State Office of Rural Health.
"While our Critical Access Hospitals’ fiscal performance improved in 2014, we face new threats," said Jill Bullock, CRH associate director and AzFlex program manager.
Some of the threats Bullock cites include the 5 percent Medicaid hospital payment cut; lower participation rates in Medicaid and Marketplace coverage in rural, Hispanic and American Indian populations served by Arizona’s CAHs and RHCs; new state and federal regulations; and requirements to report on quality, satisfaction and other performance measures.
"Those threats are ominous. Over the last five years, 58 rural hospitals have closed, including one in Douglas where 70 people lost their jobs," said Derksen, who testified on the issues challenging rural hospitals and health services before the health subcommittee of the U.S. House Committee on Ways and Means last July.

What Is a Critical Access Hospital?

A Critical Access Hospital, or CAH, is a rural acute care hospital having no more than 25 inpatient beds. The CAH must not exceed a 96-hour length of stay and will have agreements, contracts or affiliations for transfer and services. CAHs also must offer 24-hour, 7-day-a-week emergency care and must be located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or in areas with only secondary roads available, the mileage criterion is 15 miles). For more information about Arizona CAHs, visit

About the Center for Rural Health

The Center for Rural Health at the UA Mel and Enid Zuckerman College of Public Health serves Arizona through its mission to improve the health and wellness of rural and vulnerable populations. Established as the Rural Health Office in 1981 with funding from the U.S. Department of Health and Human Services, it coordinates statewide rural health initiatives. Center staff, faculty and collaborators have expertise in population, rural and border health; rural and critical access hospitals; community health centers including rural health clinics and federally qualified health centers; health workforce assessment, planning and policy development; community engagement; service-learning training; practice-based research; and rural health policy development, implementation and assessment. For more information:

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