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Rural Project Examples: Service delivery models

Evidence-Based Examples

Telepsychology-Service Delivery for Depressed Elderly Veterans
Updated/reviewed December 2019
  • Need: To provide evidence-based psychotherapy for depression in elderly veterans who are unable to seek mental health treatment due to distance or stigma.
  • Intervention: Telepsychology-Service Delivery for Depressed Elderly Veterans compared providing behavioral activation therapy via home-based telehealth and the same treatment delivered in a traditional office-based format.
  • Results: A 2015 study and two 2016 studies show that providing treatment via home-based telehealth to elderly veterans in South Carolina resulted in the same improved health outcomes, quality of life, satisfaction with care, and cost of healthcare compared to those receiving face-to-face treatment.
UAMS IDHI High Risk Pregnancy Program
Updated/reviewed November 2019
  • Need: Arkansas had high rates of low birthweight babies, and women in rural areas had difficulty accessing specialty obstetric care.
  • Intervention: The University of Arkansas for Medical Sciences created the IDHI High Risk Pregnancy Program to increase access to care for pregnant women in an effort to improve outcomes for high-risk pregnancies.
  • Results: The program has increased access to care and reduced infant mortality for rural Arkansas women through a variety of programs and has been recognized by various organizations as a model program.
Project ENABLE (Educate, Nurture, Advise, Before Life Ends)
Updated/reviewed October 2019
  • Need: To enhance palliative care access to rural patients with advanced cancer or heart failure and their family caregivers.
  • Intervention: Project ENABLE consists of: 1) an initial in-person palliative care consultation with a specialty-trained provider and 2) a semi-structured series of weekly, phone-delivered, nurse-led coaching sessions designed to help patients and their caregivers enhance their problem-solving, symptom management, and coping skills.
  • Results: Patients and caregivers report higher quality of life and lower rates of depression and (caregiver) burden.
Chronic Disease Self-Management Program
Updated/reviewed October 2018
  • Need: To help people with chronic conditions learn how to manage their health.
  • Intervention: A small-group 6-week workshop for individuals with chronic conditions to learn skills and strategies to manage their health.
  • Results: Participants have better health and quality of life, including reduction in pain, fatigue, and depression.
Project ECHO® – Extension for Community Healthcare Outcomes
Updated/reviewed July 2017
  • Need: To increase the capacity for more effective treatment of chronic, complex conditions in rural and underserved communities.
  • Intervention: Through a specially-designed project, remote primary care providers work with academic specialists as a team to manage chronic conditions of rural patients, expanding remote providers' knowledge base through shared case studies.
  • Results: Patient management and care provided by rural providers through ongoing education and mentoring from Project ECHO® has proved as effective as treatment provided by specialists at a university medical center.

Effective Examples

Avera eCARE
Updated/reviewed November 2019
  • Need: Rural hospitals and healthcare providers have less access to specialty care support.
  • Intervention: A service was created at Avera Health that provides 24-hour virtual access to specialty care physicians, nurses and pharmacists.
  • Results: Rural patients can receive specialty care without leaving their communities, and rural healthcare providers can get needed support in providing quality care to their patients.
Montana "Team Up. Pressure Down." Blood Pressure Medication Adherence Project
Updated/reviewed November 2019
  • Need: To help rural Montana patients manage their blood pressure levels.
  • Intervention: Pharmacists distributed "Team Up. Pressure Down." materials from the Million Hearts Initiative and provided consultations.
  • Results: 89% of patients were able to adhere to their blood pressure medication, compared to 73% before the intervention.
HEALTH-COP Obesity Prevention
Updated/reviewed August 2019
  • Need: Many physicians want to help rural children who are overweight or obese develop healthy lifestyles, and these physicians would benefit from receiving training on specific ways to instruct, motivate, and manage the healthcare of these children.
  • Intervention: A virtual learning network called Healthy Eating Active Living TeleHealth Community of Practice (HEALTH-COP) was created to educate rural physicians and provide peer support.
  • Results: Studies showed an increase in health and wellness topics covered by physicians during children's clinic visits. This likely contributed to healthier eating habits and more active lifestyles that were found when these children were reassessed 3 months later.
Kitsap Mental Health Services: Race to Health!
Updated/reviewed August 2019
  • Need: To improve the physical health of individuals seeking mental healthcare.
  • Intervention: Race to Health! in Washington integrates mental health, substance use disorder treatment, and primary care for individuals with severe mental illness.
  • Results: Race to Health! helped reduce emergency department visits, hospitalizations, and costs (a total savings of $5,144,000 for Medicare patients).
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder
Updated/reviewed July 2019
  • Need: Increase access to medication-assisted treatment for opioid use disorder in rural Vermont.
  • Intervention: Statewide hub-and-spoke treatment access system.
  • Results: Increased treatment capacity and care coordination.