A Healthier Future for West Virginia - Healthy People 2010

1 - Access to Quality Health Service

Objectives | References

Background

The geography of West Virginia in and of itself presents problems with access to quality health care. The surface elevation of West Virginia is extremely uneven. It ranges from a low of 240 feet in the Valley of the Potomac to a high of 4,862 feet at Spruce Knob in Pendleton County. West Virginia's mountains are often steep and rugged, rising and falling in successive waves of ranges. There is very little flat land in the state.

Because West Virginia is a mountainous state, time and distance factors applicable to the flatlands of the Midwest and the East Coast are grossly inappropriate when applied to the state's rugged terrain. For example, time/distance maps depict the distance from Charleston, WV, to Washington, DC, as 250 miles. This "as the crow flies" distance is underestimated using these maps. Actual mileage, using the best records available, is approximately 360 miles, and the average automobile trip between the two cities is about six hours.

Non-interstate travel through West Virginia can be treacherous, with numerous mountains to climb, narrow and winding secondary roads, ubiquitous coal trucks, and never-ending road repairs. During the months of late December through early April, poor weather conditions add more time or prevent driving altogether.

West Virginia is the second most rural state in the nation, with 64% of its population living in communities of fewer than 2,500. Forty-five of West Virginia's 55 counties are designated as rural, that is, "non-metropolitan" as defined by the Bureau of the Census. Almost 16% of West Virginia's population is aged 65 or older. If, as anticipated, the trend of an aging population continues, West Virginia can look forward to an older population presenting a growing demand on the state's health care system. This is an even greater burden in a state where transportation (access) problems continue to exist.

Rural Appalachian culture influences health in several important ways. Appalachians inhabit a particular mountain environment that separates them physically from other cultural groups and the resources of those groups. Thus, rural Appalachian culture has developed in a historical context of isolation and exploitation, which has assured major differences between Appalachian culture and the dominant urban culture. Many Appalachians are reluctant to enter the mainstream medical system except for emergencies. Health interventions that are developed with consideration for Appalachian culture, values, language, and behaviors have been most successful in altering the health status of mountain dwellers.

Statistics show that Appalachian residents were found to be at significantly higher risk of injury and illness from seatbelt nonuse, obesity, overweight, and current smoking and at significantly lower risk of injury and illness from heavier drinking, binge drinking, and drinking and driving than non-Appalachian residents.

Work disability is also a significant problem in West Virginia. The percentage of those in the labor force that have work disabilities, as well as the percentage of those who are prevented from working due to a work disability, is nearly twice the national average.

As with most rural areas, physician shortages are prevalent. The federal Division of Shortage Designation (DSD), Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services, designates an area as a Health Professional Shortage Area (HPSA). The designation is usually a geographic area consisting of a county or a sub-county region and is based on the ratio of primary care physician providers to the population. The state's Division of Recruitment (DOR) compiles the information and forwards it to the DSD. Currently in West Virginia there are 50 HPSA service areas that include all or part of 40 counties.

The state also provides data to the DSD for the purpose of designating dental and mental health HPSAs. In addition, 50 counties are wholly or partially designated as Medically Underserved Areas (MUAs).

The Objectives

FLAGSHIP OBJECTIVE

OBJECTIVE 1.1. Increase the proportion of persons aged 64 and under with health insurance coverage.
1.1a. Increase the proportion of persons aged 18-64 with health insurance coverage to 90%. (Baseline: 79.4% in 1998)
1.1b. (Developmental) Increase the proportion of children aged 17 and under with health insurance coverage to 100%. (Baseline data available in 2000)

Data Sources: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP), Behavioral Risk Factor Surveillance System (BRFSS); Children's Health Insurance Program (CHIP)

OBJECTIVE 1.2. (Developmental) Increase the proportion of persons with a personal primary care provider. (Baseline data available in 2000)

Data Source: WVBPH, OEHP, BRFSS

As noted above, 50 of West Virginia's 55 counties are considered medically underserved. During the program year 2000, the West Virginia Primary Care Association, in collaboration with the state Division of Primary Care, will be conducting a statewide assessment of the delivery of primary care services to determine the penetration level in the state's population. This "market place analysis" study will provide baseline data on persons served by a personal primary care provider.

OBJECTIVE 1.3. (Developmental) Provide a staffed ambulance on scene of emergency calls within eight minutes of receipt of the call by the Emergency Medical Services (EMS) agency in 90% of the cases in cities with populations of 12,000 or more. (Baseline data available in 2000)

Data Source: WVBPH, Office of Community and Rural Health Services (OCRHS), Emergency Medical Services (EMS)

The time of response to provide prehospital care to the ill or injured patient directly correlates with the type of outcome for that patient. After researching nationwide data and examining the unique situation of this state, the West Virginia Office of EMS (WVOEMS) has determined that for a population of 12,000 or more a response time of eight minutes or less would aid in decreasing the incidence of mortality within the state and lead toward an optimal outcome for all patients. It is also important that these responses be accomplished with a team of qualified EMS professionals who have the knowledge and resources required to care for the ill and injured patient. In order to incorporate this response time benchmark across the state EMS system, the legislative rule establishing regulatory policy was amended to include it as a licensing standard for EMS agencies. Analysis of current data indicates that 100% of the agencies that provide service to areas with a population of 12,000 or more meet this standard.

Representatives from the Regional Medical Command Centers in West Virginia have met and are in the process of formulating a method of data collection that will be uniform in nature. This will allow the data collected to be used to form a baseline.

The WVOEMS is in the process of revitalizing the collection and entering of data from the EMS run form. This will allow data from all state EMS agencies to be utilized in the formation of a data baseline.

OBJECTIVE 1.4. (Developmental) Provide a staffed ambulance on scene of emergency calls within 20 minutes of receipt of the call by the EMS agency in 90% of the cases in rural areas (populations less than 12,000). (Baseline data available in 2001)

Due to the rural nature of West Virginia, a consistent response time of eight minutes or less in an area with a population of less that 12,000 is not realistic. Again, looking at other rural states and statistics on response to the ill and injured patient, WVOEMS has determined that a 20 minute or less response time with qualified personnel would promote the optimal outcome for the patient in this setting. This benchmark was also incorporated into the legislative rule. Analysis indicates that 82% of all EMS agencies are currently meeting or exceeding this standard.

Representatives from the Regional Medical Command Centers in West Virginia have met and are in the process of formulating a method of data collection that will be uniform in nature. This will allow the data collected to be used to form a baseline.

The WVOEMS is in the process of revitalizing the collection and entering of data from the EMS run form. This will allow data from all state EMS agencies to be utilized in the formation of a data baseline.

Data Source: WVBPH, OCRHS, EMS

OBJECTIVE 1.5. (Developmental) Increase access to emergency care that meets the special needs of children in prehospital and hospital settings.
1.5a. (Developmental) Develop statewide protocols for both on-line and off-line medical direction of EMTs and paramedics at the scene of an emergency involving pediatric cases by 2001. (Baseline data available in 2000-2001)

The WVOEMS, in concert with the state's EMS medical director and the state Critical Care Committee, has engaged in the arduous process of developing and implementing statewide prehospital care protocols for field EMS personnel. The needs of children were addressed with protocols that stand alone, separate from those for the adult patient. First Responder and Basic Life Support (BLS) protocols were addressed first and were completed and integrated into the state EMS system in spring 2000. Advanced Life Support (ALS) protocols are currently being developed with an anticipated completion date of summer 2001.

Data Source: WVBPH, OCHRS, EMS, EMS for Children Program

The WVOEMS, along with the EMS for Children Program, will develop protocols for children with special needs and then distribute these protocols to both on-line and off-line providers of medical direction of EMTs and paramedics who respond to pediatric emergencies by 2001. The number receiving the protocols will be the number of recipients of the protocols and thus the baseline.

1.5b. (Developmental) Measure 20 acute care facilities utilizing the pediatric categorization and evaluation instrument developed by the American Academy of Pediatricians for appropriate pediatric equipment, drugs, trained personnel, and facilities necessary to provide varying levels of pediatric emergency and critical care. (Baseline developed by 2001)

Data Source: WVBPH, OCHRS, EMS, EMS for Children Program

Children, as a whole, require special care. Proper equipment and education for all medical personnel will give children the greatest chance for an optimal outcome should they become ill or injured. The American Academy of Pediatricians (AAP) has developed guidelines that assist in determining if facilities, whether urban or rural, are prepared to care for children. The West Virginia Office of EMS, with assistance from a grant provided by the Office of Maternal, Child, and Family Health, the EMS-C program, and the AAP guidelines, has developed a tool to evaluate and recognize hospitals that are equipped to deal with the special needs of the pediatric patient. This instrument is called the ARK (Always Ready for Kids) Program. Presently, 12 hospitals have been reviewed, and 10 have been ARK recognized. The remaining two have been reviewed and are acting on recommendations for improvement before formal recognition is granted. There are currently three other hospitals that have expressed interest in the ARK program. Unfortunately, the grant used to fund this program has been expended. WVOEMS is currently exploring other funding opportunities.

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The Office of Community and Rural Health Services will be leading the initiatives in reaching the objectives as listed in this chapter.

Work Group Members

Susan Griffith-Chapman, Work Group Co-Leader, Assistant Director, OCRHS, WVBPH
Mark King, Work Group Co-Leader, Director, WVOEMS, WVBPH
David Haden, Work Group Co-Leader, Director of Federal Programs, Division of Primary Care, WVBPH

References/Resources

Division of Health Legislative Review. EMS Rule 64CSR48. 1997.

West Virginia Code 16-4C. West Virginia's Changing Health Care Delivery System: Overview and Description of State Programs for Improving Health.(Prepared for the West Virginia Rural Health Access Program in association with the Southern Rural Access Program supported by the Benedum and RWJ Foundations.)

West Virginia Office of Emergency Medical Services. Licensure Manual. 1997.

West Virginia Office of Emergency Medical Services. First Responder and Basic Life Support Protocol. 2000.

West Virginia Office of Emergency Medical Services, Technical Services Network. Always Ready for Kids Guidelines. July 1998.

For More Information

Office of Community and Rural Health Services
Room 515
350 Capitol Street,
Charleston, WV 25301-3716
Phone: (304) 558-3210; Fax: (304) 558-1437

This page was last updated June 8, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov