Evaluation of New Hampshire's Rural Hospital Flexibility Program
Evaluation of the New Hampshire Rural Hospital Flexibility Program
(NH Flex Program) focused on the experience of the hospitals that have converted to Critical Access Hospital (CAH) status, the assistance provided to the remaining hospitals that are eligible for conversion, and the satisfaction of the staff of the hospitals and related community organizations with the support and assistance provided to them. Also evaluated was the role of the Access Improvement Plans prepared by the CAHs to increase local collaboration, enhance primary care, improve access to primary care, and strengthen the emergency medical services systems in their communities. Data collection efforts included the review of documents and materials related to the NH Flex Program; interviews and focus groups with NH Flex Program staff, key state officials in agencies that collaborate with the NH Flex Program, key stakeholders and members of the Rural Health Advisory Committee, hospital and community agency staff, and community representatives; and site visits to two hospitals that have converted or are in the process of converting to CAH status.
The evaluation team analyzed this data and are preparing recommendations and findings for the future development of the NH Flex Program. The evaluation team is also assisting the NH Flex Program staff in identifying performance measures to monitor program implementation, and helping program staff to develop and implement a performance monitoring system to guide the program. This performance monitoring system will help New Hampshire to prepare for the development of Program Logic Models that will be implemented as part of the evaluation of the National Rural Hospital Flexibility Program.
Data from the American Hospital Association for the years 1989-1995 and 2000 and from the Census Bureau, plus data on the states' scope of practice laws and medical malpractice liability reforms were used to estimate the number of hospitals no longer providing obstetric care and to examine the factors underlying these changes. Natality data from the National Center for Health Statistics (NCHS), including data on demographics, geographic area, and variables including birth weight, gestation, prenatal care, attendant at birth, and Apgar score were used to estimate changes in sites of delivery and relationships with birth outcomes. Experiences in counties experiencing a loss in obstetric resources were compared with experiences elsewhere. Interviews with members of communities experiencing a loss of resources supplement empirical findings. A report and policy brief along with policy recommendations will be prepared for distribution to policymakers and persons on the Center mailing list.
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