Evidence-level

Promising (About evidence-level criteria)

Description

Forty years ago, Sister Bernadette Kenny — known as "Sister Bernie"— of the Catholic Order Medical Missionaries of Mary traveled rural mountain roads in a Volkswagen Beetle to deliver health care to individuals in southwest Virginia. Now the oldest mobile clinic in the nation, her healthcare delivery model was eventually named the Health Wagon and is now a $3.6 million dollar organization.

The Health Wagon hosts the largest health outreach of its kind in the nation and cares for the medically underserved in far southwest Virginia providing primary, specialty, dental, and vision care. In addition to thirteen sites in Virginia, care is also delivered in two stationary clinics. Patients from Kentucky and Tennessee also receive care.

Throughout the years, Health Wagon has been involved with several significant "firsts," starting with Sister Bernie's use of the first mobile health van outreach in the country. In 2014, the first telehealth wound care service was developed in collaboration with University of Virginia. In 2015, the Health Wagon team sponsored the first FAA-approved drone medication delivery. This event occurred as a joint venture with Remote Area Medical Volunteer Medical Corp (RAM®) and four additional organizations. The fourth unique event occurred in 2016 when the first telemedicine bladder cancer screening was performed as a joint venture with the University of Virginia. The latter program continues and is equally unique because nurse practitioners have been trained to do the procedure, though usually a procedure performed only by physicians.

Another significant Health Wagon contribution to the region's healthcare occurred in 2017 and 2019 when the organization sponsored the Department of Defense's Innovative Readiness Training at the Wise County Fairgrounds. This activity provided additional care to individuals in southwest Virginia, Kentucky and Tennessee.

Because of philanthropic and other types of outside support, Health Wagon has been able to achieve its mission to provide free healthcare. For its first 25 years, St. Mary's Hospital, Norton, Virginia, supported the effort. Later, funding also included a 2009-2012 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant. Today, Health Wagon does not bill for services and instead, is sustained by grants and donations from individuals, corporations, and foundations.

Services offered

The extensive offerings of the Health Wagon include:

• Acute Disease Management
• Behavioral Health Clinics
• Cardiovascular Clinics
• Cardiovascular Disease Management
• Chronic Disease Management
• Colposcopy Clinics
• COVID-19 Testing Clinics
• Cystoscopies
• Dentures (low-cost)
• Dermatology Clinics
• Diabetic Education
• Ear, Nose, and Throat (ENT) Clinics
• Endocrinology Clinics
• Eye Exams and Eyeglasses (fabrication)
• Hearing Aid Assistance
• Influenza Vaccine Clinics
• Lab Services
• Medical Therapy Management
• Nephrology Clinics
• Ostomy Clinics Physical Assessments
• Podiatry Clinics
• Pre-Op and Post-Op Surgery Clinics
• Psychiatry Clinics
• Pulmonary Clinics
• Substance Use Disorder Counseling
• Sports Physicals
• Telemedicine Clinics
• Ultrasound Clinics
• Urology Clinics
• Women's Health Clinic (mammography and pap smears)
• Wound Care Clinics
• X-Ray Clinics

Additional services:

• Community and Group Lifestyle Coaching Classes

• Medicare and Medicaid Enrollment
• Pastoral Care
• Pharmacy Connect & Medication Assistance
• Psychological Counseling
• Referrals & Follow-Up Systems
• Transportation Assistance

Staffing model:
Managed by nurse practitioners, the organization's staffing model includes not only several nurse practitioners, but a small staff of nurses and volunteer specialty physicians. Nursing students from nearly 40 academic organizations come for on-site training. In 2020, the Health Wagon added a full-time dentist and dental assistant, offering no-cost services on their mobile and stationary clinic sites.

Results

In 2020, milestones data analysis revealed:

• 5,667 patients served
• 16,369 patient encounters, a percent change from 2016 encounters of over 75%
• For every $1 of support, $100 of healthcare services provided.

For more information on this program:

• Gulley T, Tyson T, Collins E, et al. The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia. J Appalach Health 2020;2(3): 146-9.
• Lobo, J. M., Horton, B., Jones, R. A., Tyson, T., Hill-Collins, P., Sims, T., Rueb, J. J., Corey, T., Rheuban, K., Battle, P., Beller, H., Schenkman, N., Culp, S., & Krupski, T. L. (2020). Blinded Comparison of Clarity, Proficiency and Diagnostic Capability of Tele-Cystoscopy Compared to Traditional Cystoscopy: A Pilot Study. The Journal of urology, 204(4), 811–817. Abstract.
• Tyson, T., Milbrath, G., Snyder, A., McGarvey, E., & Hill-Collins, P. (2015). An academic and free clinic partnership to develop a sustainable rural training and clinical practice site for the education of undergraduate and advanced practice nurses. Journal of Nursing Education and Practice, 5(4), 7-12.
• Gardner, T., Gavaza, P., Meade, P., & Adkins, D.M. (2012). Delivering Free Healthcare to Rural Central Appalachia Population: The Case of the Health Wagon. Rural and Remote Health 12 (2035).

Challenges

Accessing transportation to make appointments and specialty services is an ongoing barrier for patients for whom the Health Wagon was created to serve. In addition, food insecurity, health insurance, housing, housing repairs, and unemployment are barriers to achieving health and wellness in this population.

Contact Information

Dr. Teresa Tyson, President and CEO
The Health Wagon
276.328.8850
drtysonnp@thehealthwagon.org