Abstract

Meeting rural residents where they are: Leveraging hospital-community partnerships to improve rural community health within the Pennsylvania rural health model (PARHM)

Samantha Augenbraun, MPH¹, Jenna Sirkin, PhD¹, Jennifer Norris, MPH², Noorhan Abduljaleel³, Miriam Lupovitch³, Meghana Chandra, MPP³, Michelle Spafford, MIA³, Shena Popat, MHA³ and Alana Knudson, PhD³
(1)NORC at the University of Chicago, Cambridge, MA, (2)NORC, Denver, CO, (3)NORC at the University of Chicago, Bethesda, MD

APHA 2023 Annual Meeting and Expo

Background: Investment in hospital-community partnerships is a key strategy to address social drivers of health (SDOH), improve population health, and advance health equity. Community partnerships serve an important function in rural communities with high rates of chronic disease, limited availability of health services, and barriers to accessing care. Hospitals participating in the Pennsylvania Rural Health Model (PARHM), funded by the Center for Medicare & Medicaid Innovation, are enhancing community engagement to achieve Model goals. Exploration of PARHM hospitals’ community engagement approaches sheds light on opportunities for hospital-community partnerships to strengthen rural community health.

Objectives: We examined how PARHM hospitals engage community partners in rural communities and associated challenges and facilitators.

Methods: Our mixed-methods evaluation included semi-structured interviews with Model participating hospital staff (clinical and administrative), community partners, and patients (n=55) followed by a thematic analysis of interview transcripts. We also conducted descriptive analyses of the American Community Survey and the Recovery Ecosystem Index.

Results: We identified four areas in which PARHM hospitals are engaging community partners: (1) care coordination, intervention, and referral for mental health and substance use disorder, (2) community paramedicine and remote patient monitoring, (3) food security initiatives, (4) community health and wellness programs. Facilitators of community engagement included working with community coalitions and hiring dedicated staff to support hospital-community partnerships. Hospitals drew on braided funding streams, including grants and the annual prospective global budget provided by the Model to fund community engagement. Implementation challenges included funding constraints, COVID-19, workforce shortages, transportation issues, and limited mental health and SUD services.

Conclusions: PARHM hospitals are implementing diverse strategies to improve rural community health, with several hospitals establishing or expanding on relationships with local partners to address community needs. These partnerships advance health equity in rural communities by addressing SDOH needs and helping patients access and navigate care. Despite the PARHM hospitals’ community focus, implementation was challenging due to the COVID-19 pandemic, funding, and limited technical support.

Public Health Implications: Hospital-community partnerships leverage community assets to coordinate care and address health needs. Rural payment and delivery models should incentivize community partnerships and mitigate potential implementation challenges in hospital strategic planning.

Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Public health or related research