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Home My WebLink AboutAlaska Rural Primary Care Facility Needs Assessment Volume I - Overview Final Report 2000Alaska Rural Primary Care Facility Needs Assessment Volume I e Overview :a '. *a ' ae.?ot, a * ae a si oO oe,ry me w hbase 4 Pg we”roy4eeedTNae ALASKA RURAL PRIMARY CARE FACILITY NEEDS SE Se T October 23,2000 Dear Commissioners: The Steering Committee for the Alaska Rural Primary Care Facility Needs Assessment Project has published the enclosed Final Report summarizing its work to: e Build a statewide database of detailed information on rural primary care facilities and program services. e Develop a set of goals and guidelines that can be used as a benchmark for estimating the statewide-unmetneedrelatedtoprimarycarefacilities. e Establish a resource distribution methodology for rural primary care facility projects funded through the Commission. This Final Report is the culmination of ten months of collaborative effort incorporating information from acommunityquestionnaire,testimony received during statewide public meetings,and written comments submitted to the Steering Committee. We appreciate the significant contribution made by the 218 communities that completed the questionnaire andtheover200individualswhoattendedmeetingsand/or submitted written comments.While this project has launched a process that will improve Alaska's rural clinic infrastructure,the work has just begun.We encouragetheon-going,active participation of those who are committed to strengthening and continually improving therecommendationsandproceduresoutlinedinthisreport.Our intent and hopeis that this first effort will evolveintoanon-going process that meets the primary care infrastructure needs of all Alaskans. Sincerely, Steering Committee Members ZZJoelNeimeyer,PE Rick Boyce,PE Project Manager Director,Division of Health Facilities Denali Commission Alaska Native Tribal Health Consortium Torie Heart,MS,RN Patricia A.Carr,MPH Director,CHAP/Rural Health Manager,Primary Care and Rural Health Unit Indian Health Service Division of Public Health,State of Alaska D56914.Commissioners.JAF.102300.kms 3925 Tudor Centre Drive,Anchorage,Alaska 99508 Phone:(907)729-3606 Facsimile:(907)271-4735 Web:http://www.apcds.com ALASKA RURAL PRIMARY CARE FACILITY NEEDS ASSESSMENT PROJECT FINAL REPORT VOLUME I OVERVIEW Prepared for: DENALI COMMISSION 510 "L”Street Suite 410 Peterson Tower Anchorage,Alaska 99501 (907)271-1414 Prepared by: Alaska Native Tribal Health Consortium Department of Health and Social Services Indian Health Service October 2000 This page intentionally left blank. Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 VOLUME!-OVERVIEW TABLE OF CONTENTS Page PREFACE .......ccccsssssssssscescsccesescessecessenccssscssescseeecscesseceseseeseseessceesecsacceceessaseessesaneseeeseassaenssvososens 1 A.EXECUTIVE SUMMARY .......secsssscccssssessscesecseseceessesescececeacacensscescscensssesensosseceessessseasansass 3 B.BACKGROUND .......cccccsssssscsesssscescenescsecesescesessssuceesecsceseeseeensceeceasscecearsasareneseeseneeessaessoeass 7 C.NEEDS ASSESSMENT PROJECT..........:esssssssecsecssececceccesceccacenesceacsceecseessceessnseseesseeeeaees 8 C.1.0 Authorization and Funding ..0.0..ce sesseesssesssecessenessssssssensssessessrcsssescecssseessenseeses 8 C.2.0 Objectives and Schedule...cs sescesessssssesesssessssseceensessssseseacsensesseesseeneseaes 8 C.3.0 Project Team .........csssescsccesecceseesseesecesceccecensscescssseseseeccecsesesecesscsceeseeesaseessssoasosoes 9 C.4.0 Basic Criteria .........cc escssecscsscnsessceesssecensecssceesessesscescscesseeseesscesasesesscseseesesseessessonses 10 €.5.0 Website ......cecescssescsescsssccescesseeseesscescescensensessesesscessecessessessscessesseseccsarssesoeeeessoetes 11 C.6.0 Public and Stakeholder Input...esssecescscsececessescescsesteeceenccecsecesseecesseeseese 11 C.7.0 Phase II -Primary Care Program Development and Support...eeeseeeeeseees 11 C.8.0 Beyond Primary Care Facilities .............cssscssssccessccsesssessessccssesceescersseeeesseeesaseneees 12 D.QUESTIONNAIRE .........ecsssssssssecceseceevcncecsecscecsesecsceceecacececensesensaceneaseessceececsersceeseeteceaseeee 12 D.1.0 OVErVICW........eecessecescesecseececescescecscecssceesecsecscescessasssecseassceecsecarseseesencaseeseseeseeaseasees 12 D.2.0 Response Rate...ccesesssssesssssecececsscsssssscnesssssrscessessescasseesasossessseeseesssessasonesoees 14 E.ALASKA PRIMARY CARE DATA SYSTEM...ccessessceececeetecessscesesecsceceessesseesseesoes 14 E.1.0 Alaska Primary Care Database ..............scssssscsssssesessesscsecsscseseecesssencsecesecssesensenees 15 E.2.0 Queries and Reports...ccsssssssseccccscsecscescssesecsencenssseesesecsseeseccesscceasecseeseasesees 16 E.3.0 Geographic Information System...csssssessssecsssscssseesetceccsececseersceeseaseesseceacees 17 E.4.0 Access to Data...ee esessssceceessseeesscsssnsssseesssesscesecesssesessssesssacensseesecaseresseseeees 17 F.PUBLISHED PROGRAM GUIDELINES AND REGULATIONS ..........eeecesesceeeeeseeeees 18 F.1.0 Federal Community Health Center Program .............:csscssssssssssesescescsscenceeeesneeats 18 F.2.0 State Emergency Medical Service Program ...........cccsssssssseseeereceectecesseseeeeseesesees 19 F.3.0 IHS Community Health Aide Program..........csessscscscscecsesecseeseeseesecesseseeenseceasens 20 F.4.0 Alaska Assistance for Community Health Facilities Program ...............scesssseees 21 F.5.0 Federal Rural Health Clinic Program...teessssssssesececesseseseeeessesesescesceseseceeoess 22 G.PUBLISHED SPACE STANDARDS AND GUIDELINES...ccessssscscsssessssrsseesseeees 22 H.ALASKA RURAL PRIMARY CARE GOALS........eeescsssccesseeeseeseectsereetecessesaeseseceeaoes 23 T.UNMET NEED...eseceseseececeeseeceesescececenceceesacsessearsssescecessceessececesseaseaseneseseeseseeaesusessoos 26 1.1.0 Additional Space for Individual Locations .0.........eee eesseeecesssessaceeseaseessnseunes 26 1.2.0 Multi -Community and/or Larger Facilities...eee eeseessesseseeeeesceaseeeseseeeeunes 27 1.3.0 Backlog of Repairs...seesccsssssscsssscecsssssessssesssceseeseeesessessscsssscessseseuseaseessesarsseees 27 1.4.0 Routine Maintenance and Improvement ............ccesseccsseeceeeesceenseeeeeceeaeeseeeseesens 29 T.5.0 SUMry occ eeeeceecceceseeeseseeseeceecccesceseecessesccasecsecsageeeeeesssessesnscuasecesesseeusesssensnse 30 Volume I Page i Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 J.RESOURCE DISTRIBUTION METHODOLOGY...........ccccssssssssessssesesesessssesseseseencseseees 31 J.1.0.Part 1-Community Prioritization ..........ccccesssssescsseeseesseesees ceesceseesseeecceaeeeneeseceaes 33 J.2.0°Part II -Proposal Review and Capability Measurement .............ccccccsssseesesseseeseees 34 J.3.0 Part TT -Funding...ccccsesssssessscseecenssnescescescesceaecsesscssenesseseseessensesseaeeseesenes 35 K.PROGRAM MANAGEMENT ......ccsssssssosssssssssesssecsstscsscssssenssesseseecaseesececsceaceeaeeneerseeeee 36 L.RECOMMENDATIONS .........cscessssssssscesescssecseetescsacsnesccccessessesseassseaeesecssasaceseeceecsneessenes 38 M.LIST OF RESOURCES AND REFERENCES ..........ccssssssssseesssessesecesesessssseesecessseesssaseess 40 TABLES 6:10)(0 ee ee Unmet Need Data Table 2 ee escssssseeccsssesessesnsescesscereessessssesscssessessseeseessesoesseeseessesesessecessaseneas Project Milestones 6:10)(ke ee Primary Contacts 010)(ee FNAQ Response Summary Table 5 oo.ceccsscssssscscssssscssssessessssecsessncsscsscserscersetsssseaesacessenssuesseesenseassersnsesenes APCDS Software Table 6 vec essseccecssssessssessescacesssscecscsscencsnsscessensenecassassneossaceaseneeaesnsenes APCD Data Resources 10)(Ct ee Community Levels 61)(eee Minimum Program Goals Table 9 oo teescscccssescesescscescessceessccececssescscnesacseseesseesseseacsseeceseccnesecessaceeseeees Space Guidelines Table 10 ou.esssesssessssecsscesecceccssssecsesseassnsecesescesececeeceececsecsnssassessaseatsesscneess Unmet Need Data FIGURES Figure 1 uo...seseeseceesecsececescnsecenccensssessscncacecsasecsecanenseesscersasensacees Project Organizational Chart FIgQ"uyre 2 00...cesssessecessseseecsccncsscsccereccescessseseneecees Resource Distribution Methodology Flowchart FUGUE 3 ou...eessesecesceseceecencececcessceeeceeeseceescseearseees Rural Primary Care Facilities Program Model APPENDICES Appendx I oo...ee ecesssccsceercceesceceseesecsncsecssssoeseconcessceneeeseees Denali Commission Legislation Appendix IL...eeceesccceceseencscceseccescecessesseeseseccsesensessescescenceaseneeeceteeescesseesees Community List Appendix TID.escsescesesssececeecesceasersscescsseececesacesseesseseceaceecesseaenscensacenesseeses Questionnaire Appendix [V......eeeeeceessecessescecessensencsteasesssrssssacestesueseeaeensatessesseeeseases 2000 Census Districts Appendix Vou...eeesesesccssstsncesccssssessessesseneesessssessessessscaesceseseecseseeaeensenes Sample Ad Hoc Query Appendix VI...eessssssscecsceseeceeessencecesescees Sample Geographic Information System Display Appendix VII ..0.....ce cessscsssssssccessessessscssssessesssenscsseecessensesseseeeees Boroughs and Major Highways Appendix VIIL os escsscseecccsseesscessesceeseseeesssesersesssecersereaceeeserees Space Standards Comparison Appendix [Xue eeseececescecseessscecescececessscscesessoesasencessessansenesnees Unmet Need By Census Area Appendix Xu...ecssscesessesenecceessesscesssscensssesscessecssceecesseasesenestesseaseneesees Multiple Year Schedule Appendix XI...eesscsceceeeeeeeseeseeseceeesseeeseerseees Part I -Community Prioritization Formula Appendix XII uo.eescsessssssceeseceesesccesssessesnsssessesssessacensansecees Part I -Prioritization Summary Appendix XID...ce cssssssccsssceessecesececeeesesessseceesessnseneaseeseraes Part II -Capability Measurement Volume I Page ii Alaska Rural Primary Care Facility Final Report Needs Assessment Project ;October 2000 VOLUME II -DETAILED ALGORITHMS AND DATA TABLE OF CONTENTS Detailed Unmet Need Algorithms Detailed Part I Prioritization Algorithm Health Status Indicators Dependency Ratio,Economic and Trauma Registry Data Miscellaneous Community Data Part I Priority Scores and Unmet Need Data a7moOwD>APCD Data Field Summary Volume I Page ii Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 VOLUME III -APCDS TECHNICAL DOCUMENTATION TABLE OF CONTENTS A.General Information Alaska Pimary Care Data System Requirements Document 2.License Agreements Training Documentation =Project Website *Alaska Primary Care Data System =Alaska Primary Care Data System -Geographic Information System B.Alaska Primary Care Data System 1.Installation Procedures 2.Technical Documentation C.Alaska Primary Care Database 1.Installation Procedure 2.Entity Relationship D 3.Dictionary 4 .External Data Source Contacts and Information =Department of Community and Economic Development Database «Department of Health and Social Services Statewide Health Status,Economic Dependency and Trauma Registry Data *Department of Health and Social Services Village Health Clinic Information (1994) «Department of Transportation,Federal Aviation Administration Regional Airport Plan ="Emergency Medical Service "Facilities Needs Assessment Questionnaire *Indian Health Service Facilities Database =Public Health Nurse Survey Database D.Geographic Information System 1.Installation Procedures 2.Data Dictionary Volume I Page iii Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 LIST OF ACRONYMS ACRH ou...eesssecsessetscssceseceacencsececesceseessessessesecesecsseessseseeseesnsees Alaska Center for Rural Health ADA Qe sesesceessceeeeeeeseesseseeateoeessnssceuscassscsencassaseneacenescessesesesecens Americans with Disabilities Act ANDB 00...eiescssscsscsceecesescessccesesessneeaeecsccessessesssscencsesenseacsneeaeseneaees Alaska Native Health Board ANMC,..u ee cesssecscsseessceeesesseeserscnessceaseaceesecssersanseesneessnssseaseseeseneeas Alaska Native Medical Center ANTHC nee ecseesscssceseeeeecesneecseesseaseatecsseateseseseeeeeees Alaska Native Tribal Health Consortium APCA Quoc eeccssesssssscessesenceceseceseceecensenseseeenseesseaeesseseessessesseateseees Alaska Primary Care Association APCD...eccescssesseesesesscscesccersersesceseasesseseseeessesessessessenessssneseecseees Alaska Primary Care Database APCD...ceccssesessessesecsesentesnsesscesssensesaceessacensessteseeeseseessessscoss Alaska Primary Care Data System ARC ooecesescscceesseneseseecesscessscseeseeeeeenessesceeseeaseseasscesessesaseeenes Appalachian Regional Commission ARPCENA .....ccsecescesseseesesseeseeeseeaeseeenes Alaska Rural Primary Care Facility Needs Assessment BTU...eeeecesssssscscsesscccescscssecescesssccseacecsscessesssnsasaccencaesnsssaesneaesseaeatseeeeensseseses British Thermal Unit ©)D)5 C anne Community Development Block Grant Ol S 0.en Community Health Aide CHAP oes eeceeeecesssnccsseccersesceseesesessensessseesessssssseseeceessseneseeees Community Health Aide Program CHAP 00.ee eeeecsccssecessessescesteccesceseecsessseeessensesseseeseesseass Community Health Aide/Practitioner CHC uo.eeeeeseeseessecssersecctesecsnsctsessssesssecssesssssesrssseseeseecseceeseessessesanseas Community Health Centers CLIA woe cesesccsesseseeseesceeeeesseseeeasecesacsesecesssssenseesaeenessens Clinical Laboratory Improvement Act C/IMHC,...eeeecesssecsesessescesesersecssescensecsenesssecessssesacesesesecsereneees Community/Migrant Health Center DCED.00...eesesessecesstsereeneeesneaes Alaska Department of Community and Economic Development DHHS...eesssscsescsceececesceceeeceeteneaceeseseeseeenenss U.S.Department of Health and Human Services 1B)5 Ss ee Alaska Department of Health and Social Services HUD...ee eesccsscsescsenccseeceseeaseeteeseseeenees U.S.Department of Housing and Urban Development EMS ooo ee eesssesescsesssssccssseeesessseessssosenessnecsseessseesesseesessseasenseeseeessesseees Emergency Medical Service EMTuu...eeeesssesssssssecsesescnscesecceceesececessensenseseacscsscosseseessenceesesaeess Emergency Medical Technician FNAQ....oceeecsseseeccscesesseceseseeececeessceacseseceeseasensesenesnes Facility Needs Assessment Questionnaire FQHC1...ececesssssscseesececesesceessecececsscecsensecenecsesseeaessenesasesees Federally Qualified Health Centers FE.woes ccessssessecescecesesseseseescescscctscecsrsssssecssesceassnesseacesessesssecesesseseeseeseensees Full Time Equivalent 6)AS ne Geographic Information System GSF oo.eeecesscsesesesescesesenssseeuesctscescesessceecessenssssacessensasssesssasenessesesaesatensesessenes Gross Square Feet FRSA1.nee eeeeeesceceeeeeeeseessceeceececessseseaceenesneseesees Health Resources and Services Administration FITMLL occ ecetcessecescccescesessacsscesccesceseesessssensssesseseeensssceneeeeenses Hyper Text Markup Language FIVAC oe eeeeeseceeseceecsceseseseeeecencesctsesseasesesnsceseeneeses Heating,Ventilation,and Air Conditioning ICD BG uu.eeesseseeescesseecsseeseesesceesecesessneenenaeecees Indian Community Development Block Grant THS 0s eeeecececescececceceesscescecesesecescseessssccessesesesescesnsasessseeseeneseesseasenseseeeesees Indian Health Service 1(4 Cere Maintenance and Improvement MLP 000.cesesessesessececesensceceseeoncocesscescenseescesesssacecssseaeessereaseseensesessseessesnssseass Mid Level Provider MRP...eeececececsecectscecteceeceeseececcecsaseseecssecssseasesssssecsaesnseseaees Multi-disciplinary Review Panel NFPA o.oo.cessceeseetecescencesseccesceesseceesesaseseeessesaceneeeceaeeneeaneass National Fire Protection Association OEM0...eee ceceesscsessescesenenseceaseaeccessesseesseeseescessonsacesesssessassesaseassaeeeens Operation and Maintenance PITS ooo eecseeseeeecesceeceeseceeseeseeesseseessesscesseseseeeceessesseseens Project Information Tracking System RDM...ceeeeeecsesseeceecenseseseesseesseeesecensecaeenseeseeeesaeseessesaeesees Resource Distribution Methodology REP ose cteeececseseescseesnenscssceenenecenseseessaeseeseseasesesseeaessessessessssssssseseeaeess Request for Proposal RHC ooo ceeesesscsescecsctsecseccecescceesceacatssesceasensaesesscenesssessesseesseseeseseeneseeacstsesensees Rural Health Clinic SOW...ccescssssssssesssssssscssscnenssesssersssceecsseseesesccsescensasssessacescsetsacsesaeatsseesessaeseessenees Scope of Work UBC wee eeeeesssscscesestecestsceecencuacenseceaceasecteaesscseesaescesseaseaeeenseeseeaesaessesessees Uniform Building Code Volume I Page iv Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 UFC...eeeceecscesesscessessaceccssetensecececesseeeesssacsssasesssesescesossacsacsacssesaceacenesssersens Uniform Fire Code USDA...cesesseeseseseesseescasserscnssscesseseescesseececseeeeeseeseeseseatecees U.S.Department of Agriculture WIC.......veseceesseesensesseessncesssssesneusnsceceeceaceecensecseenscessecseseasseenseeestens Women,Infants,and Children YRHC 0...ceccsstsessssstesseeeeesesesesessesesesssesessessseseeseeeeeseees¥UKON-Kuskokwim Health Corporation Volume I Page v Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PREFACE The Denali Commission Act of 1998 (Division C,Title III,P.L.105-277)created the Denali Commission (Commission).The Commission is an innovative federal-state partnership established by Congress to provide critical utilities,infrastructure,and economic support throughout Alaska.Its mission is to lower the cost of living ---and raise the standard of living ---throughout rural Alaska in the most cost effective manner possible.The Commission receives an annual appropriation from Congress and then,through its Commissioners,allocates these funds for specific projects.Criteria for funding and an annual work plan are developed with public participation.Priority is given to comprehensive,community based and regionally supported,sustainable projects.The original enabling legislation identified three areas of focus for the Commission including job training,economic development,and infrastructure development. The Commission has seven members who are listed below. *Fran Ulmer Lt.Governor,State of Alaska and State Co-Chair «Jeffrey Staser Federal Co-Chair ="Mark Hamilton President,University of Alaska ®Julie Kitka President,Alaska Federation of Natives *Mano Frey Executive President,Alaska State AFL-CIO *Kevin Ritchie Executive Director,Alaska Municipal League "Henry Springer Executive Director (Retired),Associated General Contractors of Alaska In general,the Commission is based upon a format similar to the Appalachian Regional Commission (ARC),which was created in 1965 to fulfill a similar mission for 13 eastern seaboard states.Of interest to the Denali Commission and Alaskans is that one of ARC's primary goals was to insure that:"Appalachian residents will have access to affordable, quality health care.”As further evidence that Congress intended for the Denali Commission to address health care issues,amendments to P.L.105-277 were enacted at the end of 1999 authorizing demonstration projects between the Commission and the U.S.Department of Health and Human Services (DHHS)---that can extend beyond primary care facilities,e.g., into hospitals,mental health facilities,elder care and child care facilities (see Appendix I for Volume I Page 1 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 full text of referenced amendment).Accordingly,the Denali Commissioners adopted Resolution 00-01 on January 28,2000 identifying rural health care facilities and services as the second area of focus or theme for infrastructure related projects funded and supported by the Commission.Their first infrastructure focus was rural energy projects. The following report provides background on the goals and objectives of the Alaska Rural Primary Care Facility Needs Assessment (ARPCFNA)Project ---one of the first health care related initiatives undertaken by the Commission.It includes an initial estimate of the unmet need with respect to primary care facilities in rural Alaska,and describes the Alaska Primary Care Data System (APCDS)and Resource Distribution Methodology (RDM)developed as part of the project. The following websites contain more specific information about the Denali Commission itself and the Rural Primary Care Facility Needs Assessment Project. ="www.denali.gov =www.apcds.org Volume I Page 2 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 A.EXECUTIVE SUMMARY In October 1999,the Denali Commission approved funding for a project with the Alaska Native Tribal Health Consortium (ANTHC)to develop an assessment of rural primary care facilities related needs throughout Alaska.The Commission and ANTHC subsequently formed a partnership with the State of Alaska Department of Health and Social Services (DHSS)and the Indian Health Service (IHS)to: 1.Build a statewide database of detailed information on rural primary care facilities and program services. 2.Develop a set of goals and guidelines that can be used as a benchmark for estimating the statewide unmet need related to primary care facilities. 3.Establish a resource distribution methodology for rural primary care facility projects funded through the Commission. The purpose of this final report is to document the results of the Alaska Rural Primary Care Facility Needs Assessment (ARPCFNA)Project.The report includes an initial estimate of the unmet facility related needs. A relational database has been developed that includes detailed information on primary care facilities and program services for 288 communities throughout rural Alaska (all locations with year-round populations greater than 20 and no existing in-patient facility).The final database and associated applications are being referred to as the Alaska Primary Care Data System (APCDS)which has the following capabilities. «Web Enabled *Ad Hoc Queries "Graphical Analysis via a Geographic Information System (GIS)Component A set of primary care program goals and space guidelines have been established for rural Alaska.These goals and guidelines (reference Tables 8 and 9 on pages 24 and 25)were used as a benchmark for establishing unmet,rural primary care needs for the state.,Table 1 Volume I Page 3 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 summarizes the new statewide space requirements derived from these goals and guidelines. Also included in the table is an allowance for 12 -14 new multi-community clinics around the state where it may be more appropriate to construct a single but somewhat larger facility to serve several small communities within a common service area.This multi-community or "sub-regional”concept is a proven model and is being successfully implemented by entities such as the Yukon-Kuskokwim Health Corporation (YKHC).The last entry in the table is an estimate of the funding required to correct the backlog of needed renovations and repairs at existing rural primary care clinics. Table 1:Unmet Need Data Unmet Need Category (Gs)(millions) New Space at Individual Locations 305,000 $99 New Multi-Community Clinics 130,000 $52 Backlog of Repairs 330,000 $102 Total $253 1.In terms of May 2000 dollars The dollar estimates summarized above include design,construction,and equipment.They do not include unmet program needs (staffing and other operational costs). A resource distribution methodology has been developed for prioritizing funds made available through the Denali Commission for primary care design and construction projects. Significant public and stakeholder input was solicited during the development of this management tool.The three-part process is outlined below. Part I:Community Prioritization Comparison of all eligible communities based on data in the APCD and a prioritization formula that includes seven factors. Facility Related Deficiencies Overall Regional Health Status Isolation Dependency Ratio (Ratio of Young and Old to Working Age Residents)PYNSVolume I Page 4 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 5.Economic Status 6.Local Incidence Rates of Trauma Related Hospitalizations 7.Seasonal Population Increases Part II:Proposal Review and Capability Measurement Based on available funding,a short-list of communities from the top of the Part I prioritization list will be invited to submit detailed project proposals.Proposals will be evaluated by a multi-disciplinary review panel (MRP)with respect to the following criteria. 1.Local Support for Project 2.Site Availability and Control 3.Utility Extension Plan 4.Cost Sharing 5.Service Delivery Plan 6.Business Plan 7.Facility Related Deficiencies 8.Consistency With Overall Community Development Plan 9.Multi-use Components of Project 10.Project Management Plan If proposals are determined to be inadequate with respect to any of these factors and/or specific data needs to be verified,the proposal will be referred back to the community for amendment.In these instances,recommendations may be provided on where to secure technical assistance to develop the appropriate amendments.Based on the Part II results,an annual approved project list will be published. Part II:Funding Funding agreements and transfers will be initiated once the Denali Commission's Program Manager has determined that all appropriate planning,design,permit and construction related documents are in place. The recommended methodology is intended to be an equitable system for the distribution of federal funding to those communities with the greatest need,recognizing that the successful delivery of health services includes the ability of a community to operate and maintain the facility over the long term.More detail on the distribution methodology can be found beginning on page 31.Appendix XII contains the FY01,Part I Community Prioritization. Volume I Page 5 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 In September 2000,the Denali Commission selected ANTHC as the Program Manager for the APCDS and most of the rural primary care facilities related projects funded through the Commission.ANTHC is providing a database administrator who will maintain the APCDS. The four primary partners in the project will have full access to all data in the system.For data confidentiality reasons,other organizations and/or the general public will only have access to aggregate data summarized on a regional or service area basis. Volume I Page 6 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 B.BACKGROUND In most parts of the country,the highest cost of delivering health care service is found in urban areas.This does not hold true in Alaska where rural residents generally face higher costs than those found in the state's major population centers.Rural residents are isolated from the regional hospitals and health centers by immense distances,climatic extremes,and geographic barriers. Initial access to either the native or private health care system for most rural residents in Alaska is through a small,village-built clinic facility.Most are locally staffed with a Community Health Aide /Practitioner,funded in part by IHS.Services are generally limited to basic primary care and emergency medical treatment.Most clinics do not provide behavioral or dental health services.The IHS provides minimal lease funds (typically $20,000 annually to a community)for some 168 such facilities to cover basic utility and janitorial costs.IHS has no recurring capital improvement program for these facilities.A large number of these facilities are in need of repair,renovation or replacement.Many are not even connected to a water and wastewater system.Small,non-native communities scattered around the state have similar facility and program issues.In 1994,DHSS compiled basic information on most village health clinics in the state (reference DHSS Village Health Clinic Survey).Of the 174 facilities that were subjectively "rated”with respect to physical condition,approximately 33 percent were categorized as needing replacement or major renovation.Seventy-nine facilities (40 percent)were still using a honey bucket and/or pit privy system for sewage disposal.Currently no one federal or state agency is tasked with oversight or prioritization of improvements for these facilities.There are unmet needs both with respect to program and facility funding. There has never been a comprehensive one time or recurring funding source to build or renovate primary care clinics for rural Alaska.Nor can small rural communities participate in the normal (and backlogged)IHS health facilities priority system,which is solely for building and replacing regional and referral facilities.The limited capital funding made available for rural clinic projects to date has come largely from the U.S.Department of Housing and Urban Development (HUD)-Community Development Block Grant (CDBG) Volume I Page 7 Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 Program,Department of Agriculture (USDA)-Rural Development Loan Program,special state appropriations,and/or commercial loans.At best,communities are usually forced to patch a project together from several sources.More often,projects are either put on hold due to a lack of funding or significant compromises made with respect to space and/or construction standards. C.NEEDS ASSESSMENT PROJECT C.1.0 Authorization and Funding In October 1999,the Commissioners approved funding for a project with ANTHC to produce an assessment of rural primary care facility related needs throughout the state.ANTHC offered to provide project management and a portion of their own funds for the effort.In light of its mission to provide federal services for all of Alaska,the Commission and ANTHC sought the participation of the Alaska DHSS.After DHSS agreed to collaborate on the project,the three parties then sought the participation of the IHS based upon their long history and in-depth knowledge of rural primary care programs and facilities.On February 24,2000,the four partners finalized an agreement for carrying out the ARPCFNA Project. C.2.0 Objectives and Schedule The needs assessment project had three main goals. 1.Build a statewide database of detailed information on rural primary care facilities and program services. 2.Develop a set of goals and guidelines that can be used as a benchmark for estimating the statewide unmet need related to primary care facilities. 3.Establish a resource distribution methodology for rural primary care facility projects. Volume I Page 8 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 An overall schedule for the project appears below. Table 2:Project Milestones (Calendar Year 2000) Task Start -Finish Scoping and Project Start-Up January February Establish Criteria January May Data Collection March August Design and Develop Database April July Interim Report July Develop Methodologies May September Design and Develop Computer Applications March September Final Report October Information from the needs assessment project will be used by the partners to seek funding for both improvements and/or new facilities and primary care service enhancements.In the event Congress looks favorably on the results of the assessment,the distribution methodology should guide federal,state,municipal,and tribal managers on which projects to fund and in what order. C.3.0 Project Team A project Steering Committee was formed that included representatives from the Denali Commission,ANTHC,IHS,and DHSS.A project organizational chart and primary contact list appears below. Table 3:Primary Contacts Name Organization |Position Phone e-mail Joel Neimeyer,PE Cc openali on SC (907)271-1414 |jneimeyer@denali.gov pat_carr@health.Pat Carr,MPH DHSS SC (907)465-8618 car@nea Torie Heart,MS,RN THS SC (907)729-3642 vheart@anmc.org Rick Boyce,PE ANTHC SC (907)729-3601 rboyce@anthc.org Gary Kuhn,PE ANTHC Masser (907)729-3604 | gkuhn@anthc.org SC =Steering Committee Member Volume I Page 9 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Figure 1.Alaska Rural Primary Care Facility Needs Assessment Project .Organizational Chart Denali Commission | a J. I a l Indian Health Service Alaska Native Tribal Health Consortium State of Alaska Director,Community Health Aide Program Director,Division of Health Facilities Department of Health and Social Services Manager,Primary Care &Rural Health Unit ANTHC Project Manager | NANA/DOWL Engineers GeoNorth ANTHC was tasked with the overall responsibility for developing a work plan and schedule to meet project goals.ANTHC and the Steering Committee received assistance from two primary consultants during the project:NANA/DOWL JV (health facility expertise)and GEONORTH,LLC (database design).These services were obtained through an existing indefinite delivery contract between ANTHC and NANA/DOWL.The Commission and ANTHC agreed to use this contract in order to expedite the project and meet the key milestone dates. C.4.0 Basic Criteria The project addressed needs in all native and non-native communities in the state that met the following basic criteria: *Year-round community population of at least 20 individuals. *No local in-patient health care facility. In order to provide some practical limits to the assessment,the parties agreed to study only those communities without a local in-patient facility,i.e.a hospital.The assumption is that, in general,primary care services are available in these communities at a significantly higher level than most rural,"non-hospital”communities.A population threshold of 20 was used since the IHS has a program to lease clinic space from villages with 20 year-round residents or more.The parties accepted this existing federal program criterion as a reasonable lower community population limit for the needs assessment. Volume IJ Page 10 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 A list of the 288 communities meeting the above criteria appears in Appendix II.Both an alphabetical and ascending population sort are presented.The population figures are 1999 values as reported by the State Department of Community and Economic Development (DCED). C.5.0 Website A website was developed to facilitate communications during both the Needs Assessment Project and follow-on program implementation.The website has two levels;one for the general public and a more detailed one for use by the project /program management team. The current address is:http://www.apcds.org C.6.0 Public and Stakeholder Input The Steering Committee determined early on that developing public support through outreach to stakeholders and other interested parties would be essential to the success of the Needs Assessment Project.Accordingly,committee meetings were open to the public..The project team also conducted five regional workgroups during May.The primary purpose of these workgroups was to collect input and ideas on the factors used to develop a statewide resource distribution methodology for facilities related projects.Open workgroup meetings were held in Anchorage,Juneau,Fairbanks,Kotzebue,and Bethel.As well,there was a special statewide public meeting conducted on July 11 via both a teleconference with the twenty-two Legislative Information Office sites and a facilitated meeting at the Loussac Library in Anchorage.The partners also had on-going communications with interested organizations and individuals throughout the project by way of special mailings and presentations at related meetings (e.g.,State MEGA meetings,Alaska Native Health Board [ANHB],Primary Care Partnership,and Community Health Aide Program [CHAP] Certification). C.7.0 Phase II -Primary Care Program Development and Support In September 2000,the Steering Committee presented a proposal to the Denali Commission for a Phase ll Primary Care Program Development and Support project to build on the program data collected as part of the initial needs assessment described in this report ("Phase Volume I Page 11 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 1").The Phase Il scope of work focuses on working with communities to develop and support primary care programs.Public testimony received during Phase 1 emphasized the necessity for developing and supporting primary care programs as a complimentary component to the construction,renovation,and repair of primary care facilities. C.8.0 Beyond Primary Care Facilities It is anticipated that the work of the Denali Commission and their health care partners will be expanded to investigate other health related service delivery and infrastructure gaps in rural Alaska.There are unmet needs beyond those identified in this report and/or additional communities that should be evaluated.Undertaking this additional work would be consistent with the intent of federal legislation passed at the close of the 1999 Congressional calendar authorizing demonstration projects between the Commission and U.S.DHHS ---that can extend beyond primary care facilities (e.g.hospitals,mental health facilities,elder care,and child care facilities). D.QUESTIONNAIRE D.1.0 Overview A Facility Needs Assessment Questionnaire (FNAQ)was developed and mailed to all 288 communities meeting the basic project criteria during the last week of March 2000.Copies of the questionnaire were also made available to Regional Health Corporations and Boroughs.All data received by September 1 was entered into the database and used to develop both the unmet need estimate and the FY 2001 community priority list.The Steering Committee encourages all 288 communities to submit responses;questionnaires are still being accepted.Communities submitting after the deadline will be eligible for subsequent fiscal year funding.Three mechanisms are available for submitting data:(1)Internet,(2) hard copy via mail,and (3)hard copy via FAX. The FNAQ has an introductory section that requests information on the number of organizations/programs providing primary care services in the community and the total number of facilities being used to support these services.The body of the questionnaire is divided into two main sections that address current status and additional needs with respect to Volume I Page 12 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 facilities and services /programs.The Steering Committee agreed that a review of program needs must be a part of any facility condition and/or additional space needs evaluation.A summary of the Sections and Subsections in the main questionnaire appears below.A full copy of the questionnaire appears in Appendix III. Facilities: »Basic Data =»Ownership /Lease Data *Physical Deficiencies »Space Related Deficiencies "Medical Equipment Deficiencies *Utility and Maintenance Data Data from these sections were used to calculate the unmet need compared to the space guidelines developed as part of this project.Data were also used to estimate the backlog of repairs for existing space.The methodology to prioritize communities and distribute resources utilized some of this data. Program: "Services Provided and/or Needed =Patient Transportation Data *Program Administration Data »Support Services Delivery Location and Mechanism *Staffing Provided and/or Needed #Clinical Caseload (Workload)Data «Extended Patient Stay Data ®Living Quarters Information ®Telehealth Information As discussed in Section C7.0,the program data collected via the FNAQ will become the basis for additional research and analysis under a Phase II assessment project.It is envisioned that this data will be instrumental in the development of program advocacy and Volume I Page 13 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 support strategies for numerous organizations and entities around the state involved with primary Care issues. D.2.0 Response Rate The following is a summary of the responses received and entered into the database as of September 1,2000. Table 4:FNAQ Response Summary as of September 1,2000' Communities Responding To General Section 218 Total Program Section Responses 194 Total Facilities Section Responses 183 This represents a total response rate on the order of 76 percent.Numerous efforts were made (via phone,fax,and mail)to contact all locations that did not initially respond to the questionnaire.Documentation on the results of these efforts is on file at ANTHC.It should also be noted that some communities had multiple organizations,programs,and/or facilities. E.ALASKA PRIMARY CARE DATA SYSTEM The database and applications developed as part of the project are collectively referred to as the Alaska Primary Care Data System (APCDS).This is a web-enabled system comprised of the following core components. *The Alaska Primary Care Database (APCD),containing all questionnaire responses and other relevant data from multiple external resources. *An ad hoc query tool that facilitates data analysis and allows Primary End Users to create a variety of reports. «A Geographic Information System (GIS)that provides for the graphical presentation of data. *Applications for calculating unmet need and prioritizing communities. The primary software used to develop the APCDS tools and applications are summarized in Table 5. As of October 20,the number of responses were 220,196,and 185,respectively. Volume I Page 14 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Table 5:APCDS Software Name of Software Purpose SQL Server.Database platform Cold Fusion Web development language QueryMill™Ad hoc query tool MapObjects Internet Mapping Server |Enables development of custom GIS applications MapOptix™Web-enables graphical and tabular information E.1.0 Alaska Primary Care Database Obtaining data from existing database resources was a key requirement for the development of the APCD.Various state and federal sources were reviewed and selected to provide additional data content for a variety of research and reporting needs.The following table summarizes the major data resources utilized for the APCD. Table 6:APCD Data Resources PRIMARY SECONDARY %ofDATACATEGORYSOURCESOURCES|APCD General Community Information |State DCED Access State EMS System j|State DCED Existing Clinic Facility ENAO IHS and 1994 State |85Information°Survey Existing Health Program FNAQ State Public Health Information *Nursing Survey Demographics State DCED oe : 15 Health Status Indicators State DHSS The data content extracted from all external data resources is static,i.e.a one-time data download from each resource.The technology to create dynamic links to a variety of resources is available;however,this capability was not necessary since APCD updates will only be accomplished on an annual or semiannual basis. Volume I Page 15 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 A web-enabled application was developed for the APCD since the end users are geographically dispersed throughout the state.SQL Server was the underlying technology used to build the APCD.SQL Server is highly compatible with Access,Excel,GIS software and web applications,as well as many SQL compliant query tools.SQL Server was selected because it is a robust system and many of the external data resources and systems currently in place are already in SQL Server or Access.Also,the APCD had to be built in a manner that would support easy to learn solutions and require minimal help from support personnel at project turnover.Currently the APCD has 106 data tables and contains 1,447 data columns. In addition,it contains 32 views for querying with 747 data columns,and 12 QueryMill- specific tables with 88 data columns.The current size of the database is approximately 21.5 MB. E.2.0 Queries and Reports The APCDS provides both standard and ad hoc query and reporting capabilities.The various standard reports,such as the Unmet Need Report,are static reports in read-only format with limited access depending on the user's security level.Raw Data Reports are another example of standard reports.They contain all of the supporting data used to generate one of the summary reports,such as the Unmet Need or Part I Community Prioritization. Ad hoc queries enable the Primary End Users to create a wide variety of unique reports depending on their specific area of interest.The query tool allows individual analyses to be saved and recalled at a later date.It also allows Primary End Users to share query results electronically.The primary categories for initiating queries are listed below. *Census Area *Borough *Regional Health Organization =Community #State Election Districts,both House and Senate *Data Dictionary Each major category is further subdivided to refine the query.Ultimately,any query report can be produced in either MS Word,MS Excel or Hyper Text Markup Language (HTML) Volume I Page 16 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 format as specified by the Primary End User.Since this was a statewide project,Census Areas (see Appendix IV)have been designated as the primary method for organizing and summarizing data. While analysis of the information collected during this Needs Assessment was beyond the scope of the project (except for unmet need estimates and an initial community prioritization).Appendix V contains a sample ad hoc query report.It is a summary by House Election District of all Emergency Medical Service (EMS)Level I and II communities with clinics that are not equipped to accommodate over night patients or have no existing clinic facility at all. E.3.0 Geographic Information System The APCDS includes a GIS component that provides for the graphical presentation of data using the following geographic boundaries: =»Census Areas »State Election Districts,both House and Senate *"Boroughs It can also display the following information for individual locations: =Regional Health Organization Affiliation »Unmet Need *Communities With Hospitals *Communities Without Any Primary Care Facilities These layers are in addition to routine map elements such as major rivers and highways.The GIS application can be easily enhanced to meet future,additional requirements. E.4.0 Access to Data In September 2000,the Denali Commission selected ANTHC as the Program Manager for the APCDS and most of the rural primary care facilities related projects funded through the Commission.Accordingly,the APCDS was recently installed on a server at ANTHC. ANTHC is providing a database administrator who will maintain the system.The four Volume I Page 17 Alaska Rural Pimary Care Facility Final Report Needs Assessment Project October 2000 primary partners in the project will have full access to all data in the APCDS.For data confidentiality reasons,other organizations and/or the general public will only have access to aggregate data summarized on a regional or service area basis. F.PUBLISHED PROGRAM GUIDELINES AND REGULATIONS As with many issues related to the delivery of health care services,Alaska is unique. National recommendations,where they exist,do not adequately provide for the variables encountered in Alaska with respect to remoteness,weather,and lifestyle.Therefore,most national standards and guidelines that do exist must be adapted for use in Alaska or not used at all.The recommended program goals in this report were developed after a review of the following. (1)Federal Section 330 Community Health Center Program (2)DHSS "Community Levels-of-Care”system (3)IHS Community Health Aide Program (4)Alaska Assistance for Community Health Facilities Program (5)Federal Rural Health Clinic Program F.1.0 Federal Community Health Center Program Community health centers (CHCs)are publicly funded organizations that provide primary health and related services to residents of a defined geographic area that is medically under served.Community health centers are authorized under Section 330 of the Public Health Service Act (42 USC,254b.).Section 330 was revised in 1996 by the Consolidated Health Centers Act,which combined community health centers with migrant health centers,health care for the homeless,and public housing health care programs.The CHC program is administered by the U.S.DHHS,Health Resources and Services Administration (HRSA), Bureau of Primary Health Care. Volume I Page 18 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Community health centers are required by law to provide primary health services and additional health services as necessary to the residents of the area served by the center. Primary health services are defined as 1)health services related to family medicine,internal medicine,pediatrics,obstetrics,or gynecology,2)diagnostic laboratory and radiology services,3)preventive health services,4)EMS,and 5)pharmaceutical services. Additionally,primary health services include patient case management services,enabling services such as transportation and language translation,patient education,and referrals to providers of substance abuse and mental health services The guidelines for health center structure,population served,service area,services provided, personnel,financial characteristics,organizational arrangements,governance,community participation,and referral systems are specified by the Bureau of Primary Health Care. CHCs are recognized as federally qualified health centers (FQHCs).FQHCs meet statutory requirements for receiving federal community or migrant health center grant or health care for the homeless program funds.Certification as a FQHC reserves a health center's right to cost-based reimbursement for Medicaid services in states which have not received special waiver provisions.Health centers receiving federal Community/Migrant Health Center (C/MHC)funding are automatically eligible for certification as Medicaid and Medicare FQHCs. The information included in the Consolidated Health Center Act of 1996 and the guidelines issued by HRSA,Bureau of Primary Health Care,were instrumental in defining the program related questions and establishing the program goals for this Rural Primary Care Needs Assessment Project. F.2.0 State Emergency Medical Service Program Alaska EMS Goals (February -1996)describes Community Levels-of-Care and makes recommendations for EMS services.It is based on a regional approach /organization as described in the 1984 Alaska State Health Plan.This approach identifies appropriate health resources and services for five community levels.These are: Volume I Page 19 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Table 7;Community Levels LEVEL DESCRIPTION POPULATION IN IMMEDIATE COMMUNITY I Village 50 -1,000 Il Sub-Regional Center 500 -3,000 + Ill Regional Center 2,000 -10,000 + IV Urban Center 10,000 -100,000 Vv Metropolis 100,000 + There is no counterpart to the EMS goals document,which makes a recommendation on the level of primary care services that should be provided in Alaska communities.A key discriminator in establishing EMS levels of service is how people get to and from a community,ie.access.The EMS Goals document identifies communities as either "Isolated”or "Highway”.Highway refers to those major roadways in the state,including: «Alaska *Haines ®Copper River =Klondike ®Dalton *Richardson "Denali *Seward ®Edgerton/McCarthy Road ®Steese ®Elliott *Sterling =George Parks *Taylor/Klondike Loop *Glenn =Marine The Marine Highway is Alaska's marine transportation system,which provides year-round ferry service to Alaska's coastal communities and to Washington and British Columbia.A map showing the major roadways in relation to organized boroughs within the State appears in Appendix VII. F.3.0 IHS Community Health Aide Program The IHS has the responsibility for providing health care services to Alaska Native and American Indian beneficiaries in Alaska.The total beneficiary population is 17 percent of Volume I Page 20 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 the state's population.Historically,the Alaska Native population lived mainly in the more isolated village communities. The Community Health Aide Program (CHAP)was developed in the 1950s in response to a number of health concerns including the tuberculosis epidemic,high infant mortality,and the high rate of injuries in rural Alaska.In 1968,the CHAP received formal recognition and congressional funding.The program was established under the authority of 25 U.S.C. §16161.The long history of cooperation and coordination between federal and state governments and the Native regional health corporations has facilitated improved health status in rural Alaska.The CHAP is considered a model for delivering primary health care services in a remote area.In addition to strong training and supervision components,there is an established referral relationship that includes mid-level providers,physicians,regional hospitals,and the Alaska Native Medical Center (ANMC).One hundred forty (140)villages with less than 500 population have a clinic facility staffed by Community Health Aides / Practitioners (CHA/P)providing primary care and emergency medical services.Another 38 communities with a population greater than 500 have a Community Health Aide (CHA) clinic.In the non-Native health care delivery system,there is no model.Communities vary in their level of organization,resource base,and ability to partner with other agencies to provide primary care and emergency services at the local level. F.4.0 Alaska Assistance for Community Health Facilities Program The Assistance for Community Health Facilities Program is outlined in Alaska Statute (AS 18.23.100 and 18.25.010 -18.25.120)and Alaska Administrative Code (7 AAC 13.010 - 13.140 and 13.845 -13.900). The scope of authority is subject to legislative appropriation and the provisions of AS 18.25.070-18.25.110.The Alaska DHSS awards grants to assist in the operation of community health facilities when there are operational deficits.Statutes outline the requirements of facilities that are receiving monies such as the application procedure,an overview of service areas to be considered,government and advisory boards,collection of fees for services,self-sufficiency issues,coordination and non-duplication issues,capital expenditures,other monetary issues,and personnel. Volume I Page 21 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 The Assistance for Community Health Facilities Program through the Alaska DHSS currently:supports grants to 12-15 communities to partially support primary clinics.Most of the funds are used to help cover salaries of mid-level practitioners.Primary care clinics follow state statutes,regulations,and program guidelines in the areas of administration and program reporting. F.5.0 Federal Rural Health Clinic Program In 1977,Public Law 95-210 was enacted by Congress and authorized Medicare and Medicaid reimbursement to non-physician primary care practitioners in rural health clinics.This program was created because many isolated rural communities are not able to attract or retain physicians.Congress recognized that many clinics were staffed by non-physician providers who were not covered by Medicare unless they were under the immediate supervision of a physician.There was concern was that these clinics would never become self-sufficient;they would continue to have financial difficulties and may be forced to close. The Rural Health Clinic (RHC)Program is one of the few federal programs that is able to address under-service in small communities that do not have a traditional health care system in place.The RHC program is administered nationally by the Health Care Financing Administration. In Alaska,the RHC certification process is administered by the DHSS,Division of Medical Assistance,Health Facilities Licensing and Certification. Guidelines for the RHC Program and the Rural Health Clinic Survey Reports were considered in the development of the ARPCFNA program goals described in this needs assessment final report. G.PUBLISHED SPACE STANDARDS AND GUIDELINES Specific space planning information was collected from recent projects and existing institutional /organizational standards (e.g.prototype designs produced by the Yukon- Kuskokwim Health Corporation (YKHC),Maniilaq Association,North Slope Borough, DHSS Public Health Nursing Center Design Standards,etc.).That data is summarized in Volume I Page 22 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Appendix VIII.It includes summary information for a full range of clinic sizes,from small up to and including multi-community (sub-regional)facilities. H.ALASKA RURAL PRIMARY CARE GOALS Based on a review of the existing program and space guidelines,standards,and regulations summarized above,the Steering Committee developed the general Rural Primary Care Program Goals and Space Guidelines outlined in Tables 8 and 9.These criteria are presented as a minimum benchmark.The detail provided should not be interpreted as a prescriptive design standard.These are general guidelines only.They were used for estimating unmet needs and establishing criteria for the funding of projects through the Denali Commission. It should be noted that permanent staff quarters are not included in the recommendations based on the assumption that these facilities are more appropriately provided by private individuals and/or businesses in the community. Volume I Page 23 This page intentionally left blank. Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Table 8:Minimum Program Goals POPULATION EMS CATEGORY 20 -100 101 -500 >500! Access Space Guideline Community Small =1,535 GSF Level Medium «1,990 GSF Designation Description Large 2.460 GSF Limited air/water access and /or Isolated Road access >60 miles:Daily air/water access I&H Small Medium Large Considered a subregional center and Highway <60 minutes travel time to next care level II . S Medium Large Designated Highway <60 minutes travel time to next care level I EMS Only itinerant Space”Medium 1.Some communities in this population range may be candidates for multi-community or sub-regional centers.While services,staffing & square footage will be uniquefor each individual subregional center,a general guideline of 10,000 GSF is recommended. 2.500 GSF ofdesignated space in community building,school,etc. Dedicated -Small Medium LargeSTAFFINGi5itinerantClinicClinicClinicSpace EMT ..EMT EMTRd'id te iesidentProvidersEMTCHCHAICHA/P MLP PHN Itinerant Itinerant Itinerant Itinerant Dental Itinerant Itinerant Itinerant Itinerant Dedicated . . PROGRAMS AND SERVICES?Itinerant Small Medium LargeClinicClinicClinicSpace Basic EMS Xx X x x Preventive Health Screenings Xx x X Xx Other Preventive Health Services Xx X xX Basic Primary Care Xx x Xx Limited Laboratory &Pharmacy x X X Patient Case Management x x Outreach,Transportation &Interpreter xX x Community Health Xx Xx Advanced EMS x x Limited Radiological D4 On-site Administration &Support Xx *See Pages 14-17 and 20 of FNAQ (Appendix II)for more detail Volume I Page 24 This page intentionally left blank. Alaska Rural Primary Care Facility Needs Assessment Project Final Report October 2000 Table 9:Space Guidelines ate 'ant |i:Designated Itinerant Small Clinic Medium Clinic |Large Clinic A;Space 7 :yaQq ;Net Area |Net Area Net Area |Net Area ;Purpose /Activity Size #(SF)v Size #(SF)Size #(SF)Q Size |.#(SID Arctic Entrics é 0%50 I 50 50 2 100 5 SO}2 100 © Waiting /Reception /Closet 180 1 Iso 100 !100%150 !1508 170 1 170% Trauma /Telemedicine /Exam »200 l 200.200 i 200%200 I 200 5 200 i 200 a Office /Exam 08 150 I 1805 150 I 1908 tSo]2 300 % Admin./Records 07 On 410 I 1108 110 ]110% Pharmacy /Lab O08 80 I 804 80 I 805 80 {80» Portable X-ray 0»0:0:40 i 40» Specialty Clinic /Health Education /Conference 0 150 I 1508 150 !150-150 !150 4 Patient Holding/Iinerant Sleeping Room O#80 |80 80 i 805 150 1 150% Storage 150 |iso.80 1 804 100 !1005;120 !1205 HC Toilet Access To 60 1 604 60 2 120;60}2 1208 Janitors Closet Access To ©30 |308 30 i 305 30 I 30: Subtotal: = 500 2 8 980 1,270:tf ves 1,570 Circulation &Net to Gross Conv.Factor @ 45%i 441 $72)707 ® Subtotal (GSF)Wa &1421 1,842:2,277 2 Mechanical Space @ 8%:ae ldo 147 2 1825) Total Heated Space 2 a §00 .1535)1,989 eel 2,459 Morgue (unheated enclosed space)4 0.30 i 30 30 1 30,30 1 303! Exterior Ramps,Stairs,Loading Arca a HC Accessible y As Required As Required iG As Required 4 Volume I Page 25 This page intentionally left blank. Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 I.UNMET NEED 1.1.0 Additional Space for Individual Locations The unmet space need for individual locations was derived by subtracting the existing square footage at that location from the appropriate space standard in Table 9.The cost of this new space was calculated using the following algorithm. C=SxBxZxLl Where: C =Cost of Additional Space S =Additional Space Need =Space Standard -E E =Existing Square Footage B =Unit Construction Cost of new clinic space in Anchorage (construction only) =$183.20 per gross square foot (May 2000 dollars) Z =Other Project Cost Factor (accounts for design,movable equipment and furniture, construction inspection and contingencies),expressed as a decimal percentage of B =1.45 LI =Location Index (adjusts Anchorage base costs to specific locations) The unit construction cost and location factors were developed by Estimations,Inc.,a professional cost estimating firm with extensive rural Alaska experience.As a check on the base unit cost and the location indices,an algorithm estimate was compared to the actual bid .costs for the new 2,430 gross square feet (GSF)clinic in Noorvik.This project is now complete and occupied.The May 1999 bid price reduces to $320.93 per GSF when adjusted to the spring of 2000 at an annual inflation rate of 2.5 percent.This compares very well with the algorithm estimate of $320.60 per GSF (construction only). The total,statewide unmet need based on the algorithm is 305,000 GSF,which extends to $99M.These costs include and/or assume the following: #Site Work "Design Fees «Permits *Construction Inspection Volume I Page 26 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 »Construction Contingency *Communications System *"Movable Medical Equipment and Furnishings ="Competitive Pricing on Construction *Prevailing State Construction Wage Rates They do not account for: «Land Acquisition «Off site Utility or Road Extensions *Special Purpose Equipment (e.g.radiography,dental) =Special Local Taxes 1.2.0 Multi -Community and/or Larger Facilities A preliminary analysis indicates that there are probably 12 -14 locations around the state where it may be more appropriate to construct a single but somewhat larger clinic,which in most cases would serve several small communities within the same service area (above and | beyond these types of facilities that are already in place or currently under construction). This multi-community or "sub-regional”concept is a proven model and is being successfully implemented by entities such as the YKHC.Assuming a 10,000 GSF new facility and applying an average location factor of 1.5 yields a total multi-community facility unmet need of $52M. 1.3.0 Backlog of Repairs The total cost to correct deficiencies (other than new space)at existing facilities was estimated based on the deficiency data for each facility in the APCD.The FNAQ had requested data on each of the following eight categories and an overall condition rating. =Structural ="Mechanical =»Electrical *#Energy Management =Handicap Access #Site /Environmental «Fire /Life Safety «Floor Plan Volume I Page 27 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 The 1994 State Clinic Survey also contained an overall "status”rating for most rural clinics in the state.Each facility was evaluated against the following three algorithms in the process of assigning an estimated backlog repair cost to it.If a facility did not fall into one of these categories or if insufficient data was available to run the algorithm,then it was assigned a backlog cost of zero. 1.If data in the APCD indicated that a facility needed "replacement”or was in "poor” condition,then the new space algorithm was applied to the existing space,i.e. BRC=ExBxZxLl 2.If data in the APCD indicated that a facility had "deficiencies needing correction”, needed "major renovation”or was in "fair condition”,then the following algorithm was applied to the existing space. BRC=ExKxZxLI 3.If actual cost estimate data was submitted in response to the FNAQ,and it exceeded either of the above,then BRC was set equal to that self reported value. In these algorithms: BRC =Backlog Repair Cost K ==Base Renovation Cost =$119.08 per gross square foot The base renovation cost of $119.08 is 65 percent of the Anchorage based unit cost for new construction,i.e.,0.65 x (B).The IHS Health Facility Budget Estimating System uses this factor for renovations that involve the replacement of interior walls and finishes.This is the "middle”factor in the IHS system;they use 25 percent for projects that only involve the upgrade of finishes,but 85 percent where facilities are completely gutted on the interior and then rebuilt. The total estimated cost to correct existing deficiencies based on this methodology is $102M for 330,000 square feet of evaluated space.This figure includes design,construction, equipment and contingencies. Volume I Page 28 Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 As more accurate and site specific code and condition data is collected by ANTHC in support of the Denali Commission's primary care facilities program,it will be entered into the APCD.Through this process,the statewide unmet need estimate will be continuously refined and updated. 1.4.0 Routine Maintenance and Improvement The IHS methodology for identifying the annual maintenance and improvement (M&I) funding requirement for health care facilities is based on the "Oklahoma Formula”.This is a methodology developed at the University of Oklahoma specifically for health care facilities. It estimates the recurring annual cost for benchstock supplies and materials,service contracts, in-house repairs and minor renovations,routine replacement of fixed equipment,and maintenance training.It does not include wages for maintenance staff or the cost of utilities. The methodology is summarized below. M&I=S x B,x CCx UIxLI Where: M&I =Annual Maintenance &Improvement Funding S =Additional Space Need =Space Standard -E E =Square Footage of Facility B,=Unit Cost of new clinic space in Anchorage (design and construction) =$262.32 per gross square foot (March 2000 dollars) CC =Construction Classification UI =Use Intensity LI =Location Index (adjusts Anchorage base costs to specific locations) Applying this methodology to the total existing and total new space requirements using a construction classification factor of 0.0175 (wood frame),a use intensity of 1.00 (moderate), and an average location index of 1.5 results in a total annual M&I requirement of approximately $5M. Apart from the work of the Denali Commission,there should be an evaluation of the IHS Village Built Clinic appropriation currently being used to lease clinics in support of the CHA Volume I Page 29 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Program and its relationship to the M&I unmet needs reported here.There is some question about whether or not the lease funds being provided are sufficient to warrant these arrangements being classified as true full service leases.In communities without an IHS leased clinic,there is in all likelihood,even less chance that an adequate routine M&I funding stream is available.In the long term,this issue could represent a significant unmet need for all program providers and/or communities in rural Alaska. 1.5.0 Summary Appendix IX contains an unmet need summary by census area.A statewide summary appears below. Table 10:Unmet Need Data ;.;Basis Amount .Unmet Need Category (GSF)|(millions)Type New Space at Individual Locations 305,000 S99 Capital New Multi-Community Clinics 130,000 $52 Capital Backlog of Repairs 330,000 $102 Capital Subtotal Pe)$253 Capital Routine Maintenance and Improvement 765,000 $5 Recurring Volume I Page 30 Alaska Rural Primary Care Facility : Final Report Needs Assessment Project October 2000 J.RESOURCE DISTRIBUTION METHODOLOGY The Steering Committee has developed a three part process for funding "small”,individual community primary care facilities projects through the Denali Commission'.Figure 2 is a simplified flowchart of the process.A preliminary multiple year schedule appears in Appendix X.Facilities constructed using Denali Commission funds must be operated by not- for-profit entities,and everyone in the service area must have access to the primary care services provided in the facility.Projects funded through this methodology may include the following,but are limited to a total of one million dollars. =Planning and Pre-Design =Design *Repair of Existing Structures =Renovation and/or Expansion of Existing Structures »Construction of New Facilities «Non-expendable Medical Equipment This methodology will be reviewed annually by the Steering Committee and amended as appropriate. 'The Steering Committee has recommended that an additional funding methodology be developed for communities with populations greater than 800 (needing larger facilities)and/or those locations that may be logical candidates for a subregional or multi-community type facility.The committee will continue to work on an RFP type process for such communities.It is anticipated that this second methodology will follow a format similar to the resource distribution methodology described in this report for small individual communities.In addition,it is noted here that on 14 September 2000,the Commission approved design funding for two replacement health centers in St.Paul and Metlakatla.Extensive project justification documents have already been prepared for both projects and they have been on the JHS National Priority List since 1995.These are the only two outpatient facilities in Alaska currently on the national IHS list.Denali Commission funding for St. Paul and Metlakatla is for design only;it is assumed that IHS will construct and staff the facilities once the designs are complete.Accordingly,these two locations were excluded from the final FY 2001 Part I Prioritization analysis described in this report. Volume I Page 31 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Figure 2:Denali Commission Resource Distribution Methodology for Rural Primary Care Facilities Projects Part I: Community Prioritization Questionnaire Submitted Not Eligible No For Funding Annual Short List Code and Condition Surveys <-_-_"-_-_>RFPs Issued || Part II: Technical Proposal Assi Review andssistance4:Capability Measurement Approved Project List Design Construction Volume I Page 32 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 This model is based,to a large degree,on the comments and input received during the five regional 'workgroup meetings held in May,the public hearing held on July 11,and via feedback on the numerous draft methodologies distributed for comment in August and September.The outcome of this effort is intended to be an equitable system for distribution of federal funding to those communities with the greatest need,recognizing that the successful delivery of health services includes the ability of a community to operate and maintain the facility over the long-term. J.1.0 Part I--Community Prioritization The goal of Part I is to prioritize basic needs.Using responses to the FNAQ and other data,a rating score was developed for each community meeting the basic requirements described in Section C4.0.Points were assigned based on the following seven criteria.A more detailed summary of the Part I prioritization formula and the measurements developed for each criteria can be found in Appendix XI. Criteria Maximum Points 1.Facility Deficiency 45 2.Health Status 20 3.Isolation , 10 4.Dependency Ratio 10 5.Economic Status 9 6.Trauma Rates 5 7.Seasonal Population 1 TOTAL 100 Results for the FY 2001 cycle are presented in Appendix XII.Using this information,the Steering Committee will develop.a "short list”of communities based on anticipated FY 2001 funding and estimated unmet need for the communities at the top of the list.Short listed communities will then be invited to submit project proposals for consideration by a multi- disciplinary review panel (MRP)convened by the Steering Committee.The Denali Commission's Program Manager,ANTHC,will also conduct on-site code and condition Volume I Page 33 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 surveys at existing facilities in those short listed communities needing this type of information in order to prepare a complete proposal.ANTHC may also conduct on-site surveys to validate information used in the Part I analysis. It should be noted that communities have been listed alphabetically within point ranges on the Part I Priority List.Individual points have not been reported,nor have individual ranks been assigned ---to emphasize that the Part I formula is only an initial screening tool. Communities must have submitted a FNAQ by September 1,2000 to be eligible for the FY2001 shortlist.While questionnaires are still being accepted,communities submitting after the deadline will only be eligible to compete for funding in subsequent fiscal years. J.2.0 Part II -Proposal Review and Capability Measurement Using a Request for Proposal (RFP)type format,ANTHC will assemble project proposals for review by a MRP made up of individuals from organizations that have both facilities and health program expertise.The review panel will evaluate proposals based on the following Part II criteria.A more detailed summary of the Part II capability scoring criteria appears in Appendix XIII. Criteria Maximum Points 1.Local Support for Project*0 2.Site Availability and Control*0 3.Utility Extension Plan*0 4.Cost Sharing*20 5.Service Delivery Plan*10 6.Business Plan*10 7.Facility Related Deficiencies 45 8.Consistency with Overall Community Development Plan 5 9.Multi-Use Components of Project 10.Project Management Plan 5 TOTAL 100 The proposal must meet minimum standards for these six elements.If the proposal does not meet these minimum standards,it will be set aside and a recommendation made to the community that they seek technical assistance to develop more capability. Volume I Page 34 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Communities will have two project funding cycles to establish capability,after which time they will'be reprionitized in the current year Part I cycle. The primary focus during Part II is to determine if the community has the capability to manage the proposed health programs and maintain the facility.The detailed data and information presented during this phase will also refine and validate the initial Part I prioritization.The final recommendations developed by the MRP will be submitted to the Steering Committee after considering the specific scores per the above criteria,and more general judgements related to capability based on professional experience. Based on recommendations from the MRP,the Steering Committee will publish an annual list of approved projects.With appropriate justification,the MRP and/or the Steering Committee may recommend funding at an amount less than requested in any individual proposal. The Steering Committee will have the authority to remove a community from further Part II consideration at any time,based on current assessments of need,facility deficiencies and other Part I or II criteria.However,the committee will also develop an appeals procedure for the proposal evaluation and capability measurement process. J.3.0 Part III -Funding The appropriate funding documents and agreements will be prepared for projects on the approved Part II list once ANTHC has determined that all of the following conditions have been met and the appropriate documents are in hand. Verification of original planning assumptions Community and/or regional resolutions Stamped design documents All applicable permits and regulatory approvals Site control documentation Utility extension plan and funding (by others) Project budget and progress payment schedule Construction Schedule Construction quality control and inspection planoPNNnYMPPYDSY Volume I Page 35 Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 ANTHC will develop a menu of off-the-shelf design and construction management services to assist individual communities in completing these tasks. Funding may be phased for design and/or construction.The number of projects funded in any given fiscal year will depend on actual appropriation levels.Once a community reaches Part III,the project will remain eligible for funding until all the above readiness elements are in place and sufficient funds become available.Projects approved in any given fiscal year will have priority over projects approved in subsequent years. K.PROGRAM MANAGEMENT As previously mentioned,in September 2000 the Denali Commission named ANTHC as the Program Manager for implementing its goals related to improving primary care facilities throughout rural Alaska.DHSS will also continue to partner with the Commission,both as the Steering Committee lead,and manager of an initiative to review and document current health care delivery issues in rural Alaska.Figure 3 is a model of how the Rural Primary Care Program will be administered.Note that the existing Steering Committee will be expanded to include the Alaska Center for Rural Health (ACRH),the Alaska Primary Care Association (APCA)and the USDA --Department of Rural Development.The expanded Steering Committee will provide oversight for the Denali Commission on all aspects of the program. Volume I Page 36 Alaska Rural Primary.Care Facility Needs Assessment Project Final Report October 2000 Figure 3:Rural Primary Care Facilities Program Model Develop methodologies,Denali Commission Rural Primary Care Program coordinate prioritization process,and report back on progress of rural health care initiatives Steering Committee' e Department of Health and Social Services Indian Health Service Denali Commission Alaska Native Tribal Health Consortium e USDA --Rural Development e Alaska Center for Rural Health e Alaska Primary Care Association A ANTHC DHSS Manager for Statewide Primary Care Services Development andSupport' Primary Care Facilities Program Manager Oversight on behalf of the Denali Commission Coordination on program and facility elements Multi-disciplinary Review Panel Review project proposals and make recommendations to SC 'Lead =Director,Division of Public Health,DHSS ?Pending approval of scope of work by Commission Co-chairs Volume I Page 37 Alaska Rural Primary Care Facility . Final Report Needs Assessment Project October 2000 L.RECOMMENDATIONS This Phase I final report focuses on the statewide unmet needs of rural primary care facilities in 288 communities without hospitals,and a methodology for 'distributing resources to address those needs.An expanded steering committee is being formed to assist with the implementation of Phase I,work on primary care program development and support (Phase II),and begin to address other health related service delivery and infrastructure gaps in rural Alaska.The Phase I Steering Committee's specific recommendations to the Denali Commission are: Overall =Maintain a statewide commitment and focus on the unmet needs of rural primary care facilities and programs in the 288 communities without hospitals identified under Phase I of the project. «Maintain a public access website (www.apcds.org)for the Commission's Alaska Rural Primary Care Program. *Support on-going public participation in an annual review of the resource distribution methodologies developed by the Steering Committee. Phase I *Implement Phase I by awarding FY 2001 funds for the repair,renovation,and construction of new rural primary care facilities. «Develop a resource distribution methodology and request for proposals (RFP)process for multi-community and/or large (e.g.over $1 million)projects. *Collaborate with complimentary funding sources (e.g.HUD and USDA)to maximize resources and streamline processes to fund the repair,renovation,and/or construction of new primary care facilities. Volume I Page 38 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Complete data collection for the 70 communities that did not submit a FNAQ prior to September 1,2000. Provide leadership to locate funding for the delivery of technical support to those communities that are prioritized as having the greatest unmet need but fail to qualify for funding due to an inability to meet the capability criteria. Phase II Initiate Phase II of the needs assessment project:Primary Care Program Development and Support. Provide leadership to locate funding for the development and support of primary care programs in small,rural communities. Beyond Phase I and Phase II Assess and prioritize the unmet primary care facility needs of rural communities that were not included in Phase I. Define and authorize demonstration projects that extend beyond primary care facilities as defined in the enabling legislation found in Appendix I. Volume I Page 39 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 M.LIST OF RESOURCES AND REFERENCES Alaska Area Native Health Service.Circular No.91-75,Village BBuilt Clinic (VBC)LeasingProgram,April 1,1991. Alaska Area Native Health Service.Circular No.93-74,Environmental Health Standards for Village Health Clinics,March 31,1993. Alaska Area Native Health Service.Community Health Aide Program Certification Board Standards and Procedures,as amended February 26,1999. American Institute of Architects and U.S.Department of Health and Human Services. Guidelines For Designed Construction Hospital and Health Care Facilities,1996- 1997 Edition. City of Galena.Yukon-Koyukuk Mental Health Program Declaration of Emergency,2000. DOWL Engineers.Facilities Assessment:Atka Health Clinic,Atka,Alaska,November 1999. DOWL Engineers.Facilities Assessment:Nikolski Health Clinic,Nikolski,Alaska, December 1999. National Association of Community Health Centers,Inc.So You Want To Start a Community Health Center?Washington,DC,1996. National Association of Community Health Centers,Inc.Issue Brief,Reauthorization Series #1,Health Centers Consolidation Act of 1996,December 1996. North Slope Borough.Village Clinic Upgrade Project Analysis Report,Vol.1,October 1995. Public Health Service Act.Public Law 104-299 Health Centers Consolidation Act of 1996 (42 U.S.C.Section 330),October 11,1996. State of Alaska,Assistance for Community Health Facilities Program Regulations (7AAC 13.010 -13.140 &13.845 -13.900)and Statues (AS 18.23.100 &18.25.010 - 18.25.120) State of Alaska.Alaska Rural Health Plan:Alaska's Plan for Participating in the Medicare Rural Hospital Flexibility Program,June 1998. State of Alaska,Department of Health and Social Services,Division of Medical Assistance, Health Facilities Licensing and Certification.Packet for Certification for Rural Health Clinic including Rural Health Survey Report. State of Alaska,Department of Health and Social Services,Division of Planning,Health Planning Section.Village Health Clinic Survey,State of Alaska 1984:A Report OnTheConditionOfHealthClinicsAndTheNeedForNewConstructionInLevelI And Level IJ Communities In Rural Alaska,1984. Volume I Page 40 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 State of Alaska,Department of Health and Social Services.1994 Village Health ClinicSurvey,1994. State of Alaska,Department of Health and Social Services,Division of Public Health,Section of Community Health and Emergency Medical Services.Code Blue: Resuscitating Rural Emergency Medical Services Agencies In The Last Frontier, March 1999. State of Alaska,Department of Health and Social Services,Division of Public Health, Section of Community Health and Emergency Medical Services.Request For Grant Proposals:Assistance For Community Health Facilities For FY 2001,2000. State of Alaska,Department of Health and Social Services.Division of Public Health Section of Community Health and Emergency Medical Services,Alaska EMS Goals: A_Guide for Developing Alaska's Emergency Medical Services System,Fourth Edition,February 1996. State of Alaska,Department of Transportation and Public Facilities.2001-2003 Statewide Transportation Improvement Program,October 1999. State of Alaska,Department of Transportation and Public Facilities and Department ofHealthandSocialServicesandDepartmentofAdministration.Public Health Center Space Standards,Appendix I -State of Alaska Space Standards,May 1988. U.S.Department of Health and Human Services,Health Care Financing Administration, Federal Register,February 28,2000,(Volume 65,Number 39).42 CFR Parts 405 and 491.Medicare Program;Rural Health Clinics:Amendments to ParticipationRequirementsandPaymentProvisions;and Establishment of a Quality Assessment and Performance Improvement Program.Proposed Rule. U.S.Department of Health and Human Services,Public Health Service,Health Resources and Services Administration,Health Resources and Services Administration,Bureau of Primary Care.Program Assistance Letter 99-14,Community Health Centers:A Review of the Literature,April 5,1999. U.S.Department of Health and Human Services,Public Health Service,Health Resources and Services Administration,Bureau of Primary Health Care.Policy Information Notice 2000-06.Primary Care Effectiveness Review,March 2000. U.S.Department of Health and Human Services,Public Health Service,Health Resources and Services Administration,Bureau of Primary Health Care.Policy Information Notice 2000-16.Requirements of New Start and Expansion Grant Applications for Health Centers,August 2000. U.S.Department of Health and Human Services,Public Health Service,Health Resources and Services Administration,Office of Rural Health Policy and National Rural Health Association.Rural Health Clinic Services Act,Public Law 95-210,January 1991. U.S.Government Printing Office.Rural Health Clinic Survey Report,1996. Volume I Page 41 APPENDIX I DENALI COMMISSION LEGISLATION Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Denali Commission The conference agreement amends Section 307 of Title II --Denali Commission of Division C --Other Matters of P.L.105-277 by adding a new subsection that authorizes the Secretary of HHS to make grants to the Denali Commission to plan,construct,and equip multi-county demonstration health,nutrition,and child care projects in accordance with the Work Plan referred to under section 304.The House and Senate bills contained no similar provision. Conference Report for H.R.3194 as printed in the Congressional Record of November 17,1999 TITLE VII--DENALI COMMISSION Sec.701.Denali Commission,Section 307 of Title III --Denali Commission of Division C - Other Matters of Public Law 105-277 is amended by adding a new subsection at the end thereof as follows: (c)Demonstration Health Projects.In order to demonstrate the value of adequate health facilities and services to the economic development of the region,the Secretary of Health and Human Services is authorized to make grants to the Denali Commission to plan,construct, and equip demonstration health,nutrition,and child care projects,including hospitals,health care clinics,and mental health facilities (including drug and alcohol treatment centers)in accordance with the Work Plan referred to under section 304 of Title III --Denali Commission of Division C --Other Matters of Public Law 105-277.No grant for construction or equipment of a demonstration project shall exceed 50 percentum of such costs,unless the project is located in a severely economically distressed community,as identified in the Work Plan referred to under section 304 of Title III --Denali Commission of Division C --Other Matters of Public Law 105-277,in which case no grant shall exceed 80 percentum of such costs.To carry out this section,there is authorized to be appropriated such sums as may be necessary. Volume I -Appendix I Page 1 This page is intentionally left blank. APPENDIX II COMMUNITY LIST Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 *Communities by Alpha Sort Communities by Population Community Population Community Population i]Adak ©106 Wiseman ,20 2||Akhiok 101 Gakona 22 3\|Akiachak 560 Port Clarence 22 4|Akiak 338 Alcan 23 5]Akutan 408 Evansville 24 6)Alakanuk 659 Kupreanof 24 7 Alatna 34 Ivanof Bay 29 8||_Alcan 23 Harding Lake 30 9],Aleknagik 244 Meyers Chuck 30 10]Alexander Creek 39 Paxson 30 11)Allakaket 204 Alatna 34 12)Ambler 286 Bettles 35 13)Anaktuvuk Pass 314 Birch Creek 35 14 Anchor Point 1227 Circle Hot Springs 35 15],Anderson 517 Stony River 35 161 Andreafsky 442 Pedro Bay 36 17 Angoon 576 McCarthy 37 18}Aniak 604 Lake Minchumina 38 19]Anvik 93 Alexander Creek 39 20]Arctic Village 138 Nikolski 39 21)Atka 105 Jakolof Bay 40 22)Atmautluak 296 Karluk 4] 23)Atqasuk 274 Platinum 43 241 Beaver 126 Red Devil 44 25 Bettles 35 Prudhoe Bay 47 261 Big Delta 511 Tonsina 47 27||Big Lake 2162 Hobart Bay 48 28]|Birch Creek 35 Kasaan 48 29)Brevig Mission 279 Takotna 48 30]Buckland 428 Elfin Cove 50 31||Butte 2699 Game Creek 50 32],Cantwell 166 Port Protection 50 33||Central 62 Point Baker 51 34)Chalkyitsik 102 Chistochina 52 35]Chase 55 Lutak 53 361 Chefornak 416°Chase 55 37]Chenega Bay 69 Edna Bay 55 381 Chevak 763 Slana 55 Volume I -Appendix II Page 1 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 39 Chickaloon 212 Dot Lake 61 40]Chignik 103 Healy Lake 61 41}Chignik Lagoon 68 Central 62 42)Chignik Lake 136 Igiugig 62 43 Chiniak 75 Lime Village 62 44}Chistochina 52 Primrose 62 45|}Chitina 94 Whale Pass 62 46]Chuathbaluk 105 Oscarville 64 47)Circle 89 Rampart 66 48||Circle Hot Springs 35 Covenant Life 67 49,Clam Gulch 113 Chignik Lagoon 68 50)Clark's Point 68 Clark's Point 68 51 Coffman Cove 228 False Pass 68 52||Cohoe 602 Chenega Bay 69 53]Cold Bay 97 Halibut Cove 71 54l|College 12122 Skwentna 72 551 Cooper Landing 285 Ferry 74 56 Copper Center 553 Chiniak 75 57||Copperville 194 Twin Hills 76 58 Covenant Life 67 Hughes 80 59||Craig 2136 Mendeltna 80 60 Crooked Creek 137 Port Alexander 86 61]Crown Point 91 Tanacross 86 62}Cube Cove 139 Nelson Lagoon 87 63||Deering 148 Manley Hot Springs 88 641 Delta Junction 889 Port Alsworth 88 65]Dot Lake 61 Circle 89 66 Dry Creek 115 Tetlin 89 67|Eagle 152 Gulkana 90 68 Edna Bay 55 Crown Point 91 69]Eek 281 Pilot Point 92 70)_Egegik 117 Stevens Village 92 7 Eklutna 434 Anvik 93 72|Ekwok 125 Tliamna 93 73||Elfin Cove 50 Tenakee Springs 93 74]Elim 306 Chitina 94 75)Emmonak 818 Kobuk 94 76|Ester 240 Mosquito Lake 94 Volume I -Appendix II Page 2 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 77,Evansville 24 Cold Bay 97 78||Eyak 162 Akhiok 101 79!False Pass 68 Koyukuk 101 80]Ferry 74 Chalkyitsik 102 81]Fort Yukon 570 Perryville 102 82||Fox 332 Chignik 103 83}Fox River 439 Sleetmute 103 84l|Fritz Creek 2097 Atka 105 85]|Gakona 22 Chuathbaluk 105 86)Galena 563 Nikolai 105 87|Gambell 668 Tatitlek 105 88i|Game Creek 50 Adak 106 89}Glennallen 494 Hollis 111 90,Golovin 141 Clam Gulch 113 91 Goodnews Bay 256 Northway 113 92],Grayling 184 Dry Creek 115 93 Gulkana 90 Northway Junction 116 94}Gustavus 377 Egegik 117 95]|Haines 1775 Moose Pass 118 96]|Halibut Cove 71 Whitestone Logging Camp 118 97||Happy Valley 401 Ekwok 125 98,Harding Lake 30 Mentasta Lake 125 99]Healy 646 Port Heiden 125 100}Healy Lake 61 Beaver 126 101)Hobart Bay 48 Hyder 126 102!|Hollis 111 Hope 130 103}Holy Cross 247 Levelock 131 104]Hoonah 877 Lignite 131 105||Hooper Bay 1028 South Naknek 132 106]|Hope 130 Chignik Lake 136 107||Houston 836 Klukwan 136 108]Hughes 80 Little Diomede 136 109 Huslia 272 Crooked Creek 137 110]Hydaburg 369 Larsen Bay 137 111)Hyder 126 Pelican 137 112)Igiugig 62 Arctic Village 138 113]Thamna 93 Cube Cove 139 114])Ivanof Bay 29 Shageluk 140 Volume I -Appendix I Page 3 Ye De TRA esha ia abe BAA? Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 115]Jakolof Bay 40 Golovin 141 116]_Kachemak 419 Pitka's Point 146 117|_Kake 745 Deering 148 118]Kaktovik 259 Eagle 152 119 Kalifonsky 338 Tyonek 160 120]|Kaltag 254 Eyak 162 121]Karluk 41 Kokhanok 163 122)Kasaan 48 Naukati Bay 164 123]Kasigluk 528 Cantwell 166 124],Kasilof 548 McKinley Park 169 125]Kenai 7005 Nanwalek 170 126]Kenny Lake 507 Wales 170 127]Kiana 398 Saint George 173 128]King Cove 691 Newhalen 178 129]King Salmon 499 Port Graham 178 130]Kipnuk 573 Sheldon Point 181 131]Kivalina 366 Grayling 184 132]_Klawock 673 Ruby 184 133]Klukwan 136 Mekoryuk 193 134]Knik 483 Copperville 194 135]Kobuk 94 White Mountain 197 136 _Kokhanok 163 Allakaket 204 137]Koliganek 205 Koliganek 205 138]_Kongiganak 359 Chickaloon 212 139||Kotlik 579 Point Lay 217 140]Koyuk 280 Shaktoolik 218 141]Koyukuk 101 Nondalton 224 142||_Kupreanof 24 Coffman Cove 228 143]_Kwethluk 714 Nightmute 230 144]Kwigillingok 360 Venetie 232 145]Lake Minchumina 38 Ester 240 146 Larsen Bay 137 Port Lions 243 147||Lazy Mountain 1109 Aleknagik 244 148 Levelock 131 Holy Cross 247 149||Lignite 131 Minto 248 150]Lime Village 62 Kaltag 254 151]|Little Diomede 136 Shungnak 255 152]Lower Kalskag 310 Goodnews Bay 256 Volume I -Appendix II Page 4 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 153]Lutak ©53 Ouzinkie 256 154]|Manley Hot Springs 88 Kaktovik 259 155]Manokotak 399 Upper Kalskag 261 156]|Marshall 318 Teller 266 157,McCarthy 37 Huslia 272 158]McGrath 423 Atqasuk 274 1591 McKinley Park 169 Old Harbor 276 160||Meadow Lakes 5232 Brevig Mission 279 161||Mekoryuk 193 Koyuk 280 162||Mendeltna 80 Whittier 280 163]Mentasta Lake 125 Eek 281 164]Metlakatla 1537 Newtok 284 165)Meyers Chuck 30 Seldovia 284 166,Minto 248 Cooper Landing 285 167||Moose Creek 677 Ambler 286 168]Moose Pass 118 Tazlina 294 169]|Mosquito Lake 94 Atmautluak 296 170|Mountain Village 766 Tanana 301 171)Naknek 624 Elim 306 172]Nanwalek 170 Lower Kalskag 310 173||Napakiak 363 Russian Mission 311 174],Napaskiak 406 Anaktuvuk Pass 314 175||Naukati Bay 164 Marshall 318 176}Nelson Lagoon 87 Tununak 331 177)Nenana 435 Fox 332 178||New Stuyahok 475 Akiak 338 179]Newhalen 178 Kalifonsky 338 180],Newtok 284 Trapper Creek 344 181}Nightmute 230 Tuntutuliak 350 182||Nikiski 3038 Kongiganak |359 183]|Nikolaevsk 488 Kwigillingok 360 184]Nikolai 105 Napakiak 363 185]|Nikolski 39 Talkeetna 363 186]Ninilchik 687 Kivalina 366 187||Noatak 423 Hydaburg 369 188]Nondalton 224 Saxman 371 189||Noorvik 632 Gustavus 377 190||North Pole 1616 Nulato 381 Volume I -Appendix II Page 5 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 *Communities by Alpha Sort Communities by Population Community Population Community Population 191]Northway 113 Saint Michael 381 192 Northway Junction 116 Salcha 387 193]|Nuiqsut 486 Kiana 398 194]|Nulato 381 Manokotak 399 195}Nunapitchuk 471 Happy Valley 401 196|Old Harbor 276 Napaskiak 406 197||Oscarville 64 Akutan 408 198]Ouzinkie 256 Chefornak 416 199]Paxson 30 Kachemak 419 200!|Pedro Bay 36 McGrath 423 201]|Pelican 137 Noatak 423 202||Perryville 102 Buckland 428 203]|Pilot Point 92 Eklutna 434 204||Pilot Station 544 Nenana 435 205||Pitka's Point 146 Fox River 439 206||Platinum 43 Andreafsky 442 207||Pleasant Valley 584 Tuluksak 443 208||Point Baker 51 Sutton 470 209||Point Hope 794 Nunapitchuk 471 210)Point Lay 217 New Stuyahok 475 211)Port Alexander 86 Saint Mary's 475 212)Port Alsworth 88 Knik 483 213]|Port Clarence 22 Scammon Bay 484 214)Port Graham 178 Nuiqsut 486 215]Port Heiden 125 Nikolaevsk 488 216)Port Lions 243 Glennallen 494 217||Port Protection 50 King Salmon 499 218]Primrose 62 Kenny Lake 507 219]Prudhoe Bay 47 Willow 507 220 Quinhagak 595 Big Delta 511 221 Rampart 66 Toksook Bay 513 222||Red Devil 44 Anderson 517 223]Ridgeway 2382 Stebbins 524 224\|Ruby 184 Kasigluk 528 225||Russian Mission 311 Pilot Station 544 2261 Saint George 173 Wainwright 545 227||Saint Mary's 475 Kasilof 548 228||Saint Michael 381 Copper Center 553 Volume I -Appendix II Page 6 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 229)Saint Paul Island 673 Shishmaref 556 230],Salamatof 1122 Akiachak 560 231)Salcha 387 Galena 563 232)Sand Point 842 Fort Yukon 570 233||Savoonga 653 Kipnuk 573 234,Saxman 371 Angoon 576 235)Scammon Bay 484 Kotlik 579 236]Selawik 767 Thorne Bay 582 237 Seldovia 284 Pleasant Valley 584 238]|Shageluk 140 Quinhagak 595 239)Shaktoolik 218 Cohoe 602 240,Sheldon Point 181 Aniak 604 241],Shishmaref 556 Naknek 624 242 Shungnak 255 Noorvik 632 243 Skagway 825 Healy 646 244],Skwentna '72 Savoonga 653 245||Slana 55 Alakanuk 659 246,Sleetmute 103 Two Rivers 660 247],South Naknek 132 Gambell 668 248 Stebbins 524 Klawock 673 249]Sterling 6138 Saint Paul Island 673 250]Stevens Village 92 Womens Bay 675 251]Stony River 35 Moose Creek 677 252 Sutton 470 Ninilchik 687 253)Takotna 48 King Cove 691 254 Talkeetna 363 Kwethluk 714 255|Tanacross 86 Yakutat 729 256||Tanana 301 Kake 745 257 Tatitlek 105 Chevak 763 258||Tazlina 294 Mountain Village 766 259||Teller 266 Selawik 767 260}Tenakee Springs 93 Point Hope 794 261}Tetlin 89 Unalakleet 805 262||Thorne Bay 582 Emmonak 818 263||Togiak 841 Skagway 825 264)Tok 1235 Houston 836 265||Toksook Bay 513 Togiak 841 266)Tonsina 47 Sand Point 842 Volume I -Appendix II Page 7 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 -Communities by Alpha Sort Communities by Population Community Population Community Population 267||Trapper Creek 344 Hoonah 877 268],Tuluksak 443 Delta Junction 889 269||Tuntutuliak 350 Hooper Bay 1028 270)Tununak 331 Lazy Mountain 1109 271)Twin Hills 76 Salamatof 1122 272||Two Rivers 660 Anchor Point 1227 273|Tyonek 160 Tok 1235 274],Unalakleet 805 Metlakatla 1537 275||Unalaska 4178 North Pole 1616 276|Upper Kalskag 261 Haines 1775 277||Venetie 232 Fritz Creek 2097 278||Wainwright 545 Craig 2136 279||Wales 170 Big Lake 2162 280)Wasilla 5213 Ridgeway 2382 281]Whale Pass 62 Butte 2699 282||White Mountain 197 Nikiski 3038 283],Whitestone Logging Camp 118 Unalaska 4178 284||Whittier 280 Wasilla 5213 2851,Willow 507 Meadow Lakes 5232 286],Wiseman 20 Sterling 6138 287||Womens Bay 675 Kenai 7005 288])Yakutat 729 College 12122 Volume I -Appendix II Page 8 APPENDIX II QUESTIONNAIRE Pie cer a aah 2 Abia att sare au att ER alee alle ADS ie sah,Svinte met iwiten 2 <HE Mya Sees SR Aa a le so ane a Alaska Rural Primary Care Facility Needs Assessment Denali Commission Dated Material -Please Read Immediately 'epenpemnencane tteieganmatinmmneone eget Denali Commission and Health Care Facilities The Denali Commission Act of 1998 (see www.denaligov)created the Denali Commission (Commission).Three general areas of focus were identified for the Commission including job training, economic development and rural infrastructure development.The Commission is based upon a format similar to the Appalachian Regional Commission (ARC),which was created in 1965.Of interest to the Denali Commission and Alaskans is that the ARC (in partnership with the 13 eastem-seaboard states it serves)arrived at five broad goals including:"Appalachian residents will have access to affordable, quality health care.”Correspondingly,the seven Denali Commissioners recently identified rural health care facilities and services as the second area of focus or theme for infrastructure related projects funded and supported by the Commission.The first infrastructure focus for the Commission was rural energy projects. Agreement for the Needs Assessment In October 1999,the Commissioners approved funding for a project with the Alaska Native Tribal Health Consortium (ANTHC)for a needs assessment of rural primary care facilities.ANTHC offered to provide project management and a portion of their own funds for a needs assessment project.In light of the mission to provide federal services for all of Alaska,the Commission and ANTHC sought the participation of the Alaska Department of Health and Social Services (DHSS)to obtain representation for all rural communities.After DHSS agreed to participate in the needs assessment project,the three parties then sought the participation of the Indian Health Service (IHS),based upon their long history and in-depth knowledge of rural primary care programs and facilities.On February 24,2000,the four partners entered into an agreement for carrying out the Alaska Rural Primary Care Facility Needs Assessment project.The project will address needs in all Native and non-Native communities in the state that meet the following basic criteria: e Year-round community population of at least 20 individuals e No direct access to an in-patient health care facility Goals of the Needs Assessment Project The needs assessment project will accomplish three main tasks.First,a database will be created that provides detailed information on health care facilities and program services.Data will be obtained via a statewide questionnaire.Additional information from existing databases maintained by other agencies will also be gathered to complement information obtained from the questionnaire.Second,a report with a Statewide cost estimate will be generated that summarizes the magnitude of primary care facility needs in Alaska.The goal is to provide this report to the Alaska Congressional delegation by July 1, 2000.Third,the needs assessment project will develop a resource distribution methodology for rural primary care facilities by October 1,2000.The partners will strive to obtain maximum public participation in developing this methodology.The outcome of this effort is intended to be an equitable system for distribution of federal funding to those communities with the greatest need,recognizing that cost effective delivery of service includes the ability of a community to operate and maintain the facility over the long-term. . Information from the needs assessment project will be used by the partners to seek funding for both facilities and primary care services.In the event Congress looks favorably on the July 2000 report,the methodology should guide Federal,State and Tribal managers on which projects should be funded. Project Team A project Steering Committee has been formed that includes representatives from the Denali Commission,ANTHC, IHS and DHSS.The committee and all four parent organizations will be collaborating with stakeholders throughout the project. ANTHC has been tasked with the overall responsibility for developing a work plan and schedule to meet project goals.ANTHC and the Steering Committee will receive assistance from two primary consultants during the project; NANA/DOWL JV (heaith facility expertise)and GEONORTH,Inc.(computer expertise).These services were obtained through an existing indefinite delivery contract between ANTHC and NANA/DOWL.The Commission and ANTHC agreed to use this contract in order to expedite the project and meet the July 1 report milestone. Future Efforts The four partners have accepted that this needs assessment project is only the beginning.They are in the process of developing a follow on scope of work to address more specific program needs and "deep look”surveys (to document code and other deficiencies at existing facilities). At the close of last year's Congressional calendar,legislation was passed that authorized demonstration health projects between the Commission and U.S.Department of Health and Human Services.Demonstration projects can extend beyond primary care facilities,for example,into hospitals,mental health facilities and child care facilities. Although no funding was appropriated,one avenue is now in place for future federal support.Hopefully,the efforts of the Alaska Rural Primary Care Facility Needs Assessment project will help convince Congress to address unmet primary care needs in rural Alaska. Communications A web site has been established fo facilitate communications during the project.Please refer to http:/ruralhealthcare.geonorth.com for additional information on this initiative and e-mail links to the ANTHC project office.You can also contact the project office toll free by calling 800-560-8637 ext.3606. eee TEENYo Alaska Rural Primary Care Facility Needs Assessment Developed by: Alaska Native Tribal Health Consortium Indian Health Service State of Alaska,Department of Health and Social Services Prepared for: Denali Commission Return by April 25,2000 to Alaska Native Tribal Health Consortium 3925 Tudor Centre Drive Anchorage,Alaska 99508 Phone:(800)560-8637 ext.3606 «Fax:(907)271-4735 Website:htto://ruralhealthcare.geonorth.com Pape menecemaggonanmpetnperennename Questionnaire Desian The questionnaire is divided into two main sections that address the status and additional needs with respect to primary health care faciliies and services/programs.All subsections and questions in the main questionnaire are identified with either an F (facilities)or P (program)prefix.The partners in the project have agreed that an assessment of program needs is essential and must be included in any evaluation of facility condition and/or additional space needs.Please be aware that the data you submit now may be enhanced in subsequent phases of the project. Getting Started 1.Locate your 3-digit unique identifying number on the mailing label on the back of this packet 2.Determine how many "Facilities”and "Program”sections of the questionnaire should be completed for "-your community.You will be able to make this determination after completing the "General”section of the questionnaire.Make the appropriate number of copies of the Facilities section and the Program section. 3.Review the major headings in each section of the questionnaire and then identify the appropriate people to assist with data collection for your community.You may need to talk with several people with facilities and health care expertise to provide the most accurate responses. 4.Determine if your site will submit data electronically (via the Intemet),by mail or by fax.If you are submitting by mail or fax,please remember to fill in all the identifying information (Organization,Facility Name and Unique Identifying Number)at the top of each section that will be submitted. 5.Complete the questionnaire.Note:even if you intend to submit the final data via the Intemet,it is recommended that you first complete a "working paper copy'of the questionnaire. §.Submit your data. =Complete Questionnaires and Submit Data by April 25,2000 = THREE WAYS TO SUBMIT YOUR DATA oo(/a cD Access the project web site: pe LORS >hitp-//ruralhealthcare ceonorth.com the on-line instructions INTERNET Mail compleied questionnaire to: Alaska Native Tribal Health Consortium | Alaska Rural Primary Care Facility Needs Assessment - Project Office - 3925 Tudor Centre Drive Anchorage,Alaska 99508 MAIL completed questionnaire to: (907)271-4735 Then click on the questionnaire icon and follow You may also submit your data by faxing a .Have a question?See the Help Desk on the project web site: (htto://ruralheaithcare.geonorth.com) or call... General &Facility Related Questions oo Program Related Questions ;4 Alaska Rural Primary Care Facility Needs Patricia Carr,MPH,Program Manager Assessment Project Office Primary Care &Health Promotion Unit Alaska Native Tribal Health Consortium Alaska Department of Health and Social Services 800-560-8637 extension 3606 907-465-8618 e-mail:pat_carr@health.stafe.ak.us Gary Kuhn,P.E.,Project Manager e-mail:gkdenali@anthc.org Torie Heart,MS,RN,Director ..Community Health Aide ProgramRebeccaWwoodall,Prject Assistant Alaska Area Native Health Servicee-mail:nvdenali@anthc.org 907-729-3642 e-mail:vhear{@anmc.org Other Information Other existing data sources will be used to enhance the information that each community is able to provide via this questionnaire.Ai this time,the project team envisions using the following existing data sources to round out the database: e State of Alaska,Department of Community and Economic Development,community profile database Web site:hitp:/www.dced.state.ak.us/mra/CF_COMDB.htm Alaska EMS Goals,(Fourth Edition) Indian Health Service Data System,(Health System Workload Data) Indian Health Service Facilities Database State Public Health Nursing Database ADOT&PF Airport Runway Inventoryoe0@@@ Estimated Time to Complete Itis anticipated that if support people and data are readily available,the questionnaire will take at least 90 minutes to complete. if there are multiple facilities and/or primary care organizations in your community,it may take longer. Confidentiality Although the general public can access the project web site,all electronic responses are coniidential.All responses received by mail and fax are also confidential. This page is intentionally left blank. GENERAL | Community Unique ID # G1.1 Is there an existing primary care facility (or facilities)in your community?Check the box that best describes the situation in your community (see subsection P1 in the Program section of the Questionnaire for more detail on the categories of primary care services being used in this survey). [)(a)NO -but there is a facility in an adjacent community that provides primary care services for us;we do not need a stand-alone facility of our own. If you answered NO to (a),enter the name of the adjacent community below,sign the certification on page 2 and then stop.You do not need to complete any other sections of this questionnaire. Adjacent Community: [(b)NO -and our community needs one. If you answered NO to (b),complete the entire Program section and subsection F4.0 of the Questionnaire. [1 (c)YES -one central facility that houses all health related services is currently available. if you answered YES to (c),complete one Facilities and one Program section of the Questionnaire. O (d)YES -one organization /program,but somewhat decentralized.One or more primary care services are housed in stand-alone building(s)remote from the main facility. If you answered YES to (d),list all the different facilities (major stand-alone buildings,separate leased space in larger buildings and/or donated space)that are used to deliver primary care services in the community,then complete a Facilities section of the Questionnaire for each major facility.Please also complete the Program section.For example,if the organization /program providing services utilizes two different major buildings,you would complete one Program section and two Facilities sections of the Questionnaire. Facility Name Services Provided [J (e)YES -and there are two or more different organizations that provide primary care services in the community. Questionnaire -Page 1 If you answered YES to (e),list all the different organizations and facilities (maior stand-alone buildings, separate leased space in larger buildings and/or donated space)that are used to deliver primary care services in the community,then complete one or more Program sections of the Questionnaire.Complete an entire Program section for each separate organization that provides primary care.The total number of Program sections to be submitted will depend on your assessment of how many it takes to adequately paint a complete primary care picture for the community.You should also complete a Facilities section for each major facility used to deliver services,regardless of the organization that delivers the service.For example,if there are two organizations in the community that provide various primary care services,one utilizing three different major buildings and one that only operates out of one building,you would complete two Program sections and four Facilities sections of the Questionnaire. Organization Facility Name Services Provided A. B. Cc. Note:if you answered YES fo either (d)or (e)please do not filf out a separate Facilities section for small ancillary structures (i.e.,unheated storage buildings,etc.).Instead,associate them with an appropriate major building and then provide an overall response to the questions for that "facility”.If you are not sure how many sections of the questionnaire to complete,due to a unique multiple building,program and/or mixed use Situation,please call the HELP DESK for guidance (800-560-8637 extension 3606). This section of the Questionnaire was completed by: Signature Date Printed Name Position Questionnaire -Page 2 Community__Unique ID # Organization Name of Facility FACILITIES F1.0 Basic Data F1.1 F1.2 F1.3 F1.4 Is this facility included in a written facilities master plan for the organization /program? O NO O YES 1 Master plan is under development lf yes,has the plan been coordinated with any of the following?Check all that apply. []Main referral facility (next level of care) 1 Regional Native Health Corporation Ci Parent Organization CO Other (list) Is the facility included in the Indian Health Service (IHS)Facilities Database? []NO CO YES if yes,please provide the unique identifying number(s)from the IHS database so we can match the data provided in this questionnaire with the correct building in their database. Facility No. Building No. Does the health program share the facility with other non-medical tenants? O NO O YES If yes,total non-medical space in the building =Gross Square Feet (GSF) C)Don't Know Is a detailed floor plan available for the space occupied by the health program? C No O YES Questionnaire -Page 3 Fi.6 How much space does your health program use in the facility? Direct services &support:GSF Staff quarters:GSF Other (list):GSF 1 Don't Know O Use vaiues in IHS Facilities Database []Use value in 1994 State DHSS Village Clinic Survey F1.6 Check the box below that most closely describes the construction of the facility. Wood Frame -single story Wood Frame -multi-story Steel Frame (commercial type building)-single story Ooood0Steel Frame (commercial type building)-multi story Other0D F1.7 Is the facility protected with an automatic sprinkler system? MO No O Yes F1.8 Does the facility have a central fire alarm system? O NO O Yes F1.9 Does the facility have a standby generator? [No {1 YES F1.10 Is the facility insured against loss by fire and other perils through a commercial premium-based policy? O NO CO YES Comments: Questionnaire -Page 4 F2.0 F2.1 F2.2 F2.3 F2.4 Ownership /Lease Data Who owns the facility? City State U.S.Public Health Service IRA Regional Native Health Corporation Village Corporation Private Individual Other (list)OOooaoogo0ngao0Is the facility leased from another party? 1 (a)NO ff no,go to question F2.3. O (b)YES If yes,check the box that best describes the type of lease. O Full service (owner provides all repairs,utilities and maintenance) 0)Tripte Net (tenant provides all repairs,utilities and maintenance) O Other (list) Are there adequate funds to cover the entire lease and/or your share of the ownership,repair,utility and maintenance costs? C}(c)NO DO (d)YES If the facility is owned by a local or regional organization,and another entity pays lease money to operate the clinic,are the funds adequate to cover the cost of ownership,repairs,utilities and maintenance? O No O YES O NA If your organization owns the facility andis self supporting,are there adequate funds to cover the costofownership,repairs,utilities and maintenance? O NO O)Yes Oh N/A Questionnaire -Page 5 F2.5 If you answered "NO”to F2.2(c),F2.3 or F2.4,check the box that most accurately describes the annual funding shortfall at the facility with respect to ownership,repair,utility and maintenance costs. O $1 -$10,000 [1]$10,001 -$25,000 1 $25,001 -$50,000 O Greater than $50,000 Comments: F3.0 Physical Deficiencies Rate the condition of the facility with respect to the following categories.Use the good,fair,and poor guidelines summarized below. Structural:Related to structure or fabric of the building,including foundation,roof,framing, windows and interior finishes Mechanical:Plumbing,heating,ventilation and other special systems (e.g.,medical gas) Electrical:Electrical distribution and emergency/standby power systems.Also includes low voltage wiring and control systems for telephone,paging,alarm systems, etc. Energy Management:_Energy efficiency of building envelope and mechanical and electrical systems Handicap Access:Compliance with the Americans with Disabilities Act (ADA) Site/Environmental:Flood hazard,inadequate water and sewer connections,setback problems and known spills of hazardous materials on the immediate property,etc. Fire/Life Safety:Construction requirements related to fire protection contained in the Uniform Fire Code (UFC),Uniform Building Code (UBC)and the National Fire Protection Association Life Safety Code (NFPA 101) Floor Plan:Overall workflow issues related to staff and patient circulation patterns,room proximities,etc.This category is not meant to cover additional space needs, only the layout of existing spaces. RAAT IERIE ARIA ARERR RAK IARI TAIRA IIA IAAI IAAI AAI AAA AAI EERE AAI ER ERASER IRAN Questionnaire -Page 6 Good = System/(s)less than 10 years old and/or no documented major problems.Only routine maintenance required to keep building completely functional. Fair =System(s)more than 10 years old and/or some components need replacement. Documented problems could be corrected with a renovation project and useful life of building extended for at least another 10 years. Poor =System(s)of any age which are approaching or are beyond the end of their useful life. Complete replacement necessary to maintain a proper environment for patients and staff. Don'tGoodFairPoorKnow Structural. Mechanical : Electrical Energy Management. Handicap Access | Site /Environmental. Fire /Life Safety. Floor Plan' Comments: Structural: Mechanical: Electrical: Energy Management: Handicap Access: Site /Environmental: Fire /Life Safety: Floor Plan: F3.9 Check the box below that best describes the overall condition of the facility. [J Good CO)Fair O Poor Questionnaire -Page 7 F3.10 F3.11 F3.12 F3.13 Check the box below that best describes what your organization and the community as a whole think should be done with the facility. O Correct deficiencies,renovate and/or add space and remain in service O Replace with new facility CO Don't know or no consensus Is there a system for documenting deficiencies in the facility? O NO O YES If yes,please describe Is there a cost estimate to correct some or all of the physical deficiencies summarized above? 1)NO /fno,go to subsection F4.0. O YES -All O YES -Some If yes,estimate =$ Date of estimate: Check the boxes that apply to the estimate. C1 Prepared by an Engineer or Contractor CJ Includes design and project management fees (1 Includes a construction contingency Has your organization and/or the community received a commitment from a funding source to correct the above deficiencies? O NO O Yes O PARTIAL If yes or partial,please list 1.Source:Amount:$ 2.Source:Amount:$ 3.Source:Amount:$ Comments: Questionnaire -Page 8 F4.0 Space Related Deficiencies F4.1 Do you need a facility where none exists now,or more space in an existing facility?Check all that apply. O)NO /fno,go to.subsection F5.0. : C)YES and a planning document has been prepared for either an addition,replacement or new first time facility O Addition =GSF O New facility =GSF O YES -but don't know how much F4.2 Is there a business plan that details how additional services and space will be financially supported? O)No CO YES lf yes,please check the box below that best describes what the total ownership,repair,utility and maintenance budget would be for the new facility (do not include program costs). $1 -$50,000 $50,001 -$100,000 $100,001 -$200,000 $200,001 -$300,000 $300,001 -$400,000 $400,001 -$500,000 Greater than $500,000 QOodaanadnoDon't Know F4.3 Is there a cost estimate to construct the new space? CO)NO /Ifno,go to question F4.4. O YES If yes,estimate =$ Date of estimate: Check the boxes that apply to the estimate. (J)Prepared by an Engineer or Contractor O Includes design and project management fees C1 Includes a construction contingency (1 includes cost of new medical equipment Questionnaire -Page 9 F4.4 F4.5 F4.6 F4.7 F4.8 F4.9 Has your organization and/or the community received a commitment from a funding source to correct the space related deficiencies? O No O YES O Partial If yes or partial,please list 1.Source:Amount:$ 2.Source:Amount:$ 3.Source:Amount:$ Has the community made a commitment to provide in-kind contributions for the project? O NO O YES Are matching funds available for the project?Check all that apply. (1 Regional Native Health Corporation O State O Federal Government C1 Other (list) Is a design complete for the project? C1 No O YES []Under development Has a site been identified for the project? O NO /fno,go to question F4.11. O YES Have all site control issues been resolved? C1)NO O YES Questionnaire -Page 10 F4.10 Is the site close to existing infrastructure and primary community services,including water/sewer lines,power,local roads,airstrip,EMS office,school(s),etc.Check the box that best describes the site in this regard. [1 Good no major off site work required and in a convenient location to other primary community services (]Fair -some off site work required to connect utilities and/or location is inconvenient with respect to one or two other primary community services O Poor -significant off site work required to connect to utilities and/or location is remote from most other primary community services F4.11 Are there other funding sources or potential resource enhancement opportunities that would be more accessible if a new facility was constructed in the community? O NO O YES If yes,please list 0 Don't Know F412 is there a new clinic or major clinic renovation project for the community that is approved and awaiting funding by a government entity or other outside source? O No O YES If yes,check the box that most closely describes the status of your project. (1 Funding anticipated within 2 years 1 Funding anticipated between 2 and 5 years ([Funding year uncertain Comments: Questionnaire -Page 11 F5.0 F5.1 F5.2 Medical Equipment Deficiencies Is the existing facility in need of new or replacement capitalized medical equipment?Note: capitalized medical equipment is fixed or movable medical equipment greater than $500 in value. O No O YES If yes,is there a cost estimate for the needed equipment? O NO O YES Estimate =$ Does the facility have access to funds from any of the following sources for capitalized medical equipment? 0 IHS OO State 0 Regiona!Native Health Corporation Medical Equipment Fund 0 Medical Equipment Fund at your parent organization C)Other (list) lf you checked any of the above five boxes,what is your estimate of the remaining funds necessary to meet your current medical equipment needs? Estimate =$ Comments: F6.0 F6.1 F6.2 Utility and Maintenance Data Please provide the following energy data for calendar year 1998. Total electrical usage at facility =Kilowatt-hours Total fuel oil usage at facility =Gallons Total natural gas usage at facility =Cubic Feet Total other energy sources (e.g.waste heat,coal etc.)=Million BTU's Other (list) On average,what are the annual costs for utilities and routine maintenance activities at the facility?Include costs for all utilities,building service contracts,maintenance benchstock and supplies,maintenance training,and small (less than $10,000)in-house repair /remodel projects. Do not include wages for maintenance staff. $_:Céppe@err'yerrr Questionnaire -Page 12 F6.3 F6.4 F6.5 What funds are used to pay for ownership,repair,utility and maintenance costs at the facility? Check all the boxes that apply. O1 IHS Village Built Clinic lease funds IHS /ANTHC Maintenance and Improvement funds Regional Native Health Corporation Funds Clinic Operating Funds City Funds State Funds OoOoOooaogadqgPrivate Funds (e.g.contributions by building owner) O Other (list) Is there a regional or other non-local support system for facilities management issues that your facility/staff can access? O NO C]YES If yes,indicate the lead organization for this support Does the owner of the facility have a building replacement and depreciation fund? O NO O YES O1 Don't Know Comments: Certification:The above information is true and accurate to the best of my knowledge. Signature Date Printed Name .Position The following additional individuals participated in the completion of this section of the questionnaire. Printed Name &Position Printed Name &Position Printed Name &Position Printed Name &Position Questionnaire -Page 13 The facilities section is now complete. Questionnaire -Page 14 Community Unique ID # Organization P1.0 Services The services listed in questions P1.1 -P1.41 and P4.1-P4,.7 may be considered components of comprehensive primary care.These services may be provided by a variety of health care providers,including Community Health Aides / Practitioners,Nurse Practitioners,Physician Assistanis,Physicians,etc.Please indicate whether your program provides these services and functions.A "YES"answer implies that these services are provided on a regular basis by full or part time local staff.If you answered "NO'or "itinerant Basis Only”please indicate why by checking one or more boxes to the right,and then indicate if any of the services should be provided on a regular basis to meet local program and/or community goals. Key: Avail,=Availabl Currently if Not,Why?Should Bevail.=Available Provided?(check aif that apply)Provided? Comm.=Community Inadeq.=Inadequate wae NotItin.=Hinerant /Contract . :.Not :Itin.Needed Inadeg. :..|Wanted |Inadeq.|Inadeq.|Inadeq.Yes j Basis |No |}In This .:Staff jOtherl Yes}No;Size con,Funding }Space |Equip.Avail.Comm.mm. P14 Family Health P12 Emergency Medical Treatment: P1.3 Substance Abuse Diagnosis” P14 Substance Abuse Treatment PLS Mental Health Diagnosis : P1.6 Mental Health Treatment: Comments: Questionnaire -Page 15 Key:; : ”;Currently if Not,Why?Should BeAvail.=Available Provided?(check all that apply)Provided?Comm.=Community Inadeq.=Inadequate NHtin.=Itinerant/Contract . Oe Not . .ttn.Needed |wanted |inadeg.|Inadeq.|Inadeg.|29°9-Yes}Basis |No {{In This .:Staff jJOther}fYes]|No ::By Funding |Space |Equip.5OnlySizeCommAvail, Comm.. P1.7 Prenatal and Perinatal Services: P1.8 Breast and Cervical Cancer Screening P1.9 Well-Child Services. P1.10 Immunizations | P1.41 Supplemental Nutrition Program. (WiC) P1.12 Family Planning Services P1.13 Preventive Dental Services. P1.14 Dental Treatment Services | P1.15 Patient Education : P1.16 Other (list) Comments: Key: ;:Currently if Not,Why?Should BeAvail.=Available |Provided?(check aif that apply)Provided? Comm.=Community : Inadeq.=Inadequate : N...Itin,=itinerant /Contract :. o Not :Kin.Needed inadeq.CLIA =Clinical Laboratory 'lves|Basis |No [|in This Warted pack.ae cous Staff [Other]Yes]NoImprovementActOnlyowCo7m.Gg}vpa "|Avail. mm, P1.17 CLIA Waived Tests: P1.18 Specimen Collection for Shipment to Referral Lab P1.19 Provider Performed Microscopy P1.20 Moderate Complexity Lab. P1.21 Ultrasound P1.22 X-Ray P1.23 Mammography. P1.24 Pharmacy Services - Comments: Questionnaire -Page 16 Key: ;:Currently If Not,Why?ShouldBeAvail.=Available Provided?(check all that apply)Provided? Comm,=Community Inadeq.=inadequate .:NotItin.=Iinerant /Contract :Notfin.Needed Inadeq.Yes}Basis |No |]in This Wanted bes peoe Cou Staff [Other]}Yes}]NoOnlySizeCommS|)SP QUIP.TF avail.Comm.ae P1.25 Referral of Patients to Providers P1.26 Counseling and Follow-Up Services to Assist Patients to Become Eligible jor Health Care Coverage. Comments: Key: ;;Currently if Not,Why?Should Be Avail.=Available Provided?(check all that apply)Provided? Comm.=Community Inadeq.=Inadequate Not:.0Itin.=Itinerant /Contract .Not :Hin.Needed A inadeq.yes|Basis |No {|in This |Wanted |Inadea.|Inadeg.|Inadeg.|o+4"loner |Yes No' : :By Funding}Space |Equip..a ©Only Size Comm Avail, Comm.. P1.27 Outreach. P1.28 Home to Clinic Transportation P1.29 Language Interpretation P1.30 Sliding Fee Scale /Reduced Rates P1.31 Alternate/Extended Hours _ -Comments: Questionnaire -Page 17 7ReenF Key: .Currently if Not,Why?Shouid BeAvail.=Available Provided?(check all that apply)Provided? Comm.=Community inadeq.=Inadequate :.NotItin.=Hinerant/Contract :Notfin.Needed Inadeq.;'fYes]Basis |No in This Wanted inadeq.Inadeq.inadeq.Staff |Other}|Yes}No: :By Funding}Space |Equip.:Only Size Comm Avail. Comm.. P1.32 Education on Availability and Appropriate Use of Services P1.33 Off Site Services (e.g.,school,senior center) P1.34 Home Health Visits P1.35 Personal Care Services. P1.36 Community Health Education &: Health Promotion. Comments: Key:. Avail.=Availab!Currenily If Not,Why?Should BeVal.=AVERAGE Provided?(check all that apply)Provided? Comm.=Community Inadeq.=Inadequate : ..Notltin.=Htinerant /Contract :NotItin,Needed A inadeq.ves!Basis |No in This Wanted inadeq.Inadec.Inaceq.Stat lotherllyes}No :.By Funding |Space |Equip.'Only Size Comm Avail. Cornm.. First Responder Services Ambulance Services P1.39 Ability to Provide Advanced Cardiac Life Support in Clinic P1.46 Dedicated Area for Dealing with Emergency Patients P1.41 Radio Communications Between Clinic &Emergency Medical Personne! Comments: Questionnaire -Page 18 P2.0 P2.1 P2.2 P2.3 P2.4 P2.5 Transportation Do you arrange for transport to other communities for care? C]NO Cl YES What is the primary mode of travel to the next level of care? [1 Motor Vehicle C)Airplane []Boat []Other (list) For routine referrals,what is the average travel time to the next level of care (door-to-door)? (Less than 1 hour {1 1-2 hours 1 2-6 hours more than 6 hours In emergencies,what is the average travel time to the next level of care (door-to-door)? (J Less than 1 hour (1 1-2 hours C]2-6 hours [)more than 6 hours What were your total travel costs for patient and accompanying staff to the next level of care in calendar year 1998? $ []Don't Know Comments: Questionnaire -Page 19 P3.0 Administration P3.1 P3.2 P3.3 What term best defines the organization that provides administration of your program? O OoOodoodaOther (expiain) Private,for profit Private,not for profit City/Borough PL 93-638 Contract /Compact N/A If n/a go to question P3.3 Does the facility have a governing board /body? 1 No [i YES Check the box in each column that most accurately describes the budget situation for your health services delivery program.Note:this question relates only to "program” budget,Le.,excludes facility ownership,repair,utility and maintenance costs,which are addressed separately in the Facilities section of the questionnaire. Current Operating Budget Current Deficits Total Projected Operating Budget| if all Needed Services Were Provided $0. $1 =$50,000. $50,001 -$100,000 $100,001 -$150,000 $150,001 -$200,000 $200,001 -$250,000 $250,001 -$300,000 $300,001 -$350,000. $350,001 -$400,000. $400,001 -$450,000. $450,001 -$500,000 Greater Than $500,000 < Questionnaire -Page 20 P3.4 Check all the funding sources that apply,or would apply,to your health services program. Checking a box is the same as answering yes.Blank boxes will be interpreted as either a NO or Don't Know response.Note:this question relates only to "program”budget,i.e.,excludes facility ownership,repair,utility and maintenance costs,which are addressed separately in the Facilities section of the questionnaire. Usingow |Would Ure at Needed P3.4.1 Medicaid P3.4.2 Denali KidCare P3.4.3 Medicare. P3.4.4 Other Health Insurance P3.4.5 Federal Grants [ P3.4.6 State Grants || P3.4.7 Other Grants || P3.4.8 Private Pay P3.4.9 P.L.93-638: P3.4.10 Community Subsidy P3.4.11 Other (list) | Comments: P4.0 Support Services The following is a list of support services.Please check ail the boxes that apply. Done Onesieby itinerant'Gonteet|Done Off Site?ootStaff? Pat "Medical Records || P42 Accounting /Budget P4.3 Billing /Collections | P4.4 Computer Information Support: P4.5 Facilities Management : P4.6 Janitorial Services : P4.7 Staff Development /In-Service - Comments: Questionnaire -Page 21 P5.0 Staffing The jollowing is a list of staff.For each type of staff,please indicate the number of funded positions you have, the number of positions filled and the number needed.Also indicate if you use Itinerant or Contract staff.Please report positions in terms of "Full-time equivalents (FTE's)". Key: Fulltime employee =1.0 FTE Additional itinerants or Contract Staff;cayaiweet 4 _|Number of]|Number of Number ofaySIWESaaaFundedFilledaHalf-time 6 Positions ||Positions ||Positions2days/week 4 Needed Additional1day/week 2 Current Needed0davsiweekny)ee P54 Director/Clinical Manager- P5.2 Business Manager | P5.3 Billing /Collections Staff P5.4 Computer Information Staff.| P5.5 Clerical /Reception/Travel | P5.6 Medical Records Staff | P5.7 Maintenance /Janitorial Staff P5.8 Community Health Aide /Practitioner. P5.9 Community Health Representative | P5.10 Rural Human Services Worker |PS.11 WIC Stat:i P5.12 Emergency Medical Technician”|| P5.13 Nurse' P5.14 State/Contract Public Health Nurse _ P5.15 Nurse Practitioner | P5.16 Physician Assistant | P5.17 Physician P5.18 Dental Hygienist \ P5.19 Dentist P5.20 Other (list) Comments: Questionnaire -Page 22 P6.0 Clinical Caseload (Workload)Data P6.1 P6.2 P6.3 P6.4 P6.5 Is caseload data available for your program? []NO /fno,go to question P6.5. O Yes | CL]N/A if n/a,answer question P6.5 and then skip to section 8.0. How many total patient encounters /visits were reported in your program in calendar year 1998? (write in number) C]Don't Know How many total dental encounters /visits were reported in your program in calendar year 1998? (write in number) []Don't Know How many emergency medical patients were seen in your facility in calendar year 1998? (write in number) [Don't Know Is there a significant seasonal or itinerant population in your community that requires health services? [1 NO ff no,go to subsection P7.0. O YES If yes,is the population high risk?Check all that apply below. CO Fishing C]Logging C]Tourism []Other (list) if yes,do many of these individuals experience a language barrier at your facility? O NO MO Yes Comments: Questionnaire -Page 23 P7.0 P7.1 P7.2 P7.3 P7.4 Extended Patient Stays (greater than 4 hours) Does your primary care facility ever treat patients for extended stays including overnight? []NO /fno,go to subsection P8.0. []YES If you answered "YES”to question P7.1,how often were patients treated for extended stays in calendar year 1998? [1 1-5 times 6-10 times [1 11-20 times []More than 20 times Why did these patients require extended stays in your facility?Check all that apply. C]Lack of adequate transportation []Could not transport patient(s)out of community due to weather (1 Condition of patients(s)required extended observation or treatment,but not out of community []Other circumstances (please explain below) Is your facility equipped to accommodate patients overnight? O No O YES Comments: P8.0 P8.1 P8.2 Living Quarters Do you have living quarters available for Itinerant/Contract staff?Select one response that best describes the situation. O NO (J YES -in clinic {)YES in community Do you have living quarters available for permanent staff?Select one response that best describes the situation. []No [YES in clinic Cl YES in community Questionnaire -Page 24 P8.3 if you answered "NO"to question P8.1 or P8.2,do you believe that dedicated living quarters for clinic staff are needed?Check all responses that apply. O NO (1 YES -in the clinic O YES -in the community but not in the clinic (1 YES -this affects our ability to provide certain health care services Comments: P9.0 Telehealth P9.1 P9.2 Does your main referral facility have an advanced medical communication system in place that takes advantage of new telemedicine technology? [1 No O YES [1 Under Development 1 Don't Know If you currently have,or plan to have telemedicine equipment available in your facility,do you have adequate space for it? O no O YES [J]Don't Know Comments: Certification:The above information is true and accurate to the best of my knowledge. Signature Date Printed Name Position The following additional individuals participated in the completion of this section of the questionnaire. Printed Name &Position Printed Name &Position Printed Name &Position Printed Name &Position Questionnaire -Page 25 Community ADDITIONAL COMMENTS. Organization Unique ID # Name of Facility Question Number [| Question Number [| Question Number [| Question Number [| Question Number [ Questionnaire -Page 26 Community ADDITIONAL COMMENTS Unique ID # Organization Name of Facility Question Number [| Question Number [| Question Number [| Question Number f | Question Number [ Questionnaire -Page 27 For Hard Copy Submissions Mi Enter the community,facility and program identification information at the beginning of the General,Facilities,and Program Sections of the questionnaire. -M4 Sign the certification at the end of all applicable sections of the questionnaire. Return the General Section of the questionnaire. _&Return the appropriate number of Facilities and Program Sections of the questionnaire. .©Keep copies of all sections for your records. _For Electronic Submissions via the Project Web Site M Complete the appropriate number of Facilities and Program Sections of the questionnaire. MI Print a copy of all sections for your records. =Complete Questionnaires and Submit Data by April 25,2000 < APPENDIX IV 2000 CENSUS DISTRICTS Nome Wade-Hampton Aleutians WestE>vag oh North Slope Fairbanks North Star Yukon-Koyukuk Southeast Fairbanks Denali Skagway- Hoonah- AngoonValdez- Cordovaoabc ty JuneauBethelYakutat CS Anchorage Ky Ketchikan an :w GatewaaofKenaiSitkax'ah of Dillingham Peninsula Kodiak Wrangell- Bristol Bay Island Petersburg Prince of Wales- Lake and Outer Ketchikan Peninsula e eH Aleutians East yp? = 2000 Census Districts State of Alaska Source:Alaska Department of Labor APPENDIX V SAMPLE AD HOC QUERRY Alaska Rural Primary Care Facility Needs Assessment Project ZSGeOONOanWNNNNYNNNNYDNANND|BBaASseseaOMANOAARWDNYDBAODOANODOo&WDFinal Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays The following information is sensitive and restricted from public release 1994 House Clinic Equipped Election EMS Has |FNAQ]|IHS |Survey for District Community Level Clinic}GSF |GSF |GSF Overnight 1 Hyder 1-Isolated Y 0 0 300 N 1 Saxman 1-Highway Y 0 0 288 N 2 Kupreanof 1-Isolated N 0 0 0 N 5 Angoon 1-Isolated Y 1950 0}1950 N 5 Coffman Cove 1-Isolated N 0 0 0 N 5 Covenant Life 1-Isolated N 0 0 0 N 5 Craig 2-Isolated Y 2800 0|3730 N 5 Cube Cove 1-Isolated N 0 0 0 N 5 Edna Bay 1-Isolated N 0 0 0 N 5 Elfin Cove 1-Isolated N 0 0 0 N 5 Game Creek 1-Isolated Y 108 0 0 N 5 Gustavus 2-Isolated Y 800 0 0 N 5 Haines 2-Isolated Y 6000]1561 0 N 5 Hobart Bay 1-Isolated N 0 0 0 N 5 Hollis 1-Isolated N 0 0 0 N 5 Hoonah 2-Isolated Y 0 O|2740 N 5 Kake 1-Isolated Y 3300]3295]3134 N 5 Kasaan 1-Isolated N 0 0 0 N 5 Klawock 2-Isolated Y 6772|6769}1176 N 5 Klukwan 1-Isolated N 0 0 0 N 5 Lutak 1-Highway N 0 0 0 N B)Metlakatla 2-Isolated Y 8255]8273 0 N 5 Meyers Chuck 1-Isolated N 0 0 0 N 5 Mosquito Lake 1-Isolated N 0 0 0 N 5 Naukati Bay 1-Isolated N 0 0 0 N 5 Pelican 2-Isolated Y 1600 0 0 N 5 Point Baker 1-Isolated N 0 0 0 N 5 Port Alexander 1-Isolated N 0 0 0 N 5 Port Protection 1-Isolated N 0 0 0 N 5 Skagway 2-Isolated Y 0 0 720 N 5 Tenakee Springs 1-Isolated N 0 0 0 N 5 Thorne Bay 2-Isolated Y 1102 0 0 N 5 Whale Pass 1-Isolated N 0 0 0 N 5 Whitestone Logging Camp 1-Isolated N 0 0 0 N 6 Chiniak 1-Isolated N 0 0 0 N 6 Karluk 1-Isolated Y 0 0 392 N 6 Larsen Bay 1-Isolated Y 615 0 615 N 6 Old Harbor 1-Isolated Y 784 0 784 N 6 Ouzinkie 1-Isolated Y 1056 0 960 N 6 Port Lions 1-Isolated Y 1655 O}1465 N 6 Womens Bay 1-Highway N 0 0 0 N 7 Anchor Point 2-Highway N 0 0 0 N 7 Clam Gulch 1-Highway N 0 0 0 N Volume I -Appendix V Page 1 Alaska Rural Primary Care Facility Needs Assessment Project Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays The following information is sensitive and restricted from public release 1994 House Clinic EquippedElectionEMSHas|FNAQ|IHS |Survey for District Community Level Clinic]GSF |GSF |GSF Overnight 7 Cohoe 1-Highway N 0 0 0 N 7 Fox River 1-Highway N 0 0 0 N 7 Fritz Creek 1-Highway N 0 0 0 N 7 Halibut Cove 1-Isolated N 0 0 0 N 7 Happy Valley 1-Highway N 0 0 0 N 7 Jakolof Bay 1-Isolated N 0 0 0 N 7 Kachemak 1-Highway N 0 0 0 N 7 Kalifonsky 1-Highway N 0 0 0 N 7 Kasilof 1-Highway N 0 0 0 N 7 Nikolaevsk 1-Highway N 0 0 0 N 7 Ninilchik 1-Highway Y 3202 0 0 N 7 Port Graham 1-Isolated Y 0 0 530 N 8 Cooper Landing 1-Highway N 0 0 0 N 8 Crown Point 1-Highway N 0 0 0 N 8 Hope 1-Highway N 0 0 0 N 8 Moose Pass 1-Highway N 0 0 0 N 8 Primrose 1-Highway N 0 0 0 N 8 Ridgeway 2-Highway N 0 0 0 N 8 Sterling 2-Highway N 0 0 0 N 9 Kenai 2-Highway Y O}3600 0 N 9 Nikiski 2-Highway N 0 0 0 N 9 Salamatof 1-Highway N 0 0 0 N 26 Wasilla 2-Highway N 0 0 0 N 27 Butte 1-Highway N 0 0 0 N 27 Chickaloon 1-Highway N 0 0 0 N 27 Lazy Mountain 1-Highway N 0 0 0 N 27 Sutton 1-Highway N 0 0 0 N 28 Alexander Creek 1-Isolated N 0 0 0 N 28 Big Lake 2-Highway N 0 0 0 N 28 Chase 1-Isolated N 0 0 0 N 28 Houston 1-Highway N 0 0 0 N 28 Knik 1-Highway N 0 0 0 N 28 Meadow Lakes 2-Highway N 0 0 0 N 28 Skwentna 1-Isolated N 0 0 0 N 28 Talkeetna 2-Highway Y 3000 0 0 N 28 Trapper Creek 1-Highway N 0 0 0 N 28 Willow 1-Highway N 0 0 0 N 29 Ester 1-Highway N 0 0 0 N 33 Fox 1-Highway N 0 0 0 N 33 Pleasant Valley 1-Highway N 0 0 0 N 33 Two Rivers 1-Highway N 0 0 0 N 34 Anderson 1-Isolated N 0 0 0 N 34 Cantwell 1-Isolated Y 0 0 589 N Volume I -Appendix V Page 2 Alaska Rural Primary Care Facility Needs Assessment Project Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays Thefollowing information is sensitive and restricted from public release 1994 House Clinic Equipped Election EMS Has }FNAQ!IHS |Survey for District Community Level Clinic}GSF |GSF |GSF Overnight 87 34 Ferry 1-Isolated N 0 0 0 N 88 34 Harding Lake 1-Isolated N 0 0 0 N 89 34 Healy 2-Isolated N 0 0 0 N 90 34 Lignite 1-Isolated N 0 0 0 N 91 34 McKinley Park 1-Isolated N 0 0 0 N 92 34 Moose Creek 1-Highway N 0 0 0 N 93 34 North Pole 2-Highway N 0 0 0 N 94 34 Salcha 1-Highway N 0 0 0 N 95 35 Big Delta 2-Isolated N 0 0 0 N 96 35 Chenega Bay 1-Isolated Y 0 0 $45 N 97 35 Delta Junction 2-Isolated N 0 0 0 N 98 35 Eyak 1-Highway N 0 0 0 N 99 35 Gakona 1-Isolated N 0 0 0 N 100 35 Glennallen 2-Isolated N 0 0 0 N 101 35 Kenny Lake 1-Isolated N 0 0 0 N 102 35 Mendeltna 1-Isolated N 0 0 0 N 103 35 Paxson 1-Isolated N 0 0 0 N 104 35 Tazlina 1-Isolated N 0 0 0 N 105 35 Tonsina 1-Isolated N 0 0 0 N 106 35 Whittier 2-Isolated Y 900 0 0 N 107 36 Alatna 1-Isolated N 0 0 0 N 108 36 Alcan 1-Isolated N 0 0 0 N 109 36 Allakaket 1-Isolated Y 0 0 437 N 110 36 Aniak 2-Isolated Y 6300{7538 841 N 111 36 Anvik 1-Isolated Y 944)1055 765 N 112 36 Arctic Village 1-Isolated Y 0 0]1240 N 113 36 Beaver 1-Isolated Y 0 0 480 N 114 36 Bettles 1-Isolated N 0 0 0 N 115 36 Birch Creek 1-Isolated Y 500 0 0 N 116 36 Central 1-Isolated N 0 0 0 N 117 36 Chalkyitsik 1-Isolated Y 0 0 480 N 118 36 Chistochina 1-Isolated Y 0 0 768 N 119 36 Chitina 1-Isolated Y 540 0 980 N 120 36 Chuathbaluk 1-Isolated Y 840|720 720 N 121 36 Circle 1-Isolated Y 0 0 480 N 122 36 Circle Hot Springs 1-Isolated N 0 0 0 N 123 36 Copper Center 1-Isolated Y 140|2977 980 N 124 36 Copperville 1-Isolated N 0 0 0 N 125 36 Crooked Creek 1-Isolated Y 680 680 680 N 126 36 Dot Lake 1-Isolated Y 384 0 363 N 127 36 Eagle 1-Isolated Y 0 0 448 N 128 36 Evansville 1-Isolated Y 720 0 0 N 129 36 Fort Yukon 2-Isolated Y O|5920 0 N Volume I -Appendix V Page 3 i) Alaska Rural Primary Care Facility Needs Assessment Project Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays Thefollowing information is sensitive and restrictedfrom public release 1994 House Clinic EquippedElectionEMSHas|FNAQ!IHS |Survey for District Community Level Clinic]GSF |GSF |GSF Overnight 130 36 Galena 2-Isolated Y 2307 0O|3702 N 131 36 Grayling 1-Isolated Y 899]898 768 N 132 36 Gulkana 1-Isolated Y 50 0 816 N 133 36 Healy Lake 1-Isolated N 0 0 0 N 134 36 Holy Cross 1-Isolated Y 768)1125 768 N 135 36 Hughes 1-Isolated Y 896 0 265 N 136 36 Huslia 1-Isolated Y 0 0 832 N 137 36 Kaltag 1-Isolated Y 117 0 713 N 138 36 Koyukuk 1-Isolated Y 0 0 805 N 139 36 Lake Minchumina 1-Isolated N 0 0 0 N 140 36 Lime Village 1-Isolated Y O|480 480 N 141 36 Lower Kalskag 1-Isolated Y 768|768 768 N 142 36 Manley Hot Springs 1-Isolated Y 0 0 488 N 143 36 Marshall 1-Isolated Y 1632]1632 696 N 144 36 McCarthy 1-Highway N 0 0 0 N 145 36 McGrath 2-Isolated Y 0 0]1600 N 146 36 Mentasta Lake 1-Highway Y 400 0 980 N 147 36 Minto 1-Isolated Y 636 0 792 N 148 36 Nenana 2-Highway Y 0 0 513 N 149 36 Nikolai 1-Isolated Y 576 0 $20 N 150 36 Northway 1-Isolated Y 0 0 673 N 151 36 Northway Junction 1-Isolated Y 0 0 673 N 152 36 Nulato 1-Isolated Y 864)910 757 N 153 36 Pilot Station 1-Isolated Y 1200]768 768 N 154 36 Rampart 1-Isolated Y 0 0 320 N 155 36 Red Devil 1-Isolated Y 0 0 336 N 156 36 Ruby 1-Isolated Y 0 0 653 N 157 36 Russian Mission 1-Isolated Y 1280}1000]1000 N 158 36 Shageluk 1-Isolated Y 538]288 810 N 159 36 Slana 1-Isolated N 0 0 0 N 160 36 Sleetmute 1-Isolated Y 840]840]1408 N 161 36 Stevens Village 1-Isolated Y 396 0 443 N 162 36 Stony River 1-Isolated Y 956}437 437 N 163 36 Takotna 1-Isolated Y 376 0 575 N 164 36 Tanacross 1-Isolated Y 710 0 495 N 165 36 Tanana 2-Isolated Y O|55772 0 N 166 36 Tetlin 1-Isolated Y 0 0 480 N 167 36 Tok 2-Isolated Y 7780 O|1338 N 168 36 Tuluksak 1-Isolated Y 1008}1000 837 N 169 36 Tyonek 1-Isolated Y 800 0 900 N 170 36 Upper Kalskag 1-Isolated Y 960]960 504 N 471 36 Venetie 1-Isolated Y 0 O|1200 N 172 36 Wiseman 1-Isolated N 0 0 0 N Volume I -Appendix V Page 4 Alaska Rural Primary Care Facility Needs Assessment Project 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays Thefollowing information is sensitive and restricted from public release 1994 House Clinic Equipped Election EMS Has |FNAQ]IHS |Survey for District Community Level Clinic]GSF |GSF |GSF Overnight 37 Ambler 1-Isolated Y 870 0 870 N 37 Anaktuvuk Pass 1-Isolated Y 2623 O|4400 N 37 Atqasuk 1-Isolated Y 2623 0;4400 N 37 Buckland 1-Isolated Y 805 0 805 N 37 Deering 1-Isolated Y 725 0 725 N 37 Kaktovik 1-Isolated Y 0 0}4400 N 37 Kiana 1-Isolated Y 780 0}1083 N 37 Kivalina 1-Isolated Y 930 0 867 N 37 Kobuk 1-Isolated Y 805 0 805 N 37 Noatak 1-Isolated Y 800 0 800 N 37 Noorvik 1-Isolated Y 2500]3284 0 N 37 Nuigsut 1-Isolated Y 0 0}4400 N 37 Point Hope 1-Isolated Y 4000 0 870 N 37 Point Lay 1-Isolated Y 5246 0}4400 N 37 Prudhoe Bay 2-Isolated N 0 0 0 N .37 Selawik 1-Isolated Y 2100 884 768 N 37 Shungnak 1-Isolated Y 1620 0 0 N 37 Wainwright 1-Isolated Y 0 O|4400 N 38 Alakanuk 1-Isolated Y 1344|1344}1344 N 38 Andreafsky 2-Isolated N 0 0 0 N 38 Brevig Mission 1-Isolated Y 0 O|1260 N 38 Chevak 1-Isolated Y 2816}2836]1977 N 38 Elim 1-Isolated Y 737 0 954 N 38 Emmonak 1-Isolated Y 1792|13473 869 N 38 Gambell 1-Isolated Y 2587|1048]1260 N 38 Golovin 1-Isolated Y 1267 0 992 N 38 Hooper Bay 1-Isolated Y 1790]2838{1790 N 38 Kotlik 1-Isolated Y 2400}960 960 N 38 Koyuk 1-Isolated Y 1110 O|1120 N 38 Mekoryuk 1-Isolated Y 966|800 768 N 38 Mountain Village 1-Isolated Y 1656}1899}1900 N 38 Newtok 1-Isolated Y 442 442 442 N 38 Nightmute 1-Isolated Y 910;910 417 N 38 Nunam Iqua (Sheldon Point)|_1-Isolated Y 768;768 840 N 38 Pitka's Point 1-Isolated Y 1000|_999 374 N 38 Port Clarence 1-Isolated N 0 0 0 N 38 Saint Mary's 1-Isolated Y 720;720 0 N 38 Saint Michael 1-Isolated Y 1800 0 0 N 38 Scammon Bay 1-Isolated Y 1020{1019 880 N 38 Stebbins 1-Isolated Y 722 0}1833 N 38 Teller 1-Isolated Y 1472 0 910 N 38 Toksook Bay 1-Isolated Y 1440]1440]1200 N 38 Tununak 1-Isolated Y 768|768 768 N Volume I -Appendix V Page 5 Alaska Rural Primary Care Facility Needs Assessment Project 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays Thefollowing information is sensitive and restricted from public release 1994 House Clinic Equipped Election EMS Has |FNAQ{|IHS |Survey for District Community Level Clinic}GSF |GSF |GSF Overnight 38 Unalakleet 2-Isolated Y 3202};1400]1440 N 38 White Mountain 1-Isolated Y 0 0 768 N 39 Akiachak 1-Isolated Y O|1791 768 N 39 Akiak 1-Isolated Y 1628] 831{1628 N 39 Aleknagik 1-Highway Y 0 0 623 N 39 Atmautluak 1-Isolated Y 768}4425 768 N 39 Chefornak 1-Isolated Y 960 936 609 N 39 Clark's Point 1-Isolated Y 0 0 240 N 39 Eek 1-Isolated Y 729|1399 768 N 39 Ekwok 1-Isolated Y 0 0 439 N 39 Kasigluk 1-Isolated Y 768}768 768 N 39 Kipnuk 1-Isolated Y 1536|1536 960 N 39 Kongiganak -1-Isolated Y 960}960 768 N 39 Kwethluk 1-Isolated Y 1792}1791 792 N 39 Kwigillingok 1-Isolated Y 946}1039 946 N 39 Napakiak 1-Isolated Y 1008{1000 768 N 39 Napaskiak 1-Isolated Y 960]1959 0 N 39 New Stuyahok 1-Isolated Y 800 0;1000 N 39 Nunapitchuk 1-Isolated Y 1679}1678 775 N 39 Oscarville 1-Isolated Y 320|320 320 N 39 Platinum 1-Isolated Y 0 0 427 N 39 Quinhagak 1-Isolated Y 1161}1139]1139 N 39 Togiak 2-Isolated Y 0 0 784 N 39 Tuntutuliak 1-Isolated Y 1440}1439]1440 N 39 Twin Hills 1-Isolated Y 0 0 725 N 40 Adak 2-Isolated N 0 0 0 N 40 Akutan 2-Isolated Y 960 0 720 N 40 Atka 1-Isolated Y 960 0 960 N 40 Chignik 2-Isolated Y 1200 0 0 N 40 Egegik 1-Isolated Y 400 0 432 N 40 False Pass 1-Isolated Y 0 0 530 N 40 Igiugig 1-Isolated Y 854 0 640 N 40 Tliamna 1-Isolated Y 0 0 750 N 40 Ivanof Bay 1-Isolated Y 0 0 576 N 40 King Cove 2-Isolated Y 790 OF 2000 N 40 King Salmon 1-Isolated Y 0 0 528 N 40 Levelock 1-Isolated Y 0 0 912 N 40 Naknek 2-Isolated Y 0 0 672 N 40 Nelson Lagoon 1-Isolated Y 0 0 670 N 40 Newhalen 1-Isolated Y 0 0 440 N 40 Nikolski 1-Isolated Y 820 0 382 N 40 Nondalton 1-Isolated Y 100 0 660 N 40 Pedro Bay 1-Isolated Y 800 0 400 N Volume I -Appendix V Page 6 Alaska Rural Primary Care Facility Needs Assessment Project 259 260 261 262 263 264 Final Report October 2000 Alaska Primary Care Data System EMS Level 1 or 2 Communities Without A Clinic,or Not Equipped for Overnight Stays Thefollowing information is sensitive and restrictedfrom public release 1994 House Clinic Equipped Election EMS Has |FNAQ|IHS |Survey for District Community Level Clinic}GSF |GSF |GSF Overnight 40 Perryville 1-Isolated Y 600 0 760 N 40 Port Alsworth 1-Isolated N 0 0 0 N 40 Port Heiden 1-Isolated Y 0 0 710 N 40 Saint George 2-Isolated Y 2100 0}2100 N 40 South Naknek 1-Isolated Y 0 0}1045 N 40 Unalaska 2-Isolated Y 1796 O|3100 N Volume I Appendix V Page 7 ge This page is intentionally left blank. APPENDIX VI SAMPLE GEOGRAPHIC INFORMATION SYSTEM DISPLAY Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 E ::»Mictos ::1-1|File Edit View Favortes Tools Help -.”*.,.O ff &42|/a8 &@ 6/8 4 8.8 "|Back Forward Stop Refresh Home Search Favorites History Mail Print Edit Discuss |Address |7]Go ||Links ”) :2G] Airport 4 Q MV Alaska Pipeline T Alaska side 19 Boroughs 3 I Census Areas 3 I Communities by Unmet vs T™Communitites without ClfeGuerytown!2 IT Community Population1 COMMUNITY:ys M Elections:house district a -Ln I Elections:senate distric), 3 IT Hospitals _ 2 T Marine highways M Railroad - «j o 436,000,008teeaten Query Results L Query_Town (23 Records) COMMUNITYME boRoUGHmR |binatedPseespanois:9awe-mei.asIAdak Unorganized Aleutians West Unassigned 40.0 T al ,Kodiak Island .KODIAK AREA NATIVEAkhiokBoroughKodiakIslandASSOCIATION 6.0 Cc eal -OKVWVIM HEALTHAkiachakUnorganizedBetheltone.KUSK 39.0 T rie é][[1 Intemet A Volume I -Appendix VI Page 1 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 5 |Oy x |Eile Edit View Favorites Tools Help .Pe F =&=»es.>.©a |Q ed -6 6 .& |]Back Forward __Stop Refresh Search Favorites -_History Mail Print Edit Discuss |Address ||z|eGo ||Links » 2G) E=dueryTownt COMMUNITY: a Search |Clear #6666640666585pa [J Bristol Bay | Pe Kodiak Island CI Prince af Wales-Outer Ke c]Ketchikan Gateway (I Aleutians East [7]Aleutians West a £VYakutat ja |Skagway -Hoonah -Anc COMMUNITIES BY UNMET NEE 3 Less than 165 e 165-505 =506 -664 =665 -18.666 Query Results L Query_Town (23 Records) SAV A0 AO Ae 2 fH)<%|[COMMUNITY Communrrg [Reonoucry erumeseetAdak Unorganized Aleutians Vest Unassigned 40.0 .Kodiak Island .KODIAK AREA NATIVEAkhiokBoroughKadiakIslandASSOCIATION 6.0 ,.YUKON-KUSKOKWIM HEALTHAkiachakUnorganizedBethelCORP 39.0 T el >| iS]i [[>Internet Wy Volume I -Appendix VI Page 2 APPENDIX VII BOROUGHS AND MAJOR HIGHWAYS Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 AKCTHIC OCRAN yaSTATE OF ALASKA BOROUGHS AND sp easkteaseo ta %MAJOR HIGHWAYS ' REY we x + AGTFE MEE 'N,4 \ seuaD -.\Legend Vee:ee no City or fews aWaises ue aba ene Z Geograpars Counsaries CeemnnameaaeeneeeedaogHeleHighwaySpotemeetert'Atosas Route Members Blasting May.Seward Hay,Giene May @tr:Risherdean May,Teh Set On *: ;AUSA0s Rey,Stveen Key,Lives tee > Ee .js :wor eo Ganga Darts Mey ro) 'Nome Se Fe og Aitherdsee wey @”nameun . :({Vayter May ro) '% ..5 Shetne Hay CD]ey Vannence wo : .': iSakeivee;y A : E Haring Map -ax Z Gisciae hay.Egan Ceres féoatoeySyLs-MCE Oring,MUST May (Peterederg)aesi>a Saute Tongeae Hos Keredvert2+}wa Meri Congage Wag iketediban)ra ion (aaa \oa aL i ° wevannane ¥\eon Hey ts é a f >MAG 4 Semnes Hey,Sowece te Rees hee a'}i Capper Rivas teny By'.'rn Bee vf i i domes Oaiten way at ae aarrnen 4 * f oft 4 Rteagea nee48200raneteas4geredras%aless 4 , % wae y oa :i >wes on eneaey, ; oe "af é 'deaeeesSbONwate,A a\3 4 rrr fh J Re en "care ses ;eel +8 nt iy WARE5yeSpdALSoF 4 be eetacanceRUSKONWIM5fot,'¢A oar Yeu BY' \.eae or2osOtegnscsseteVosae'--v aersron ear Qo ed tisven then oeMEASEO .naersrur war AeGutiees 4agt benered ey tye dik'Rye) prorat ate"g Yew Atey,5tay.NgUnstegngwaneef+ .:x Bos,odafee"te by 1a e BER shtype.ac iti s ee BadheeSoutce:Alaska Departawnt of Transportation and Public Pacitities 'Ngetene i West Ae, Volume I -Appendix VII Page 1 APPENDIX VIII SPACE STANDARDS COMPARISON Alaska Rural Primary Care Facility Final ReportNeedsAssessmentProjectOctober2000 Space Standards Comparison Code Criterta STANDARD or &PROJECT gfe Designer Year Planned . Sle 9 S i or ora(Sa,Pt)Desfen Pon.5 a <Standard Desiened tne cohirnn a b cj ¢¢f g h {[YKUC PROTOTYPES s [oat aba i:ohne 28 bs 2 Small 1,078 20-300 |XEXITX 3 Medium 1,470 300-600 |X |X|X .':=Ww x 9994Large|_1,870 >600 |xT XTX inchester AK ' $Sub-Regional 10,607**varies XLX LEX 6 J|MANIILAQ PROTOTYPE :rte on ede 7 One Size Fits All 5,150 100-800 |X |XJ X Bettisworth and Co.2000 8 JNORTH SLOPE BOROUGH STANDARDS fs ees ' ' 9 Original Prototype 4,400 150-500 |X}|X McCool -McDonald 1982 10 Upgrade Standard -Level 4,400 <300 X{X{jxX EC?-Hyer iT Upgrade Standard -Level 2 5,020 >400 XL XIX ECL -Hyer 1995 12 Upgrade Standard -Level 3 6,060 X{[X]X ECL -Hyer 13 [IHS PLANNING STANDARDS nes ::' : i 14 Small Leased Facilities |3,022 «8,250 >500 X[X HEPM Addendum 199] 16 St.Paul PID 18,697 Jor XUX]X .:"19942NEPAkPM(1986 Ed.16 Metlakatla PID 28,632 1576 XEX4EX Ht PM (1986 Ed)1995 17 JAANHS VBC STANDARDS eo ee cies ee en :; 18 Small 400 20-200 |Norek to |NEPA ; 19 Medium 800 200-450 |UBCorADA In |NEC Nec orae 1986 29 Large |1,000 -2,500]>450 _Citcutars [bre 21 [DUSS PUBLIC HEALTH CENTER STANDARDS [ooo oe ae : 22 Snaall 2,162 Livingston -Stone 23 Intermediate 3,798 n/a & ; 1988 2A Large "7345 ._|Dept.of Admin. oe pe Current : : 26 ISPECIFIC RECENT PROJECTS cee be Pep. _ : 26 Crooked Creek 1,078 137 YKHIC 1999 2?Holy Cross 1,078 247 YKHC 1999 28 Lower Kalskag 1,470 310 YKHC 1999 20 K wigillingok 1470 360 YKHC 1999 30 St.Marys Sub-Repional 10,607 3012 YRKHC 1999 3 Aniak Sub-Replonal 6,250 2636 Livingston Sione 1993 32 Noorvik 2,432 632 NANA/DOWL $999 Alakanuk 1,870 659 YRKHC 1999 34 King Cove 9,541 691 Planning For tHealth 1999 35 Sclawik 1,707 167 Whitmore Jolson 1996 Unalaklect Sub-Regional 14,500 2157 Archifects Alaska 2000 37 Eamonak Sub-Regional 10,607 3749 YKHC 1999 Ki)Craig 11,000 2,136 Livingston Slone 1996 39 Unalaskaf 16,000#**4,178 ECI -Hyer 1993 Volume [-Appendix VIII Page ! Alaska Rural Primary Care Facility Needs Assessment Project Final Report October 2000 Space Standards Comparison Services Annual Outpatient Workload Stafting .a oASTANDARDiaFibyorpega.FePROJECTii3|cum poten io |8 '. :alien ecords5=Oo a 'i 2 i 3 Encounters =PCPV's OP V's *z §8 a COMMENTS ' fine column]ff k 1Yiminfotpt|4 t ${ufyv iw]x tb JYKUC PROTOTYPES 2 Small}X |X x 2 exam rooms +ofc. 3 Medium |X |X x 4 exam rooms +ofc. 4 Large |X |X x S exam ronnis +ofc, 5 Sub-Regional |X |X |X Xx]X x X|Xf X 6 IMANTILAQ PROTOTYPE ES ose ' : 1 One Size Fits AN |X 4X x X |X Xx x 8 {NORTH SLOPE BOROUGH STANDARDS ;1 9 Original Prototype}X |X x X|X EMS =ainbulance garage 10 Upgrade Standard -Level If X |X x xX |X <2000 Wl Upgrade Standard -Level 2}X |X x xX 2000-3000 distinction between level 2 and 3 based 12 Upgrade Standard -Level 3}X |X X4iX x >3000 primarily on demographics &workload 1a JUIS PLANNING STANDARDS . i Simall Leased Facilities |]X |X |X x 1,EIS -4,400)XPEX]XI]4: Bs SLPaullPIDE X|X |X]xX EX]xX x wa §,237 10,458 X {X |X |30 Iyeoj.not yet designed 16 MetlakatlaPJID]X |X |X |XX]xX |X x ATT X |X |X |60 free).not yet designed17|AANHS VBC STANDARDS : :- 18 Small}X |X x bE fl exam room +oft. i9 Medium |X |X No Specific Standards xX 1 [?exam room +ofc 20 Large |X |X x 2 [2 cxamsoom +ofc.2)[DHSS PUBLIC HEALTH CENTER STANDARDS I | 22 Smail X1X]3 23 Intermediate No Specific Standards X|X16 24 Large ewe X{X{X i 16 25 SPECIFIC RECENT PROJECTS ar :FY 98 IHS DATA 26 Crooked Creck |X |X 877 x 4 27 Holy Cross [|X |X 1,083 x 3 28 Lower Kalskag |X |X 2,091 x 3 29 K wigillingok |X |X 2,696 xX 5 30 St.Marys Sub-Regional}X |X |X X|xX x 3,160 Xi X under construction ut Aniak Sub-Regional]X |X |X X1X xX 6,966 7,898 11,549 X1X original YKHC subregtonal desig 32 Noorvik |X |X xX 3,836 x 33 Alakanuk |X |X 3,894 x 6 34 King Cove 2,154 1,924 3,811 X in planning stage 35 Selawik |X |X |X Xx $44 xX 36 Unalakicet Sub-regionalt 2,989 x in planning stage 32 Enmnonak Sub-Regional]X |X |X X LX x 4,725 X1X under construction 38 Craig X 4X a9 Unalaskah X |X 1 X PX EX EX]X x Notes: *Total OPV inay not *CHAP +PCPV's since CHAP encounters are not "adjusted”values,and not all CHAP data finds its way into the official OPV reporting system. **There is an additional 3,430 sf of open storage space on the mezanine storage level. ***City clinic (Hliuk)only,ie.,exeludes second floor space leased by APIA for their health programs:total building =19,130 sf Blauk cells indicate cither N/A or no data available. Volume [-Appendix VII Page 2 APPENDIX IX UNMET NEED BY CENSUS AREA Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 :UNMET NEED BY CENSUS AREA 4 Cost - Additional of -Cost Total Space Need Additional to Unmet Census Area (sf)Space Repair Need ALEUTIANS EAST 4,941 $2,011,941 $2,954,950 $4,966,892 ALEUTIANS WEST 3,436 $1,166,404 $6,740,817 $7,907,221 ANCHORAGE 0 $0 $124,320 $124,320 BETHEL 33,331 $14,648,422 $11,845,943 $26,494,365 BRISTOL BAY 4,192 $1,363,262 $406,897 $1,770,159 DENALI 11,831 $3,897,847 $121,023 $4,018,871 DILLINGHAM 8,897 $3,483,922 $2,375,556 $5,859,477 FAIRBANKS NSB 9,961 $2,522,281 $0 $2,522,281 HAINES BOROUGH 3,070 $1,072,402 $1,880,731 $2,953,133 JUNEAU 0 $0 $0 $0 KENAI PENINSULA 23,725 $8,111,283 $3,696,759 $11,808,042 KETCHIKAN 0 $0 $0 $0 KODIAK ISLAND 10,187 $2,305,513 $1,657,692 $3,963,205 LAKE-PENINSULA 17,648 $6,205,531 $3,885,523 $10,091,054 MATANUSKA-SUSITNA 19,938 $790,383 $1,020,058 $1,810,440 NOME 13,423 $5,511,953 $7,524,901 $13,036,854 INNORTH SLOPE 1,535 $505,619 $8,846,655 $9,352,274 NORTHWEST ARCTIC 8,482 $3,626,833 $3,432,803 $7,059,636 PRINCE OF WALES 18,523 $4,674,042 $6,428,289 $11,102,331 SE FAIRBANKS 16,989 $4,332,912 $3,196,540 $7,529,452 SITKA 0 $0 $0 $0 SKAGWA Y-HOONAH-ANGOON 15,825 $5,489,334 $1,779,964 $7,269,298 VALDEZ-CORDOVA 23,746 $7,941,851 $1,554,079 $9,495,930 WADE HAMPTON 12,075 $4,513,803 $6,098,352 $10,612,154 WRANGELL-PETERSBURG 3,070 $1,060,169 $585,000 $1,645,169 YAKUTAT 1,259 $394,640 $0 $394,640 YUKON-KOYUKUK 39,232 $13,415,306 $26,339,773 $39,755,079 TOTALS 305,316 $99,045,654 $102,496,623 $201,542,277 Volume I -Appendix IX Page 1 This page intentionally left blank. APPENDIX X MULTIPLE YEAR SCHEDULE Alaska Rural Primary Care Facility DRAFT MULTI-YEAR SCHEDULE Final Report Needs Assessment Project PRIMARY CARE FACILITIES PROJECTS FUNDED THROUGH THE DENALI COMMISSION October 2000 'H2 00 11 '04 H2 '01 H1 '02 H2 '02 Hi '03 ID |Task Name Duration Start Finish [|Qi 3 |Qtr 4 |Qte 4 |Qtr 2 |Qtr 3 |ate 4 |Qtr 1 |Qtr2 |Atr3 |Qtr 4 |Ate 1 [Qt2 1 FY 01 Funding Cycle 272 days FriSep01/Thu May 34 : FY 01 Funding Cycte 2 FNAQ Due "O days Fri Sep 01 Fd Sep 01 3 Develop Community Shortlist st ssti'iéSOSOS™ *™;”;”;C*dSC!” 75 days Fri Sep 01 Tue Nov 14 4 Code &Condition Surveys 75 days Wed Nov 15 Sun Jan 28 §RFP's issued 0 days Tue Nov 14 Tue Nov 14 8 Proposal Preparation Period 106 days Wed Nov 15}Wed Feb 28 7 ,Proposals Due 0 days Thu Mar 01 Thu Mar 01 8 ”MRP Evaluates Proposals /30 days Thu Mar 01}Sat Mar 31 9 Publish FY 01 Approved Project List QO days Sun Apr 014 Sun Apr 01 10 "TA WindowFor Projects Lacking Capability 90 days}Thu Mar01]}Wed May 30 i1 "[nilate Funding For Approved Projects 0 days Sun AprOt|Sun Apr 01 12 Updated Proposals Due For Projects Needing TA 0 days Thu May 31 Thu May 31 42 ©! 13.|FY 02 Funding Cyclo 395 days Tue May 01 Fri May 31 |ee ey 02 Funding Cyclo 14 FNAQ Due .0 days Tue May ot Tue May 01 14 ® 15 Develop Community Short List 45 days Tue May 04 Thu Jun 14 15 16 Code &Condilion Surveys 75 days Sun Jun 17 Fri Aug 31 16 [ 17 RFP's Issued 0 days Fri Jun 16 Fr Jun 15 47 @ 18 Proposal Preparation Period 108 days Fri Jun 15 Sun Sep 30 48 : 19 Proposals Due Odays}Mon Oct01}Mon Oct 01 ) 20 MRP Evaluates Proposals &Completed Design Projects 30 days Mon Oct 01 Tue Oct 30 21 PublishFY02 Approved Project List 0 days Tue Oct 30|Tue Oct 30 22 TA Window For Projects Lacking Capability 240 days Mon Oct 01 Tue May 28 23 Iniliate Funding For Approved Projects 0 days Wed Oct 31 Wed Oct 31 24 Updated Proposals Due For Projects Needing TA 0 days Fri May 31 Fri May 31 24 ® Volume }-Appendix X Page 1 Alaska Rural Primary Care Facility DRAFT MULTI-YEAR SCHEDULE Final Report Needs Assessment Project PRIMARY CARE FACILITIES PROJECTS FUNDED THROUGH THE DENALI COMMISSION October 2000 +2 '00 H1 '01 H2'01 Ht '02 H2'02 Hi '03 1 |Task Name Duration Start Finish Qir 3 [ates |Qte1 |Atr2 |Qte3 [Qtr 4 [Qtr t |Ate2 |ate3 [ates |Qte1]Qr25 A25|FY 03 Funding Cycle 393 days;Wod May 01!Wed May 28 FY 03 Funding Cyclo (py 26 FNAQ Due 0 days Wed May 01]Wed May 01 26 ® 27 Develop Community Short List 45 days Wed May 01 Fri Jun 14 27 28 Code &Condition Surveys 75 days Mon Jun 17 Sat Aug 34 28 Spe eae meee :29 RFP's issued 0 days Fri Jun 14 Fri Jun 14 29 O) 30 |Proposal Preparation Period 108 days Sat Jun18|Mon Sep 30 30 rT 31 Proposals Due 0 days Tue Oct 01 Tue Oct 01 32 MRP Evaluates Proposals &Completed Design Projects 30 days Tue Oct 01 Wed Oct 30 33 |Publish FY 03 Approved Project list Odays|Wed Oct 30]Wed Oct 30 "34 |TA Window For Projects Lacking Capability "240 days|Tue Oct 01]Wed May 28 35 Initiate Funding For Approved Projects 0 days Wed Oct 30]Wed Oct30 Volume |-Appendix X Pane 2 APPENDIX XI PART I -COMMUNITY PRIORITIZATION FORMULA Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 .PART T-COMMUNITY PRIORITIZATION FORMULA Total Point Score For Each Community =Sum of the Following:_ Maximum Points 1.Facility Deficiency Score (FDS)45 2.Health Status Score (HSS)20 3.Isolation Score (IS)10 4.Dependency Ratio Score (DRS)10 5.Economic Status Score (ESS)9 6.Trauma Registry Score (TRS)5 7.Seasonal Population Score (SPS)1 TOTAL 100 Volume I -Appendix XI Page 1 Alaska Rural Primary Care Facility Needs Assessment Project FACILITY DEFICIENCY This factor characterizes the physical condition of existing clinic facilities as well as the need for additional and/or new space.The basic assumption is that the ability to deliver quality health care services is affected by the quality of the facility or facilities that house the program.Physical condition was judged to be a function of the following: *Available space compared to a recommended guideline "Age of existing facilities =Condition of basic building systems at existing facilities FACILITY DEFICIENCY SCORE Facility Deficiency Score (FDS)=G-(Ex AFx CF)X (45) G G =Space Guideline from Table 8 in ARPCFNA Final Report 1.For EMS Level I-IS or II-IS and Population =20 -100: 2.For EMS Level I-IS or II-IS and Population =101 -500: 3.For EMS Level I-IS or II-IS and Population >500: KEKAERK 4.For EMS Level J-HI and Population =20 -100: 5.For EMS Level I-HI and Population =101 -500: 6.For EMS Level I-HI and Population >500: RKERKK 7.For EMS Level II -HI and Population =101 -500: 8.For EMS Level II -HI and Population >500: 36 ORK a 9.For EMS Levels III and higher: G,=1535 G2 =1989 G;=2459 G4=0 G5=500 G6 =1989 G7 =1989 G8 =2459 Ge =2459 Volume I -Appendix XI Page 2 Final Report October 2000 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 E =Existing Square Footage Existing space data is taken from one of the following sources. a.Response to F1.5 in the FNAQ b.THS Facilities Database c.1994 State Clinic Survey Database If no data was available from any of these sources then E is set equal to G. If a community indicated in the FNAQ that they do not have a clinic and they need one,then E is set equal to 0. AF =Age Adjustment Factor per the attached Age Factor Table Age data is obtained from one of the following sources. a.DCED Database b.IHS Facilities Database c.1994 State Clinic Survey Database If no data is available,then AF is set equal to 1.0 FACILITY AGE FACTOR TABLE Age(yrs)Age Factor <10 yrs.1.0 10-14 0.95 15-19 0.90 20 -24 0.85 25 -29 _0.80 >30 0.75 Volume I -Appendix XI Page 3 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 CF Condition Factor Sum of points from attached Condition Factor Table divided by 26. Total points derived based on responses to F3.1 through 3.8 in the FNAQ. If no response to any of the above or if response ="Don't Know”,then the response to F3.9 in the FNAQ is used.If there is no response to any of the above,then a default response of "Good”is used. FACILITY CONDITION FACTOR TABLE CATEGORY GOOD FAIR POOR Structural 4 2 1 Mechanical 4 2 1 Electrical 4 2 1 Fire &Life Safety 4 2 1 Floor Plan 4 2 1 Energy Management 2 ]0.5 Handicap Access 2 1 0.5 Site /Environmental 2 1 0.5 Totals 26 13 6.5 Volume I -Appendix XI Page 4 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 HEALTH STATUS This factor characterizes a community's health status based on the census area where the community is located.The overall factor is a combination of nine separate health status indicators that were selected to reflect differential conditions between the census areas.The indicators and the resultant overall factor reflect health status of the population as a whole, and the more specific requirements of various age groups.The nine health status indicators that have been included are: »Fertility rate =Percent of births to teens = Post-neonatal mortality rate *Age adjusted mortality rate #Suicide death rate *Unintentional injury death rate «"Homicide death rate «Heart disease death rate "Cancer death rates This is a robust measure of health status due to the quantity and quality of vital statistics data. Differences within a given census area will be revealed with other community level measures (see Economic Distress,Dependency Ratio,Trauma Registry). HEALTH STATUS SCORE The nine health status indicators are being provided by DHSS on a statewide average and census area basis for incorporation into the APCD.For each indicator,DHSS compares the rate for the census area to the state average,creating a "rate ratio”for each indicator.The "rate ratios”for each of the nine indicators are then summed up for each of the census areas. Once imported into the APCD,an overall score is generated for each community as follows. 1.Divide 20.00 by the census area with the highest aggregate rate ratio sum to determine the Health Status Scaling Factor (HSSF). Volume I -Appendix XI Page 5 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 2.The sum of the rate ratios for each of the other census areas is then multiplied by the scaling factor to generate the Health Status Score (HSS)for that particular census area. 3.The score for each individual census area is assigned to each community within that census area. Volume I -Appendix XI Page 6 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 ISOLATION The isolation factor is a measure of the inherent complications related to providing primary care services and managing a health program in an isolated setting.The assumption is that geographic isolation has a negative impact on both routine service delivery and emergent care. ISOLATION SCORE The isolation score is based on each community's EMS category,and the FNAQ responses, which characterize the mode of travel to and from a given community.The distance from the community to the nearest hospital is also considered.Based on these variables,a community is assigned a score from 0 to 10.Points are assigned according to the table below. 1.Primary mode of travel is determined based on the response to P2.2 in the FNAQ.If the P2.2 response ="Other”then the mode is set equal to "Air or Water”.If there is no response to P2.2,then the mode is assigned based on a review of the Economy and Transportation Section of the Community Information Summary in the DCED database. 2.Distance to nearest hospital is determined based on the following: *List of hospitals per the June 1998 Alaska Rural Health Plan. *Straight-line air miles to the nearest community with a hospital as calculated by a subroutine within the GIS application of the APCD. 3.All communities with an EMS level of III or higher are assigned an isolation score of 0, regardless of travel mode or distance to the nearest hospital. Volume I -Appendix XI Page 7 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 ISOLATION SCORING TABLE EMS CATEGORY ISOLATED I ISOLATED HIGHWAY I |HIGHWAY II Primary Mode Of Travel To Next Level of Care istaDistance Air Air Nearest or Motor or Motor Motor Motor Hospital Water |Vehicle Water Vehicle Vehicle Vehicle (miles) 0-100 7 4 S40 1 0 101 -200 8 2 5 2 we 201 -600 9 3 6 3 >600 10 4 7 4 Volume I -Appendix XI Page 8 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 DEPENDENCY RATIO The Dependency Ratio (DR)was selected as the best indicator of demographic differences between communities with respect to health care needs.The DR is the sum of the elderly and youth population divided by the working age population.Elderly =people 65 or over,youth =people under 18,and working age population =people ages 18 -64.This ratio is the most reliable measure available of the different levels of "need”in communities related to the age structure of the population.It also suggests possible economic stress on a community if there is a very small population of working age adults supporting a large population of youth and elderly people. The data used to determine this ratio is taken from the 1990 census information.This factor can be updated in 2001 with 2000 Census information.Census area,population estimates of age groups indicate that the dependency ratios have shifted slightly in some of the census areas and boroughs but not a great deal over the last decade.Those that were very high have moderated somewhat. Like the health status indicators,the DR in one community can be compared with a state or project average to get the relationship to the state norm and the new ratio can be used as an index or score. DEPENDENCY RATIO SCORE DR data is being provided by DHSS on a community specific basis.Once imported into the APCD,a score is generated for each community as follows. 1.A statewide average DR or "ADR”is calculated using only the data for those communities meeting the baseline ARPCFNA Project criteria,i.e.only for those communities that received a FNAQ. ADR =Y¥Youth +¥Elderly >Working Volume I -Appendix XI Page 9 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 2.A Dependency Ratio Index (DRI)is calculated for each community. DRI =Community DR ADR Divide 10.00 by the highest individual DRI to determine the Dependency Ratio Scaling Factor (DRSF). Multiply each individual DR Index by the DSF to determine the Dependency Ratio Score (DRS)for each community. Volume I -Appendix XI Page 10 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 ECONOMIC STATUS The most readily available measure of economic status at the community level based on the research conducted under this project is the per capita income of the community at the time of the last census (1990).An update with the 2000 census data will be possible in 2001. Other economic measures were considered such as subsistence income but they did not significantly change the ranking of communities in relation to each other.Therefore,per capita income alone is being used to define the economic status factor. ECONOMIC STATUS SCORE The State of Alaska,Division of Health and Social Services is providing per capita income (PCI)and population data for all communities in the state (based on 1990 census data).Once imported into the APCD,a score is generated for each community as follows. 1.A statewide average PCI or "APCI'is calculated using only the data for those communities meeting the baseline ARPCFNA Project criteria,i.e.only for those 288 communities that received a FNAQ. APCI =3 (PCIx Pop) x Pop 2.The following ratio is calculated for each community. PCI Ratio =APCI Community PCI 3.Divide 9.00 by the highest individual Income Ratio to determine the Economic Scaling Factor (ESF). 4.Multiply each individual community income ratio by the ESF to determine the Economic Status Score (ESS)for each community. Volume I -Appendix XI Page 11 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 TRAUMA REGISTRY The Trauma Registry factor offers an additional dimension of community level information related to demands on the local health care system.Trauma Registry data reports hospitalizations due to injuries (starting in 1993,poisonings were also included)by closest community of occurrence.Data is available beginning in 1991.Hospitalized injuries are assumed to be a proxy for the overall burden of injury occurrences in communities.The method of comparison for the community level data is similar to the vital statistics data on health status.Although in this case,the "rate”for a community is based on the occurrences which may be to nonresident workers,tourists or part-year residents or visitors,in relation to the resident population of the nearest community.Vital statistics data,in contrast,relate to the place of residence of the individual who is born or who dies,rather than the place of birth or death.Small communities in terms of resident population can have very high numbers of occurrences of serious injuries related to fishing,fish processing,extreme sports,etc.Thus, it is expected that places with a high frequency for the base population have a greater need for health service facilities than places of similar size that do not experience such high levels of serious injury. TRAUMA REGISTRY SCORE Predicted and Trauma Registry data on hospitalizations for injuries by closest community of occurrence are being provided by DHSS on a community specific basis.The predicted values are calculated based on state averages in terms of per 100,000 resident population. The actual values are corrected Trauma Registry data.DHSS is also providing a trauma rate ratio (TRR)for each community that compares each community's actual value to the state average.Once imported into the APCD,a Trauma Registry Score (TRS)score is generated for each community based on the following table. Volume I -Appendix XI Page 12 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 TRAUMA REGISTRY SCORING TABLE POINTS TRAUMA RATE RATIO (TRR) 1 TRR <1 2 1<TRR<2 3 2<TRR <3 4 3<TRR <4 5 TRR 24 Volume I -Appendix XI Page 13 Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 SEASONAL POPULATION FLUCTUATION This factor is a measure of the demands on the local health care system as a result of an increase in a particular community's population ---due to seasonal or transient influences. The assumption is that seasonal increases in population related to industries such as tourism (high percentage of elderly clients)or fishing and logging (high accident rates)have a negative impact on both routine service delivery and emergent care. SEASONAL POPULATION SCORE If the first response to P6.5 of the FNAQ =YES,then the Seasonal Population Score (SPP)= 1;otherwise,SPP =0. Volume I -Appendix XI Page 14 APPENDIX XII PART I -PRIORITIZATION SUMMARY Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PART I-FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,|FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level Group 75.00 -85.00 Points Alatna YUKON-KOYUKUK Y B 0 34]1-Isolated 1 Arctic Village YUKON-KOYUKUK Y D 1240 138]1-Isolated i Birch Creek YUKON-KOYUKUK Y c $00 35]1 -Isolated i Grayling YUKON-KOYUKUK Y Cc 899 184|1-Isolated 1 Holy Cross YUKON-KOYUKUK Y Cc 768 247)1-Isolated 1 Kaltag YUKON-KOYUKUK Y E 117 254|1-Isolated 1 Kobuk NORTHWEST ARCTIC Y Cc 805 94}1-Isolated 1 Lake Minchumina YUKON-KOYUKUK Y B 0 38]1-Isolated 1 Minto YUKON-KOYUKUK Y Cc 636)248}1 -Isolated 1 Nikolai YUKON-KOYUKUK Y Cc 576 105}1-Isolated 1 Nondalton LAKE-PENINSULA Y D 100 224}1-Isolated 1 Nulato YUKON-KOYUKUK Y Cc 864 381}1-Isolated 1 Ruby YUKON-KOYUKUK N 653 184)1-Isolated 1 Scammon Bay WADE HAMPTON Y Cc 1020 484]1-Isolated 1 Shageluk YUKON-KOYUKUK Y Cc $38 140]1-Isolated 1 Stevens Village YUKON-KOYUKUK Y Cc 396 92|1-Isolated 1 Wiseman YUKON-KOYUKUK Y B 0 20|1-Isolated I 70.00 -74.99 Points Alakanuk WADE HAMPTON Y Cc 1344 6591 1-Isolated 2 Allakaket YUKON-KOYUKUK N 437 204!1-Isolated 2 Ambler NORTHWEST ARCTIC Y Cc 870 286;1-Isolated 2 Beaver YUKON-KOYUKUK N 480 126]1-Isolated 2 Buckland NORTHWEST ARCTIC Y Cc 805)428}}-Isolated 2 Chalkyitsik YUKON-KOYUKUK Y Cc 480 102|1-Isolated 2 Chignik Lake LAKE-PENINSULA Y Cc 44)136]I-Isolated 2 Clark's Point DILLINGHAM Y Cc 240 68|I-Isolated 2 Crooked Creek BETHEL Y Cc 680 137)1-Isolated 2 Deering NORTHWEST ARCTIC Y Cc 725 148}I-Isolated 2 Egegik LAKE-PENINSULA Y Cc 400)117)1-Isolated 2 Elim NOME Y Cc 737 306)1-Isolated 2 Evansville YUKON-KOYUKUK Y D 720 241 1-Isolated 2 Game Creek SKAGWAY-HOONAH-ANG Y E 108)50}1-Isolated 2 Hooper Bay WADE HAMPTON Y Cc 1790 1028}!-Isolated 2 Hughes YUKON-KOYUKUK Y Cc 896)80j 1-Isolated 2 Huslia YUKON-KOYUKUK Y Cc $32)272|1-Isolated 2 Kasigluk BETHEL Y Cc 768 528}1-Isolated 2 Kiana NORTHWEST ARCTIC Y Cc 780 398]1-Isolated 2 Kivalina NORTHWEST ARCTIC Y Cc 930 366|1-Isolated 2 Lower Kaiskag BETHEL Y Cc 768 310]1-Isolated 2 Newtok BETHEL Y Cc 442 284)1-Isolated 2 Noatak NORTHWEST ARCTIC Y Cc 800 423)t-Isolated 2 Nunam Iqua (Sheldon Point)WADE HAMPTON Y Cc 768 181)1-Isolated 2 Perryville LAKE-PENINSULA Y Cc 600 102)1-Isolated 2 Pilot Station WADE HAMPTON Y Cc 1200 $44)1-Isolated 2 Port Alexander WRANGELL-PETERSBG Y B 0 86)1-Isolated 2 Port Alsworth LAKE-PENINSULA Y B 0 88}1-Isolated 2 Rampart YUKON-KOYUKUK Y Cc 320)66)1-Isolated 2 *See Appendix III,Page | Volume I -Appendix XI Page | Alaska Rural Primary Care Facility .Final Report Needs Assessment Project October 2000 PART I-FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community .by Sept.1,|FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level Group Red Devil BETHEL Y Cc 0 44)1 -Isolated 2 Russian Mission WADE HAMPTON Y Cc 1280,311{1-Isolated 2 Savoonga NOME Y Cc 940)653|1-Isolated 2 Shungnak NORTHWEST ARCTIC Y Cc $10)255)1-Isolated 2 Stebbins NOME Y Cc 722 524}1-Isolated 2 Takotna YUKON-KOYUKUK Y Cc 376)48)1-Isolated 2 Wales NOME Y Cc 864)170}1-Isolated 2 65.00 -69.99 Points Akhiok KODIAK ISLAND Y D 315 101]1-Isolated 3 Chefornak BETHEL Y Cc 960)416)l-Isolated 3 Chuathbaluk BETHEL Y Cc 840)105}1-Isolated 3 Circle YUKON-KOYUKUK Y c 480 891 1-Isolated 3 Covenant Life HAINES BOROUGH Y B 0 67)l-Isolated 3 Eek BETHEL Y Cc 729 2811 1-Isolated 3 Elfin Cove SKAGWAY-HOONAH-ANG Y B 0 50}1-Isolated 3 False Pass ALEUTIANS EAST Y Cc 530 68)1-Isolated 3 Galena YUKON-KOYUKUK Y D 2307 563}2-Isolated 3 Golovin NOME Y D 1267 141]1-Isolated 3 Goodnews Bay BETHEL Y Cc 600 256)1-Isolated 3 Igiugig LAKE-PENINSULA Y Cc 854 62)1-Isolated 3 Hiamna LAKE-PENINSULA Y Cc 750)93}1-Isolated 3 Karluk KODIAK ISLAND Y Cc 392 41]1-Isolated 3 Kipnuk BETHEL Y Cc 1536 573}1-Isolated 3 Kokhanok LAKE-PENINSULA Y Cc 480 163}1-Isolated 3 Koyuk NOME Y Cc 1110 280}1-Isolated 3 Koyukuk YUKON-KOYUKUK N 805 101}1-Isolated 3 Kwigillingok BETHEL Y Cc 946 360}1-Isolated 3 Levelock LAKE-PENINSULA Y Cc 912 131)1-Isolated 3 Lime Village BETHEL Y Cc 480 62}1-Isolated 3 Mekoryuk BETHEL Y Cc 966 193)1-Isolated 3 Meyers Chuck PRINCE OF WALES Y B 0;30}1-Isolated 3 Mountain Village WADE HAMPTON Y Cc 1656 766}1-Isolated 3 Newhalen LAKE-PENINSULA Y Cc 440 178]1-Isolated 3 Nightmute BETHEL Y Cc 910 230}1-Isolated 3 Nikolaevsk KENAI PENINSULA Y B 0 488)Highway 3 Oscarville BETHEL Y Cc 320 64]1-Isolated 3 Port Protection PRINCE OF WALES Y B 0 50}1-Isolated 3 Shishmaref NOME Y Cc 1879 $56}1-Isolated 3 Sleetmute BETHEL Y Cc 840 103]1-Isolated 3 Tazlina VALDEZ-CORDOVA Y B 0 294]1-Isolated 3 Tetlin SE FAIRBANKS Y Cc 480 89}1-Isolated 3 Tununak BETHEL Y Cc 768 331}1-Isolated 3 Tyonck KENAI PENINSULA Y D 800 160]1-Isolated 3 Venetie YUKON-KOYUKUK Y Cc 1200;232)1-Isolated 3 White Mountain NOME Y Cc 768 197|1-Isolated 3 60.00 -64.99 Points Akiak BETHEL Y Cc 1628 338]1-Isolated 4 Anchor Point KENAI PENINSULA Y B 0 1227|Highway 4 Volume I -Appendix XII "See Appendix Ill,Page }Page 2 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PART I-FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,}FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level GroupAngoonSKAGWAY-HOONAH-ANG Y Cc 1950)$76}1-Isolated 4 Atka ALEUTIANS WEST Y Cc 960)105}1-lsolated 4 Atmautluak BETHEL Y Cc 768 296|1-Isolated 4 Chenega Bay VALDEZ-CORDOVA Y Cc 545 69}1-Isolated 4 Chickaloon MATANUSKA-SUSITNA Y B 0 212|Highwav 4 Chignik LAKE-PENINSULA Y D 1200 103)2-Isolated 4 Chitina VALDEZ-CORDOVA Y Cc 540 94)1-Isolated 4 Cooper Landing KENAI PENINSULA Y B 0 285|Highwayv 4 Copper Center VALDEZ-CORDOVA Y Cc 139.5 553]l-Isolated 4 Dot Lake SE FAIRBANKS Y Cc 384 61)1-Isolated 4 Ekwok DILLINGHAM N 439 125]1-Isolated 4 Emmonak WADE HAMPTON Y Cc 1792)$18)1-Isolated 4 Gambell NOME Y Cc 2587 668|1-Isolated 4 Gulkana VALDEZ-CORDOVA Y D 50 90}1-Isolated 4 Hope KENAI PENINSULA Y B 0 130)Highway 4 Ivanof Bay LAKE-PENINSULA N 576 29|1-Isolated 4 Knik MATANUSKA-SUSITNA Y B 0 483i Highway 4 Koliganek DILLINGHAM Y c 480 205}1-Isolated 4 Larsen Bay KODIAK ISLAND Y Cc 615 137}1-Isolated 4 Little Diomede NOME Y Cc 768 136}1-Isolated 4 Manokotak DILLINGHAM Y Cc 1120 399]1-Isolated 4 Marshall WADE HAMPTON Y Cc 1632 318)1-Isolated 4 McGrath YUKON-KOYUKUK Y Cc 1600 423|2-Isolated 4 Napaskiak BETHEL Y Cc 960)406}1-Isolated 4 Nenana YUKON-KOYUKUK Y Cc $13 435|Highway 4 Nikolski ALEUTIANS WEST Y Cc $20 39}1-Isolated 4 Platinum BETHEL Y c 427,43}1-lsolated 4 Port Graham KENAI PENINSULA Y Cc 530)178}1-Isolated 4 Saint Mary's WADE HAMPTON Y Cc 720 475}1-Isolated 4 Shaktoolik NOME Y Cc 1792)218}1-Isolated 4 Stony River BETHEL Y Cc 956 35|1-Isolated 4 Teller NOME Y Cc 1472 266]I-Isolated 4 Tuntutuliak BETHEL Y Cc 1440)350|1-Isolated 4 Twin Hills DILLINGHAM Y Cc 725 76|1-Isolated 4 Wasilla MATANUSKA-SUSITNA Y B 0 $213)Highway 4 55.60 -59.99 Points Akutan ALEUTIANS EAST Y Cc 960 408)2-Isolated 5 Anvik YUKON-KOYUKUK Y Cc 944 93)1-Isolated 5 Cold Bay ALEUTIANS EAST Y Cc 1200 97|1-Isolated 5 Dry Creek SE FAIRBANKS Y Cc 192 115]1-Isolated 5 Eagle SE FAIRBANKS Y A 448 152}1-Isolated $ Eklutna ANCHORAGE Y D 360 434/5 $ Hyder PRINCE OF WALES Y B 300 126]i-Isolated 5 Kothk WADE HAMPTON Y Cc 2400)579)1-Isolated 5 Kwethluk BETHEL Y Cc 1792 714)1-Isolated 5 Maniev Hot Springs YUKON-KOYUKUK N 488 88 1-Isolated b} Napakiak BETHEL Y Cc 1008 363)1-Isolated 5 New Stuyahok DILLINGHAM Y Cc 800:475)1-Isolated 5 *See Appendix I,Page | Volume I -Appendix XI Page3 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 ; PART I -FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,;FNAQ Space EMS (in alphabetical order)Census Area 2000 Git (sf)Pop.Level GroupNunapitchukBETHELYCc167947}|1-Isolated $ Pitka's Point WADE HAMPTON Y c 1000 146]1-{solated 5 Port Heiden LAKE-PENINSULA Y Cc 710 125|1-Isolated 5 Saint Michael NOME Y Cc 1800 381]1-Isolated $ Skagway SKAGWAY-HOONAH-ANG Y Cc 720 825)2-Isolated 5 Tanacross SE FAIRBANKS Y Cc 710 86)1-Isolated 5 Tanana YUKON-KOYUKUK Y Cc 4388 301)2-Isolated 5 Thome Bay PRINCE OF WALES Y Cc 1102)582)2-Isolated 5 Togiak DILLINGHAM Y D 784 841|2-Isolated 5 Tuluksak BETHEL Y Cc 1008 443)1-Isolated 5 50.00 $4.99 Points ; Brevig Mission NOME Y A 1260)279}1-Isolated 6 Cantwell DENALI Y Cc $89 166}1-Isolated 6 Kake WRANGELL-PETERSBG Y E 3300 745|1-Isolated 6 King Cove ALEUTIANS EAST Y Cc 790 69 1{2-Isolated 6 King Salmon BRISTOL BAY Y Cc 528 499}1-Isolated 6 Kongiganak BETHEL Y C 960 359}1-Isolated 6 Naknek BRISTOL BAY Y Cc 672 624]2-Isolated 6 Nelson Lagoon ALEUTIANS EAST Y¥Cc 670 $7}1-Isolated 6 Northway SE FAIRBANKS N 673 113}1-Isolated 6 Northway Junction SE FAIRBANKS N 673 116]1-Isolated 6 Old Harbor KODIAK ISLAND Y Cc 784 276)l-Isolated 6 Pedro Bay LAKE-PENINSULA Y Cc 800 36|1-Isolated 6 Port Lions KODIAK ISLAND Y Cc 1655 243)l-Isolated 6 Quinhagak BETHEL Y Cc 1160.55 595|1-Isolated 6 Saint George ALEUTIANS WEST Y Cc 2100 173)2-Isolated 6 Unalakleet NOME Y D 3202 805|2-Isolated 6 Upper Kalskag BETHEL Y c 960 2611 1-Isolated 6 Whittier VALDEZ-CORDOVA Y Cc 900 280|2-Isolated 6 45.00 49.99 Points Atqasuk NORTH SLOPE Y E 2623 274)1-lsolated 7 Chevak WADE HAMPTON Y Cc 2816 763}1-Isolated 7 Chignik Lagoon LAKE-PENINSULA Y Cc 1200 68|1-Isolated 7 Chistochina VALDEZ-CORDOVA Y Cc 768 52}1-Isolated 7 Gustavus SKAGWAY-HOONAH-ANG Y Cc 800 377|2-lsolated 7 Point Lay NORTH SLOPE Y E 2623 217 1-Isolated 7 Sand Point ALEUTIANS EAST Y D 2421 842)2-Isolated 7 Selawik NORTHWEST ARCTIC Y Cc 2100!767|1-Isolated 7 South Naknek BRISTOL BAY Y Cc 1045 132)1-Isolated 7 Tatitlek VALDEZ-CORDOVA Y Cc 2532 105]1-Isolated 7 Toksook Bay BETHEL Y Cc 1440 513}l-Isolated 7 Yakutat YAKUTAT 4 Cc 1200 729)2-fsolated 7 40.00 -44.99 Points Akiachak BETHEL N 1791 $60]1-Lsolated 8 Aleknagik DILLINGHAM Y D 400 244i Highway 8 Ouzinkie KODIAK ISLAND Y Cc 1056 256]1-Isolated 8 Pilot Point LAKE-PENINSULA Y Cc $213 92}1-Isolated 8 Saxman KETCHIKAN Y A 288 371)Highway 8 *See Appendix I,Page f Volume I -Appendix XII Page 4 Alaska Rural Primary Care Facility .Final Report Needs Assessment Project October 2000 PART I -FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,}FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level Group Seldovia KENAI PENINSULA Y E 2376 284)2-Isolated 8 35.00 -39.99 Points Craig PRINCE OF WALES Y E 2800 2136|2-Isolated 9 Haines HAINES BOROUGH Y E 6000 1775|2-Isolated 9 30.00 -34.99 Points Anaktuvuk Pass NORTH SLOPE Y E 4400 314 l-Isolated 10 Bettles YUKON-KOYUKUK N 0 351 1-Isolated 10 Fort Yukon YUKON-KOYUKUK Y D 9620)570}2-Isolated 10 Kaktovik NORTH SLOPE Y E 4400 259}1-Isolated 10 Mentasta Lake VALDEZ-CORDOVA Y Cc 400 125|Highway 10 Noorvik NORTHWEST ARCTIC Y Cc 25001 632)1-Isolated 10 Nuiqsut NORTH SLOPE N 4400 486]1-Isolated 10 Pelican SKAGWAY-HOONAH-ANG Y Cc 1600 137|2-Isolated 10 Point Hope NORTH SLOPE Y Cc 4000 794 1-Isolated 10 Talkeema MATANUSKA-SUSITNA Y E 3000 363|Highway 10 Tenakee Springs SKAGWAY-HOONAH-ANG Y Cc 0 93}1-Isolated 10 Unalaska ALEUTIANS WEST Y Cc 1796 4178|2-Isolated 10 25.00 29.99 Points :. Andreafsky WADE HAMPTON N 0 442)2-Isolated il Central YUKON-KOYUKUK Y 0 62)1-Isolated li Circle Hot Springs YUKON-KOYUKUK N 0 35)1-Isolated 11 Healy Lake SE FAIRBANKS N 0 61}1-Isolated i Nanwalek (English Bay)KENAI PENINSULA Y D 1774 170}1-Isolated i Wainwright NORTH SLOPE N 4400)545)1-Isolated ll 20.00 -24.99 Points ; Anderson DENALI Y E 0 $171 1-Isolated 12 Aniak BETHEL Y Cc 6300)604/2-Isolated 12 Cube Cove SKAGWAY-HOONAH-ANG N 0 139]1-Isolated 12 Delta Junction SE FAIRBANKS Y A 0 889|2-Isolated 12 Edna Bay PRINCE OF WALES Y A 0 55)1-Isolated 12 Fox River KENAI PENINSULA N 0 439)Highway 12 Gakona VALDEZ-CORDOVA N 0 22|1-Isolated 12 Klawock PRINCE OF WALES Y E 6772 673|2-Isolated 12 Klukwan SKAGWAY-HOONAH-ANG N 0 136]1-Isolated 12 Mosquito Lake HAINES BOROUGH N 0 94)1-Isolated 12 Point Baker PRINCE OF WALES N 0 51)1-Isolated 12 Port Clarence NOME N 0 22)1-Isolated 12 Prudhoe Bay NORTH SLOPE N 0 47)\2-Isolated 12 Skwentna MATANUSKA-SUSITNA Y A 0 72)1-Isolated 12 Tok SE FAIRBANKS Y Cc 7780 1235)2-Isolated 12 Tonsina VALDEZ-CORDOVA N 0 47)1-Isolated 12 Willow MATANUSKA-SUSITNA Y A 0 307|Highway 12 15.00 -19.99 Points Adak ALEUTIANS WEST N 0 106}2-Isolated 13 Alcan SE FAIRBANKS N 0 23}1-Isolated 13 Big Delta SE FAIRBANKS N 0 511/2-Isolated 13 Big Lake MATANUSKA-SUSITNA Y A 0 2162)Highway 13 Bute MATANUSKA-SUSITNA Y A 0 2699)Highway 13 *See Appendix HL Page } Volume I -Appendix XI] Page § Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PART I -FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,;/FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level GroupChaseMATANUSKA-SUSITNA Y A 0 55]1-Isolated 13 Chiniak KODIAK ISLAND Y A 0 75|1-Isolated 13 Ciam Gulch KENAI PENINSULA N 0 113|Highway 13 Coffman Cove PRINCE OF WALES Y A 0 228|1-Isolated 13 Cohoe KENAI PENINSULA N 0 602)Highway 13 Copperville VALDEZ-CORDOVA N 0 194/1-Isolated 13 Eyak VALDEZ-CORDOVA Y Cc 0 162|Highway 13 Fritz Creek KENAI PENINSULA N 0 2097}Highway 13 Glennallen VALDEZ-CORDOVA N 0 494|2-Isolated 13 Halibut Cove KENAI PENINSULA N 0 71 1-Isolated 13 Happy Valley KENAI PENINSULA N 0 401)Highway 13 Healy DENALI Y E 0 646)2-Isolated 13 Hobart Bay SKAGWAY-HOONAH-ANG N 0 48}1-Isolated 13 Hollis PRINCE OF WALES N 0 111)1-Isolated 13 Hoonah SKAGWAY-HOONAH-ANG N 2740 $77|2-Isolated 13 Houston MATANUSKA-SUSITNA Y A 0)§36|Highway 13 Hvdaburg PRINCE OF WALES Y Cc 2967 369)1-Isolated 13 Jakolof Bay KENAI PENINSULA N 0 40]1-Isolated 13 Kasaan PRINCE OF WALES Y Cc 0 48|1-Isolated 13 Kasilof KENAI PENINSULA N 0 $48|Highway 13 Kenai KENAI PENINSULA N 3600 7005|Highway 13 Kenny Lake VALDEZ-CORDOVA N 0 507|1-Isolated 13 Kupreanof WRANGELL-PETERSBG N 0 24}1-Isolated 13 Lazy Mountain MATANUSKA-SUSITNA Y A 0 1109]Highway 13 Lutak HAINES BOROUGH N 0 53)Highway 13 McCarthy VALDEZ-CORDOVA Y A 0 37|Highway 13 Mendelmna VALDEZ-CORDOVA N 0 80}1-Isolated 13 Moose Pass KENAT PENINSULA Y A 0 118|Highway 13 Nikiskt KENAI PENINSULA N 0 3038|Highway 13 Ninilchik KENAI PENINSULA Y Cc 3202,687|Highway 13 North Pole FAIRBANKS NSB Y A 0 1616)Highway 13 Paxson VALDEZ-CORDOVA N 0 30]1-Isolated 13 Primrose KENAI PENINSULA N 0 62)Highway 13 Salcha FAIRBANKS NSB N 0 387|Highway 13 Slana VALDEZ-CORDOVA N 0 $35}1-Isolated i3 Sutton MATANUSKA-SUSITNA N 0 470|Highway 13 Trapper Creck MATANUSKA-SUSITNA N 0 344)Highway 13 Whale Pass PRINCE OF WALES Y A 0 62}1-Isolated 13 Whitestone Logging Camp SKAGWAY-HOONAH-ANG N 0 118]1-Isolated 13 0.00 -14.99 Alexander Creek not a census designated place Y A 0 39}1-Isolated 14 College FAIRBANKS NSB N 0 12122)3 14 Crown Point KENATI PENINSULA N 0 91 Highway 14 Ester FAIRBANKS NSB N 0 240)Highway 14 Ferry DENALI N 0 74 1-Isolated i4 Fox FAIRBANKS NSB N 0 332)Highway 14 Harding Lake FAIRBANKS NSB N 60 30|1-Isolated 14 Kachemak KENAI PENINSULA N 0 419|Highway 14 "See Appendix HH,Page | Volume I-Appendix XI Page 6 Alaska Rural Primary Care Facility |Final Report Needs Assessment Project October 2000 PART I-FY 01 PRIORITIZATION SUMMARY FNAQ Submitted Existing Community by Sept.1,|FNAQ Space EMS (in alphabetical order)Census Area 2000 G1.1*(sf)Pop.Level GroupKalifonskyKENAIPENINSULAN0338]Highway 14 Lignite DENALI N 0 131)1-Isolated 14 McKinley Park DENALI N 0 169)1-Isolated 14 Meadow Lakes MATANUSKA-SUSITNA Y A 0 §232|Highway 14 Moose Creek FAIRBANKS NSB N 0 677|Highway 14 Naukati Bay PRINCE OF WALES N 0 164 1-Isolated 14 Pleasant Valley FAIRBANKS NSB N 0 584|Highway 14 Ridgeway KENAI PENINSULA N 0 2382|Highway 14 Salamatof KENAI PENINSULA N 0 1122|Highway 14 Sterling KENAI PENINSULA N 0 6138]Highway 14 Two Rivers FAIRBANKS NSB N 0 660|Highway 14 Womens Bay KODIAK ISLAND Y A 0 675iHighway 14 *See Appendix II,Page Volume 1-Appendix XII Page 7 This page intentionally left blank. APPENDIX XIII PART II -CAPABILITY MEASUREMENT Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PART IJ -CAPABILITY MEASUREMENT Total Point Score =Sum of the Following: Maximum Points 1.Local Support For Project * 2.Site Availability and Control * 3.Utility Extension Plan * 4.Cost Share Score *20 5.Service Delivery Plan Score *10 6.Business Plan Score *10 7.Existing Facility Deficiency Score 45 8.Comprehensive Facility Development 5 Plan Score 9.Multi-use Facility Score 5 10.Project Management Plan Score 5 TOTAL 100 *Proposals must meet minimum standards with respect to items 1 -6 in order to be considered for funding.Proposals that do not meet the minimum standards for these elements will be set aside and a recommendation made to the community that they seek technical assistance to develop more capability.If a proposal does meet the minimum standards for all six elements,then it will be further evaluated and points awarded based upon the quality of the submitted documentation. Volume I -Appendix XIII Page 1 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 LOCAL-SUPPORT FOR PROJECT Have all the necessary resolutions of support from local and regional organizations been passed?YES or NO SITE AVAILABILITY AND CONTROL Is there legal control of the proposed project site?YES or NO UTILITY EXTENSION PLAN If utility and transportation extensions of greater than 150 feet are required to develop the proposed site,has funding been identified for this additional infrastructure?YES or NO Volume I -Appendix XII Page 2 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 COST SHARE Description:In accordance with the authorizing language for the Denali Commission, minimum project cost shares are required based upon the economic conditions in a community.Communities categorized as economically distressed have a required cost share of 50 percent and communities that are severely economically distressed have a required cost share of 20 percent.The Denali Commission will prepare a list of what the cost share requirement will be for each community eligible for rural primary care facility funding.If an applicant does not have the minimum cost share available,then the project will not be funded. Evaluation:Proposals should identify the amount of community and other non-Denali Commission contributions that will be applied to the project.For cash contributions or other grants,specify whether funds are immediately available or whether they represent a future anticipated commitment (e.g.HUD CDBG).If a future commitment,indicate whether the project would be viable if those funds do not become available. Proposals meeting the minimum criteria will be scored based on the extent of non-Denali Commission resources available for the project according to the following table.In-kind contributions other then land will not be considered as a part of the cost share. Volume I -Appendix XIII Page 3 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 Community Cost Share Economically Severely Points Distressed Distressed Community Community (%)(%) 50.00*20.00*0 51.25 22.00 i 52.50.24.00 2 53.75 26.00 3 55.00 28.00 4 56.25 30.00 5 57.50 32.00 6 58.75 34.00 7 60.00 36.00 8 61.25 38.00 9 62.50 40.00 10 63.75 42.00 11 65.00 44.00 12 66.25 46.00 13 67.50 48.00 14 68.75 50.00 15 70.00 52.00 16 71.25 54.00 17 72.50 56.00 18 73.75 58.00 19 75.00 60.00 20 *minimum requirements Volume I -Appendix XIII Page 4 Alaska Rural Primary.Care Facility Final Report Needs Assessment Project October 2000 SERVICE DELIVERY PLAN Description:It is essential that new or expanded primary care facilities provide services that match the needs of the community,and meet the health program goals as recommended in the Final Report.Proposals must include documentation showing that the completed facilities will have an open door policy and score at least 6 overall points on this criteria. Proposals that do not meet these requirements will not be funded. Evaluation:Proposals should contain a comprehensive,written service delivery plan that addresses population served,services,staffing and operational policies.State whether the completed facility will fully meet accreditation requirements.The applicants'ARPCFNA questionnaire will be reviewed as background information in evaluating the service delivery plan.Points will be awarded based on the criteria summarized in the following table. SERVICE DELIVERY PLAN ELEMENTS POINTS Population Served e Identification of numbers of people served currently e Increases or changes in services anticipated with 0-3new/renovated facility e Population to be served in comparison to program and space guidelines presented in Final Report Services e Services provided currently e Services to be provided with new/renovated facility 0-3eServicesprovidedaccordingtoFinalReport. guidelines per facility size and population size e Level of service(s) Staffing e Staff providing services currently e Staff anticipated in new/renovated facility 0-2 e Staff employed compared to Final Report programguidelines Service Delivery Policies and Agreements e Open door policy on seeing patients*0-2 e Referral agreements established *minimum requirement Volume I -Appendix XIII Page 5 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 BUSINESS PLAN Description:The capability to sustain a primary care clinic is dependent upon adequate funding and strong financial management practices.Proposals that do not score at least 6 points on this criteria will not be funded. Evaluation:Proposals should contain a comprehensive,written business plan that addresses funding,operations,administration,and community support.The applicants'ARPCFNA questionnaire will be reviewed as background information in evaluating the proposed business plan.Points will be awarded based on the criteria summarized in the following table. BUSINESS PLAN ELEMENTS POINTS Funding Status e Cost share for new facility e Current financial status e Sources of revenue,funding /income for the clinic e Projection of sources of funds to operate the facility after it is 0-3 built Plans for long term financial sustainability Billing for Medicaid,Medicare,Tricare,private insurance and other sources Clinic Administration e The organization that will administer the funding for the new / renovated clinic Projected administrative staff for new/renovated clinice e Policies and procedures manuals 0-3 e Quality of care,quality assurance procedures e History of providing care efficiently and effectively e Board of directors or other oversight body Facility Operations e Budget for operating the current facility 0-2 ©Projected budget for operating new /renovated facility Community Support e Resolutions and other documents that indicate community support e No adverse competition is created with private practices in the community 0-2 e Evidence of community support through participation on boards e Description of the sources and commitment of funding for the cost share Volume I -Appendix XIII Page 6 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 EXISTING FACILITY DEFICIENCY Description:The condition of building systems (structural,mechanical,electrical),energy management issues,handicap access,site /environmental conditions,compliance with fire / life safety codes,and space /floor plan issues all impact the ability to provide quality care in any facility. Evaluation:Existing facilities will be evaluated via an in depth,on-site code and condition survey.The resultant information will be used to update the Part I Facility Deficiency score. These surveys will be performed by architects and engineers (A&Es),licensed in the State of Alaska,who are fully knowledgeable about life/safety/building codes and compliance issues associated with rural primary care facilities.The Denali Commission,or its agent(s),will hire the A&Es to perform these surveys.With Commission approval,individual communities,and/or their representatives,may directly contract with A&E firms to collect the necessary information.On-site surveys completed by individual communities must follow guidelines developed by the Commission and the results submitted for review by the Commission or its agent. If it is determined that the facility is in much better condition than indicated in the FNAQ,the Commission reserves the right to revise the community's Part I score.This could lead to the community and the proposal being eliminated from any further consideration for funding. While the specific Part II scoring criteria have not yet been developed,it is anticipated that they will be very similar to the criteria used in Part I. Volume I -Appendix XII Page 7 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 COMPREHENSIVE FACILITY DEVELOPMENT PLAN Description:The Denali Commission encourages community wide planning efforts.Since health clinics are an essential part of a community's overall infrastructure and services it is expected that proposed health facility projects would be addressed in existing community wide development plans. Evaluation:Comprehensive community development plans that are submitted with a proposal will be reviewed to determine if the proposed project is consistent with the overall plan.A maximum of 5 points may be awarded based on this review. Volume I -Appendix XIII Page 8 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 MULTI-USE FACILITY Description:Combining appropriate,but separate,services and programs in one building can result in operation and maintenance efficiencies.For example,a structure that houses both a community washeteria and a clinic can save heating costs,as well as reducing the capital cost of water and sewer connections to the clinic space.Head Start and other health care related services are also good examples of services that might be co-located in the same building. Of course,joint occupancies must make operational sense and not create significant conflicts for any of the programs or uses. Evaluation:If there is a joint use aspect of the project,the proposal should include a written description of the multi-use facility /campus concept and summarize how the combined use enhances the performance of the structure and the delivery of primary care services.Only the clinic portion of the multi-use structure is eligible for Commission primary care facility funding;the balance of the building must be paid for from other sources.Up to 5 points may be awarded for this element based on the following table.Points are not additive,i.e., proposals will be assigned to one of the following categories. PROJECT DESCRIPTION POINTS No significant multi-use aspect to the project.0 The clinic facility is located in a central campus area to take advantage of improved and/or lower cost utility service,and/or ...2togenerallyimprovecommunityaccesstoprimarycare services. 25 to 50 percent of the structure (square footage basis )is occupied by other than the-primary care clinic in an appropriate 3 manner. Over 50 percent of the structure is occupied by other than the 5primarycareclinicinanappropriatemanner. Volume I -Appendix XIII Page 9 Alaska Rural Primary Care Facility Final Report Needs Assessment Project October 2000 PROJECT MANAGEMENT PLAN Description:Having a well organized management plan that addresses both design and construction phase activities is essential for the successful completion of a project.The Commission encourages the development of such written plans. Evaluation:Proposals should include a project summary document with a scope of work (new facility,replacement facility,expansion of an existing facility,or modernization / renovation of an existing facility),overall budget,schedule,design drawings (if available), summary of proposed contracting procedures,and an outline of the management team that will coordinate the project.Also describe the standards used in developing the plans (e.g.the IHS Health Facilities Planning Manual,the AIA Guidelines for Construction and Equipment of Hospitals and Medical Facilities,etc.)and other construction standards that will be followed (e.g.Uniform Building Code).Provide environmental review documentation and approvals,permits,etc.if available.Project Management plans that are submitted with a proposal will be reviewed to determine how well organized the project is and the status of all relevant project documentation.A maximum of 5 points may be awarded based on this review. Volume I -Appendix XIII Page 10 This Report Was Prepared With Assistance From NANA/DOWL JV and GeoNorth,LLC under Contract No.ANTHC 98-03 Delivery Order 00-D-0297 NANA/DOWL ENGINEERS INTERNET +GIS =DATABASE