Diverse ways to enhance access to child healthcare in underserved rural communities: Implementing medical home models

Children in rural communities have multiple barriers to healthcare access. Even if adequately insured, health professional shortages lead to distances of ten miles or more that must be traveled to reach a doctor. Inadequate transportation resources are a major barrier to access. In response to these problems, The Children's Health Fund developed The Medical Home Initiative to ensure access to care for children in isolated rural areas of Arkansas, Idaho, Mississippi, and West Virginia. The model is consistent with the American Academy of Pediatrics standards for a true “medical home”: Care that is comprehensive, continuous and culturally appropriate. This presentation will demonstrate effective ways to bridge multiple barriers to access, with a focus on enabling services that may (or should) be reimbursable by public health insurance, and on suggested policy changes that may contribute to both better access in rural communities and narrowing of health disparities that affect the poor and underserved. Different models of care will be described including school-based and school-linked health centers, use of mobile medical units, and ways to enhance care at federally qualified health centers. During the first six months of 2006, these programs provided 2,374 immunizations, 14,766 primary medical encounters and 3,352 dental encounters, 1,005 case management encounters (including social work services and arranged transportation), 673 referrals to pediatric subspecialists, and 7,288 health education encounters. We will also discuss the medical profile found among these geographically and demographically diverse, medically underserved populations, and the implications of our clinical work for advocacy and policy strategies.