Three Ways To Tackle Rural Health Disparities

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Rural populations face unique health care challenges, including limited public transportation, geographic isolation and fewer care providers, according to the Rural Health Information Hub. As a result, these populations often experience higher rates of disease and disability, and lower life expectancies.

To address these challenges, quality improvement leaders nationwide are developing and advancing innovative approaches to reach rural populations and close the gap in health outcomes. Here are three ways to improve access to quality care for rural patients:

1. Leverage population health data for local interventions

Greg Wolverton, ARcare Health Center’s chief information officer, has made population health data the cornerstone of his organization’s plan to give better and more targeted care to rural residents in Arkansas.

ARcare found in one survey that only 16 percent of patients with diabetes had an HbA1c test within the last 12 months—evidence that diabetes wasn’t being controlled effectively for many patients.

“That [survey] showed we didn’t even have enough information to know whether diabetes or hypertension was being managed appropriately,” Wolverton said at the 2018 Centers for Medicare & Medicaid Services’ Quality Conference. “The process was broken.”

Among the action items that came out of the data analysis were that ARcare started sending out patient reminders in real-time via email, phone and mail. Wolverton said his team committed to identifying and deploying process changes that would enable them to identify the patients who did not have a current visit or test scheduled.

By using population health data measurements, ARcare saw diabetes control improve from 38 percent to 67 percent, and hypertension control improve from 28 percent to 57 percent.

2. Create strategic partnerships through care coordination

Coordinating effectively among health care providers and finding new groups with which to partner are essential to expanding rural populations’ access to care, according to Andrea Harris, public health advisor for the Substance Abuse and Mental Health Services Administration (SAMHSA). Peer-run programs enable rural patients who are recovering from substance abuse to rely on a network of family and friends for support.

Harris also advocates for the expansion of the behavioral health workforce in rural areas to remedy the shortage of these professionals in key areas. At the 2018 CMS Quality Conference, she recommended increasing the workforce through continuing education, grant programs and technical assistance to substance use disorder professionals.

3. Empower rural patients to self-manage diseases

To help patients in rural communities better self-manage diseases, including diabetes, Qualis Health—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Idaho and Washington—holds workshops and trainings on how to deal with stress, exercise safely, eat healthy and make weekly action plans.

According to Jeff Smith, a quality improvement consultant for the Everyone with Diabetes Counts (EDC) program at Qualis Health, the program has successfully spread its impact through relationships and partnerships in rural areas, and training local partners as leaders. The program, which started in 2014, now has six Diabetes Self-Management Program (DSMP) master trainers, six DSMP licenses and 344 beneficiaries who have completed the workshop.

At the 2018 CMS Quality Conference, Smith highlighted several lessons learned during the program, such as ensuring workshop leaders and partners understand the commitment beforehand and the importance of recruiting at the local level.