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Rural Health
Resources by Topic: Care coordination

Rural Surgery - A View from the Front Lines: “I Need to Transfer This Patient”
Describes the process of a patient transfer from a rural hospital to a larger hospital from the perspective of Mark Puls, a rural general surgeon and the vice chair of the American College of Surgeons (ACS) Council for Rural Surgery.
Author(s): Mark Plus
Date: 09/2018
Type: Document
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Rural Health Opioid Program Funds Care Coordination Efforts for Recovery
Highlights programs funded by the Federal Office of Rural Health Policy that provide opioid treatment and recovery care coordination. An Ohio program uses care coordination in an existing syringe exchange program and county family drug court, a Kentucky program focuses on helping prisoners, and a Montana program reaches new and expectant mothers.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 09/2018
Type: Document
Sponsoring organization: Rural Health Information Hub
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Navigating Towards Health
Examines how health navigators can be incorporated into workplaces and healthcare teams. Health navigators are professionals who help people find care despite barriers, such as insurance, transportation, or finding a doctor. Discusses three critical points for integrating health navigators into the workforce and offers guidance for employers to determine the appropriate ratio of navigators to patients.
Author(s): Karam Ahmad, Alex Caldwell, Brian Clark, et al.
Date: 07/2018
Type: Document
Sponsoring organization: Colorado Health Institute
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Getting Ready for an Upcoming Grant Opportunity: The Rural Communities Opioid Response
A collection of resources useful in preparing to apply for a Federal Office of Rural Health Policy grant opportunity, The Rural Communities Opioid Response, which is expected to be available in June 2018. Includes resources on building networks and partnerships, integrating behavioral health, care coordination, substance abuse, and applying for federal grants.
Date: 06/2018
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Delta Memorial Hospital’s SEAL Team
Describes Delta Memorial Hospital's (DMH) progress as part of the Small Rural Hospital Transition (SRHT) Project, completed in 2017, focused on improving quality of care and transition of care. DMH is a 25-bed Critical Access Hospital located in Dumas, Arkansas. 12 months after implementing the recommendations, DMH met two of their three measurable goals. The SEAL team, or Service Excellence Advisor Leaders, are charged with regularly reviewing patient satisfaction surveys to identify service areas that need improvement.
Date: 05/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Relationships and Partnerships: How ACOs Are Improving Treatments for Super-Utilizers
Highlights three rural Accountable Care Organizations (ACOs) that are working to improve care for their super-utilizer patients. Features three success stories showing how the ACOs helped meet patient needs and improve patient health.
Author(s): Allee Mead
Citation: Rural Monitor
Date: 05/2018
Type: Document
Sponsoring organization: Rural Health Information Hub
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Evaluation of the Comprehensive Primary Care Initiative: Fourth Annual Report
Final report evaluating the Centers for Medicare and Medicaid Services four-year Comprehensive Primary Care (CPC) initiative. Examines CPC participants, program implementation, and impact of CPC on clinicians and staff, patient experience, cost, service use, and quality-of-care. Includes information on rural practices participating in CPC.
Author(s): Deborah Peikes, Grace Anglin, Stacy Dale, et al.
Date: 05/2018
Type: Document
Sponsoring organization: Mathematica Policy Research
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Case Studies From the 2017 Care Coordination Comparative Study
Provides an overview of four care coordination approaches being used in rural areas: care coach, clinical, community health worker, and school-based. Includes individual case studies of rural care coordination programs, with detailed information on target populations, technology used, partners, care team composition, and more.
Date: 05/2018
Type: Document
Sponsoring organizations: National Rural Health Resource Center, Rural Health Innovations
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OSF HealthCare – Peoria, IL: Connecting Health Systems and Community-Based Organizations to Improve Outcomes
Features a faith-based, 13-hospital health care system serving Illinois and Michigan's Upper Peninsula. Describes OSF Center for Health - Streator, which will feature the first rural freestanding emergency department in Illinois. Discusses how OSF HealthCare is using a case management platform and working with community-based organizations to meet a wide range of patient needs.
Date: 05/2018
Type: Document
Sponsoring organization: American Hospital Association
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Minnesota Accountable Community for Health Saves Medicaid $3.8 Million Through Its Opioid Prevention Initiative
Details the opioid prevention and cost saving efforts of a community health initiative in Morrison County, Minnesota. Discusses the measures implemented and the various participating entities, such as providers, pharmacies, social services, and law enforcement, among others.
Author(s): Amy Clary
Date: 04/2018
Type: Document
Sponsoring organization: National Academy for State Health Policy
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