Improving health through rural healthcare linkages: Results of a three year study

This study examined the organization and delivery of health and medical care services and education for chronically ill, uninsured adults in a rural county through a partnership among a rural public health department, area hospitals, community mental health agency and social service organization. Service components included 1) Health screenings, community education and outreach with blood pressure and cholesterol screenings, and influenza vaccinations; 2) Mobile health van primary care services with a clinic on wheels scheduled at outreach sites with medical and nursing staffing labs and medicines; 3) Nursing case management with provided triage, care coordination for specialty referrals and hospital out-patient services, drug assistance program applications; 4) Specialty Care with mental health screenings, dental, medical subspecialty services by referral to private providers within the county or affiliated regional hospitals; 5) Health Education with a four-part (diabetes overview, diet, medication and monitoring)diabetes self-management classes; and 6) Telehealth with clinical visits including cardiology consults, diabetes classes. Telehealth clinic rooms established with linkage to other counties allowed real time clinical evaluation of patients by provider based in areas with more health resources. Program implementation and outcomes were assessed. A paired t-test was used to compare initial and final lab results. Chi square analysis was used to determine statistical significance on education programs. Implementation results showed the project served 130 low income, uninsured residents, providing 900 mobile health visits; >3600 case management services; and 818 medical subspecialty care services. Fifty eight clients received 676 medical subspecialty services; 107 attended diabetes self-management classes; 11 received transportation assistance; and 31 were screened for mental health needs with 20 receiving 420 services. Over 90 percent of attendees reported using health information to improve their lifestyles and strongly supported using telehealth to deliver health information. Post program case studies indicted that clients who received mental health and behavioral services fit the profile for those in need of services for co-morbid mental health issues. The outcome evaluation showed statistical significance on most self-management questions, and over half of the clients stated they had made and were maintaining improvements in self-managing their diabetes. Client health status lab benchmarks showed statistically significance changes in glycohemoglobin with positive movement toward significance in other lab values. Success of the specialty network was built upon existing collaborative relationships between community-focused hospitals, specialty providers, and public sector agencies. Recruiting new providers was enhanced by hospital leadership, case management to facilitate patient adherence, and timely reimbursement.