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Health and Healthcare in Frontier Areas Resources

Selected recent or important resources focusing on Health and Healthcare in Frontier Areas.

Report to Congress: Demonstration Project on Community Health Integration Models in Certain Rural Counties, Interim Report 2018
Provides an overview of and first year findings from the Frontier Community Health Integration Project Demonstration (FCHIP), which includes 10 Critical Access Hospitals (CAHs) in three states: North Dakota, Montana, and Nebraska. The demonstration intends to increase the quality and coordination of care, with focuses on access to and payments for telehealth, ambulance services, and skilled nursing facility/nursing facility beds, as well as related regulatory challenges.
Date: 09/2018
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Emerging Strategies to Ensure Access to Health Care Services: Frontier Health System
Discusses the challenges to providing care in frontier communities and offers solutions for improving access to and the delivery of care. Proposes the creation of a frontier-specific accountable care organization (ACO), the Frontier Health System (FHS), that provides traditional ACO services along with transportation, swing bed, home-based care, expanded visiting nurse services, and more.
Date: 11/2017
Type: Document
Sponsoring organization: American Hospital Association
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Who Are Frontier Americans?
Provides an overview of the various definitions for frontier, including their development, definitions currently in use, and the need for specific frontier definitions. Includes demographic and economic characteristics of frontier areas.
Author(s): Ben Rasmussen
Date: 08/2017
Type: Presentation Slides
Sponsoring organization: National Center for Frontier Communities
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Frontier Community Health Integration Project (FCHIP) Demonstration Fact Sheet
Provides an overview of the Frontier Community Health Integration Project (FCHIP) Demonstration, which tests models of health care delivery in the most sparsely populated rural counties. Identifies the participating Critical Access Hospitals and the interventions they focus on.
Date: 08/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Integrated Care in a Frontier Community
Examines the Southeast Health Group (SHG) in La Junta, Colorado, which coordinates physical and behavioral health using patient-centered, wellness-based care coordination to empower patients and promote self-directed care. Focuses on hiring providers who share SHG's philosophy of care, using community resources, and engaging peer support specialists.
Date: 07/2016
Type: Document
Sponsoring organization: Rural Health Value
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Frontier Behavioral Health: Innovations, Challenges and Solutions
Summarizes the discussion focused on the state of frontier behavioral health systems that occurred during a National Center for Frontier Communities (NCFC) meeting of frontier researchers, practitioners, and advocates. Includes slide presentations on topics affecting frontier behavioral health: certified community behavioral health clinics, community engaged behavioral health planning, and the prevention of opioid abuse.
Date: 06/2016
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Definition of Frontier
A policy paper discussing the various definitions of frontier, and the methodologies for determining the different definitions. The intent of this paper is to support state and federal programs in their selection of the most appropriate definition to attain their program goals.
Author(s): Susan Wilger, National Center for Frontier Communities
Date: 02/2016
Type: Document
Sponsoring organization: National Rural Health Association
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The Feasibility of a Regional Food Hub for Southwest New Mexico: Ideas for Rural and Frontier Communities
A study to determine the viability of developing a food hub for rural and frontier regions. Interviews were conducted with farmers to gauge their interest and capacity to support a food hub, and with food service directors to review the requirements of food vendors, and their participation and interest in purchasing local foods from a regional food hub.
Author(s): Benjamin Rasmussen, Susan Wilger
Date: 01/2016
Type: Document
Sponsoring organization: National Center for Frontier Communities
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National Characteristics of Emergency Medical Services in Frontier and Remote Areas
Outlines national characteristics for emergency medical services in Frontier and Remote Areas (FAR). Includes patient demographics, provider clinical impression and injuries, and procedures performed in FAR and non-FAR patients.
Author(s): Landon R. Mueller, John P. Donnelly, Karen E. Jacobson, et al.
Citation: Prehospital Emergency Care, 20(2), 191-199
Date: 2016
Type: Document
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Leading Change: Best Practices in Technical Assistance for Rural and Frontier Health-Care in an Era of Transformation
Provides resources, tools, and proven practices to augment technical assistance and support the development and implementation of services provided by State Offices of Rural Health (SORH), nonprofit organizations, and government agencies when working with rural and frontier health service organizations (HSOs).
Date: 08/2015
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Designation of Frontier Health Professional Shortage Areas
Discusses the frontier-specific health professional shortage area designation and the unique characteristics attributed to frontier areas that may contribute to a more fragile healthcare delivery system and a greater need for healthcare professionals. Includes policy recommendations supporting an appropriate designation, improved healthcare access, and assistance in recruiting healthcare providers.
Author(s): Susan Wilger, Charlie Alfero
Date: 04/2015
Type: Document
Sponsoring organization: National Rural Health Association
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Fact Sheet: Implementation of Coordinated Specialty Services for First Episode Psychosis in Rural and Frontier Communities
Details a six-step guide to implementing, facilitating, and sustaining evidence-based coordinated specialty care (CSC) services to treat first-episode psychosis (FEP) in rural and frontier communities. Presents the integration of telehealth as a crucial coordination and information sharing tool in CSC FEP delivery in rural areas.
Author(s): A.S. Crisanti, D. Altschul, L. Smart, C. Bonham
Date: 2015
Type: Document
Sponsoring organization: National Association of State Mental Health Program Directors
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Special Considerations for Mental Health Services in Rural Schools
Discusses the challenges experienced by rural and frontier schools regarding the development, implementation, and the expansion of behavioral health services for students and their families.
Author(s): Susan Wilger
Date: 2015
Type: Document
Sponsoring organization: Substance Abuse and Mental Health Services Administration
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Frontier and Remote (FAR) Level 4 Zip Code Areas, 2010
Printable map that identifies the frontier and remote (FAR) level four ZIP code areas in the United States. Data source: USDA Economic Research Service, 2015.
Date: 2015
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Frontier and Remote (FAR) Level 3 Zip Code Areas, 2010
Printable map that identifies the frontier and remote (FAR) level three ZIP code areas in the United States. Data source: USDA Economic Research Service, 2015.
Date: 2015
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Frontier and Remote (FAR) Level 2 Zip Code Areas, 2010
Printable map that identifies the frontier and remote (FAR) level two ZIP code areas in the United States. Data source: USDA Economic Research Service, 2015.
Date: 2015
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Frontier and Remote (FAR) Level 1 Zip Code Areas, 2010
Printable map that identifies the frontier and remote (FAR) level one ZIP code areas in the United States. Data source: USDA Economic Research Service, 2015.
Date: 2015
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Evaluation of the Medicare Frontier Extended Stay Clinic Demonstration: Report to Congress
Reports on the results of a Medicare Frontier Extended Stay Clinic (FESC) demonstration project that used an enhanced clinic model in frontier areas to address the needs of seriously ill or injured patients who could not be transferred to a hospital or needed monitoring and observation for a limited period of time. Includes an overview of the demonstration and key findings from the project.
Date: 2014
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Characteristics of the Frontier Extended Stay Clinic: A New Facility Model
Describes the characteristics of five pilot Frontier Extended Stay Clinics (FESCs), four in rural frontier communities in Alaska and one in Washington. Analyzes patient utilization and outcomes, and provides statistics on FESC extended-stay encounters by type and data year.
Author(s): Rosyland Frazier, Sanna Doucette
Citation: International Journal of Circumpolar Health, 72(1)
Date: 08/2013
Type: Document
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The Frontier Extended Stay Clinic Model: A Potential Health Care Delivery Alternative for Small Rural Communities
Describes how the Frontier Extended Stay Clinic model may be appropriate in rural communities other than the five original demonstration sites. Appendix includes data reports for the demonstration states.
Additional links: Appendix
Author(s): A. Clinton MacKinney, Fred Ullrich, Keith J. Mueller
Date: 08/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Mapping Frontier and Remote Areas in the U.S.
Describes frontier and remote areas (FAR) zip codes used to denote remote and sparsely settled areas in the U.S. Covers the four levels of FAR areas.
Author(s): John Cromartie, David Nulph, Gary Hart
Citation: Amber Waves
Date: 12/2012
Type: Document
Sponsoring organization: USDA Economic Research Service
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The Frontier Extended Stay Clinic: A Promising Model for Frontier Communities
Reports on access to Frontier Extended Stay Clinics (FESCs) and how FESCs have been shown to improve patient services through increased clinic staffing, improved equipment and facilities, and enhanced ability to treat and monitor patients locally when necessary.
Author(s): Susan Wilger, Saskia van Hecke
Date: 08/2012
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Community Health Worker Model for Care Coordination: A Promising Practice for Frontier Communities
Describes the Community Health Worker (CHW) model. Covers current care coordination policies and applications, and the role CHWs can play in care coordination in frontier communities.
Author(s): Susan Wilger
Date: 08/2012
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Dental Therapists: A Promising Practice for Frontier Communities
Describes a class of allied dental health workers, dental therapists, who are working in frontier and rural areas of Alaska and Minnesota.
Author(s): Saskia van Hecke
Date: 08/2012
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Behavioral Health Aides: A Promising Practice for Frontier Communities
Provides information on seven emerging behavioral health aide (BHA) models: care coordinators and case managers; support workers; mental health first aid certified laypeople; peer counselors and peer specialists; promotoras with supplemental behavioral health training; Alaska’s BHA model; and behavioral health practitioners.
Author(s): Saskia van Hecke
Date: 08/2012
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Frontier/Remote, Island, and Rural Literature Review
Highlights the evolution of the term frontier as it applies to remote, sparsely settled territory in the U.S. Discusses related definitions of rural relevant to creating a national frontier/remote and island geographic taxonomy.
Author(s): L. Gary Hart
Date: 08/2012
Type: Document
Sponsoring organization: University of North Dakota Center for Rural Health
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Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
Compares the quality of care provided by rural and urban hospitals for patients with acute myocardial infarction. Includes breakdowns by admission characteristics, such as concurrent conditions, and for remote rural areas.
Additional links: Policy Brief
Author(s): Laura-Mae Baldwin, Leighton Chan, C. Holly A. Andrilla, Edwin Huff, L. Gary Hart
Date: 03/2010
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Frontier Counties
Printable map that shows the location of frontier counties nationwide. Data source: U.S. Census Bureau, 2010.
Date: 2010
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Defining the Term "Frontier Area" for Programs Implemented through the Office for the Advancement of Telehealth
An expert panel report to the Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services. Provides an overview of current frontier definitions and describes the process used to develop a new frontier area definition that could be applied to telehealth programs.
Date: 05/2006
Type: Document
Sponsoring organization: University of North Dakota Center for Rural Health
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Frontier: A New Definition
Discusses the definition of frontier, based on population density, distance to the closest market for services, and travel time. Also describes the process by which this definition was developed. Includes a matrix that can be used to determine frontier status.
Date: 04/1998
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Frontier Extended Stay Clinics (FESC) Demonstration
An overview of a completed CMS demonstration that looked at an enhanced clinic model in frontier areas to address the needs of seriously ill or injured patients who cannot be transferred to a hospital, or who need monitoring and observation for a limited period of time.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Frontier Community Health Integration Project Demonstration (FCHIP)
An overview of a CMS demonstration to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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PubMed Search: Frontier Rural Health Services
Searches PubMed's collection of journal article citations on the topic of rural health services in frontier areas.
Type: Literature Search
Sponsoring organization: U.S. National Library of Medicine
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Frontier Definitions List
Describes all of the major definitions of frontier and remote areas currently in use.
Type: Document
Sponsoring organization: National Center for Frontier Communities
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Frontier Community Health Integration Project (FCHIP) Demonstration
Describes the Frontier Community Health Integration Project (FCHIP) demonstration including the project purpose, legislation, eligible states, partners, and program contacts.
Type: Website
Sponsoring organization: Rural Health Information Hub
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Frontier Extended Stay Clinics (FESC)
Describes the Frontier Extended Stay Clinic (FESC) program including the legislation, definition, project timeline, participants, early findings, and program contact information.
Type: Website
Sponsoring organization: Rural Health Information Hub
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Frontier Areas from 2010 U.S. Census
List of frontier counties, by state, with county population and population density information based on 2010 Census data. Includes total state population and percent of population in frontier areas for each state.
Type: Website
Sponsoring organization: National Center for Frontier Communities
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Frontier News and Updates
Newsletter published quarterly by the National Center for Frontier Communities.
Type: Journal/Newsletter
Sponsoring organization: National Center for Frontier Communities
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Frontier and Remote Area Codes: Data Set
Provides access to zip code-level frontier and remote area (FAR) codes to meet the need for delineation that is geographically detailed and adjustable for application in diverse research and policy contexts.
Type: Database
Sponsoring organization: USDA Economic Research Service
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National Center for Frontier Communities Resource Library
Lists a searchable collection of reports, books and articles relevant to frontier issues on various topics including health.
Type: Literature Search
Sponsoring organization: National Center for Frontier Communities
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Rural Health Grants Eligibility Analyzer
Determines if a community is rural according to the Federal Office of Rural Health Policy’s (FORHP) definition.
Type: Tool
Sponsoring organization: Federal Office of Rural Health Policy
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National Center for Frontier Communities: Maps
Maps on topics of interest to frontier. Includes maps showing frontier counties, federal lands, American Indian and Alaska Native lands, and frontier demographics.
Type: Map/Mapping System
Sponsoring organization: National Center for Frontier Communities
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Frontier Designation Matrix
A matrix that can be used to determine if an area is frontier, based on population density, distance to services, and travel time.
Type: Website
Sponsoring organization: National Center for Frontier Communities
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North Carolina Rural Health Research and Policy Analysis Cartographic Archive
A collection of maps that define rural and characterize rural America. Includes a variety of maps showing rural areas based on different definitions. Thematic maps cover demographics, health status, Critical Access Hospitals, rural hospitals, skilled nursing facilities, and health workforce supply.
Type: Map/Mapping System
Sponsoring organization: North Carolina Rural Health Research Program
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Rural-Urban Commuting Area (RUCA) Codes
A list of rural-urban commuting area (RUCA) code data sets. RUCA codes classify U.S. census tracts using measures of population density, urbanization, and daily commuting. The most recent RUCA codes are based on data from the 2010 decennial census and the 2006-10 American Community Survey decennial census.
Type: Database
Sponsoring organization: USDA Economic Research Service
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American FactFinder
Access to a wide range of U.S. Census data on the population, housing, economy and geography. Provides community profiles, as well as a range of search options, including the ability to narrow to rural data.
Type: Database
Sponsoring organization: U.S. Census Bureau
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Rural and Remote Health
An international, peer-reviewed journal covering topics that inform improvement in rural health service delivery and health status in rural communities.
Type: Journal/Newsletter
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 10/9/2018