- Need: Rural Appalachian Kentucky residents have deficits in health resources and health status, including high levels of cancer, heart disease, hypertension, asthma, and diabetes.
- Intervention: Kentucky Homeplace was created as a community health worker initiative to address the lifestyle choices, inadequate health insurance, and environmental factors that are believed to contribute to these diseases.
- Results: From July 2001 to June 2016, over 152,262 rural residents have been served. Preventive health strategies, screenings, educational services, and referrals are all offered at no charge to clients.
Effective (About evidence-level criteria)
Kentucky Homeplace was created in 1994 by the University of Kentucky Center of Excellence in Rural Health and funded by the Kentucky General Assembly to combat health disparities in rural areas of the state. This community health worker (CHW) initiative was first based in the eastern town of Hazard, KY, and has since connected thousands of rural Kentucky residents with medical, environmental, and social services.
Currently, 30 counties located in the Appalachian region of eastern Kentucky are being served by Kentucky Homeplace. Compared to the rest of the state and country, eastern Kentucky residents are statistically poorer and less educated and have inadequate health insurance. In addition, a majority of the counties in Kentucky are designated as Medically Underserved Areas. Rural, poverty-stricken community members lack proper knowledge of their health conditions and run into barriers of social/cultural inhibitors, financial burdens, and transportation.
Kentucky Homeplace trains CHWs, usually individuals who were born and raised within the community, to provide access to numerous health and social services.
A majority of the clients served are at 100%-133% of the federal poverty level. Kentucky Homeplace does not charge clients for services provided. Within their communities, these services include:
- Free health information
- Health Coaching for clients and family members
- Chronic Disease Self-Management Program (CDSMP)
- Diabetes Self-Management Program (DSMP)
- Eye exams and eyeglasses
- Hearing aids at reduced rates
- Reduced or no-cost medications
- Reduced fee for dental services and low-cost dentures
- Sliding fee referrals for doctor visits
- Enrollment/re-enrollment for Medicaid and Kentucky Children's Health Insurance Program (KCHIP)
- Medicare D information
Kentucky Homeplace puts an emphasis on care coordination and health coaching on the following:
- Chronic disease management
- Healthy lifestyles and eating habits
- Importance of preventive care
- Prenatal care
- The condition
- Eye care
- Foot care
- Physical activity
- Hypertension, cholesterol, and heart disease
- The conditions and appropriate diets
- Preventive screenings
- Mammograms, Pap Smears, colon and prostate exams
- Tobacco cessation
- Education and referrals for cessation classes
- Resources for support groups and aides
From July 2001 to June 2016, Kentucky Homeplace has served well over 152,262 clients and provided 4,748,727 services with a combined medication and service value of $308,335,241. The return on investment (ROI) is $11.55 saved for every $1 invested.
For specific, recent information on the statewide impact of Kentucky Homeplace, view the latest Quarterly Reports.
Kentucky Homeplace has received numerous awards and recognition over the years, including the National Rural Health Association’s 2008 Outstanding Rural Health Program Award. See a list of more awards.
Kentucky Homeplace was a collaborating partner in C-Change, an organization that assembles key cancer leaders from the three sectors — private, public, and not-for-profit — and from across the cancer continuum — prevention, early detection, treatment, and quality of life.
In 2014, Congressman Hal Rogers presented a Health Impact Award to Kentucky Homeplace for its Improving Diabetes Outcomes (I DO) Campaign. Funded by a grant from the Anthem Foundation, I DO is a nurse-led outreach initiative coordinated by CHWs to educate patients about their diabetes. This is important because 31 of the 38 Kentucky Homeplace counties that participated in I DO are located in the “National Diabetes Belt.” In that region, 11% or more of adults had been told by a healthcare professional they have diabetes, yet the belt has the lowest number of certified diabetic educators to help individuals live healthy lives.
Kentucky Homeplace has been recognized by the U.S. Department of Health and Human Services’ Healthy People 2020 initiative for its work to improve colorectal cancer screening rates.
Read more on the Sharing Library at HealthyPeople.gov: Kentucky Homeplace: Improving Colorectal Cancer Screening Rates Through Tailored, Community-Based Approaches.
For more detailed program results:
Cardarelli, R., Roper, K.L., Cardarelli, K., Feltner, F.J., Prater, S., Ledford, K.M., ... & Cantrell, C. (2017). Identifying Community Perspectives for a Lung Cancer Screening Awareness Campaign in Appalachia Kentucky: the Terminate Lung Cancer (TLC) Study. Journal of Cancer Education, 32(1), 125-134. Article Abstract
Cardarelli, R., Reese, D., Roper, K.L., Cardarelli, K., Feltner, F.J., Studts, J.L., ... & Shaffer, D. (2017). Terminate Lung Cancer (TLC) Study – a Mixed-Methods Population Approach to Increase Lung Cancer Screening Awareness and Low-Dose Computed Tomography in Eastern Kentucky. Cancer Epidemiology, 46, 1-8. Article Abstract
Feltner, F., Thompson, S.P., Baker, W.M., & Sloane, M. (2017). Community Health Workers Improving Diabetes Outcomes in a Rural Appalachian Population. Social Work in Health Care, 56(2), 115-123. Article Abstract
Kitzman, P., Hudson, K., Sylvia, V., Feltner, F., & Lovins, J. (2016). Care Coordination for Community Transitions for Individuals Post-Stroke Returning to Low-Resource Rural Communities. Journal of Community Health. Advance online publication. Article Abstract
Snell-Rood, C., Hauenstein, E., Leukefeld, C., Feltner, F., Marcum, A., & Schoenberg, N. (2016). Mental Health Treatment Seeking Patterns and Preferences of Appalachian Women with Depression. American Journal of Orthopsychiatry. Advance online publication. Article Abstract
Dignan, M., White, C., Schoenberg, N., Shelton, B., Feltner, F., Slone, S., ... & Ely, G. (2014). Effectiveness of an Intervention for Adherence to Follow-Up Recommendations for Abnormal Pap Tests in Appalachian Kentucky. Health Behavior and Policy Review, 1(1), 6-15(10). Article Abstract
Donaldson, E., Holtgrave, D., Duffin, R., Feltner, F., Funderburk, W., & Freeman, H. (2012). Patient Navigation for Breast and Colorectal Cancer in 3 Community Hospital Settings: an Economic Evaluation. Cancer, 118(19), 4851-4859.
Ely, G., White, C., Jones, K., Feltner, F., Gomez, M., Shelton, B., ... & Dignan, M. (2014). Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care. WSHC: Social Work in Health Care, 53(2), 83-95. Article Abstract
Feltner, F., Ely, G., Whitler, E., Gross, D., & Dignan, M. (2012). Effectiveness of Community Health Workers in Providing Outreach and Education for Colorectal Screening in Appalachian Kentucky. Social Work in Health Care, 51(5), 430-440. Article Abstract
Feltner, F., Wilson, E., Whitler, E., & Asher, L. (2011). UK College of Medicine – Future Role of Community Health Workers for Reducing Health Disparities. Poster presented at the NRHA Annual Rural Health Conference, Austin, Texas. Poster Presentation
Schoenberg, N., Campbell, K., Garrity, J., Snider, L., & Main, K. (2001). The Kentucky Homeplace Project: Family Health Care Advisers in Underserved Rural Communities. Journal of Rural Health, 17(3), 179-186. Article Abstract
Whitler, E., Feltner, F., Owens, J., & Gross, D. (2005). Kentucky Homeplace Defeat Diabetes Screening Test: an Analysis of Rural Kentucky's Challenge to Overcome the Growing Diabetes Epidemic. Journal of the Kentucky Medical Association, 130(7), 307-314. Article Abstract
Kentucky Homeplace is also featured in RHIhub's Community Health Worker Toolkit Program Clearinghouse.
Challenges for implementing and maintaining the CHW program include:
- Funding mechanisms for sustainable employment
- Workforce development and training
- Occupational regulations
- Standards and guidelines for publicly funded CHW program evaluation and research
- Staff retention in grant-funded or annual contract situations
Kentucky Homeplace has provided CHW training for more than two decades to CHWs within Kentucky as well as numerous other states across the nation. Lessons learned in the Kentucky Homeplace model have enhanced the success of other programs, service delivery, and research projects. For more information on training opportunities, go to Community Health Worker Training Overview.
Building upon the successes of the Kentucky Homeplace program, Connecting Kids to Coverage is an outreach and enrollment cooperative made possible by a grant from the Centers for Medicare and Medicaid Services and is currently underway in 40 counties in eastern Kentucky. The plan is to expand the capacity and build upon the existing CHW program (Kentucky Homeplace) and to collaborate with existing programs to complement and fill gaps within rural communities. All CHWs are trained to enroll and/or re-enroll individuals in KCHIP and Medicaid programs. The project period is from July 1, 2016, to June 30, 2018.
Also modeled after Kentucky Homeplace is an innovative program called Kentucky Care Coordination for Community Transition Program (KC3T). The CHW serves as a patient navigator for clients who have suffered a stroke. The CHW starts service upon patient admission and serves on the discharge planning team. After discharge, the CHW conducts home visits and provides self-management education and health coaching along with assisting the client to overcome an array of obstacles and barriers. The results: Participants in KC3T had no stroke-related 30-day readmissions compared to 42% of non-KC3T participants who were readmitted within 30 days of discharge.
The Kentucky Homeplace model has been recognized by policymakers at the local, state, and national level, including the following:
- Promoting Policy and Systems Change to Expand Employment of Community Health Workers (CHWs), Centers for Disease Control and Prevention (CDC), 2011.
- Community Health Workers: Expanding the Scope of the Health Care Delivery System, National Conference of State Legislatures, April 2008.
Community health workers
Wellness, health promotion, and disease prevention
January 28, 2015
May 10, 2018
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.