Rural Health
Resources by Topic: Care coordination
Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives — United States, 1996–2013
Reports on diabetes-related end-stage renal disease by race/ethnicity from 1996-2013. Discusses clinical, public health, and population management approaches used by Indian Health Service that may have positively impacted incidence rates among American Indians and Alaska Natives.
Author(s): Ann Bullock, Nilka Ríos Burrows, Andrew S. Narva, et al.
Citation: MMWR (Morbidity and Mortality Weekly Report), 66(1), 26-32
Date: 01/2017
Sponsoring organization: Centers for Disease Control and Prevention
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Reports on diabetes-related end-stage renal disease by race/ethnicity from 1996-2013. Discusses clinical, public health, and population management approaches used by Indian Health Service that may have positively impacted incidence rates among American Indians and Alaska Natives.
Author(s): Ann Bullock, Nilka Ríos Burrows, Andrew S. Narva, et al.
Citation: MMWR (Morbidity and Mortality Weekly Report), 66(1), 26-32
Date: 01/2017
Sponsoring organization: Centers for Disease Control and Prevention
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Social Determinants of Health and Vulnerable Populations in Rural Maryland
White paper discussing how social determinants of health impact those who face barriers to health and are susceptible to poor health due to circumstances such as environmental conditions, housing concerns, lack of transportation, and poverty. Includes strategies and examples of programs that have worked in rural communities to address topics such as substance use disorder and care coordination.
Date: 12/2016
Sponsoring organizations: Maryland Community Health Resources Commission, Maryland Rural Health Association
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White paper discussing how social determinants of health impact those who face barriers to health and are susceptible to poor health due to circumstances such as environmental conditions, housing concerns, lack of transportation, and poverty. Includes strategies and examples of programs that have worked in rural communities to address topics such as substance use disorder and care coordination.
Date: 12/2016
Sponsoring organizations: Maryland Community Health Resources Commission, Maryland Rural Health Association
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Rural Health Networks and Care Coordination: Health Care Innovation in Frontier Communities to Improve Patient Outcomes and Reduce Health Care Costs
Discusses the findings of a single-case, community-based participatory design study in a frontier community in northern Minnesota to determine the effectiveness of developing a community care team focused on collaboration and care coordination to improve patient outcomes and reduce emergency room use.
Author(s): Pat Conway, Heidi Favet, Laurie Hall, Jenny Uhrich, Jeanette Palcher, et al.
Citation: Journal of Health Care for the Poor and Underserved, 27(4A), 91–115
Date: 11/2016
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Discusses the findings of a single-case, community-based participatory design study in a frontier community in northern Minnesota to determine the effectiveness of developing a community care team focused on collaboration and care coordination to improve patient outcomes and reduce emergency room use.
Author(s): Pat Conway, Heidi Favet, Laurie Hall, Jenny Uhrich, Jeanette Palcher, et al.
Citation: Journal of Health Care for the Poor and Underserved, 27(4A), 91–115
Date: 11/2016
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"How Can We Talk about Patient-centered Care without Patients at the Table?" Lessons Learned from Patient Advisory Councils
Reports on a survey of patient advisory council (PAC) members associated with 8 primary care clinics and Federally Qualified Health Clinics (FQHCs), both rural and urban, in Northern California. Focuses on how PACs are developed, challenges faced, and the benefits of effective PACs.
Author(s): Anjana E. Sharma, Rachel Willard-Grace, Andrew Willis, et al.
Citation: Journal of the American Board of Family Medicine, 29(6), 775-784
Date: 11/2016
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Reports on a survey of patient advisory council (PAC) members associated with 8 primary care clinics and Federally Qualified Health Clinics (FQHCs), both rural and urban, in Northern California. Focuses on how PACs are developed, challenges faced, and the benefits of effective PACs.
Author(s): Anjana E. Sharma, Rachel Willard-Grace, Andrew Willis, et al.
Citation: Journal of the American Board of Family Medicine, 29(6), 775-784
Date: 11/2016
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Innovations in Rural Health System Development: Service Delivery Advances in Care Coordination, Emergency Care, and Telehealth
Offers examples of emergency services, telehealth technology, and care coordination initiatives with a focus on Maine, and how they impact rural service delivery and safeguard rural access to critical health services.
Author(s): Amanda Burgess, Andrew Coburn
Date: 10/2016
Sponsoring organizations: Maine Health Access Foundation, Maine Rural Health Research Center
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Offers examples of emergency services, telehealth technology, and care coordination initiatives with a focus on Maine, and how they impact rural service delivery and safeguard rural access to critical health services.
Author(s): Amanda Burgess, Andrew Coburn
Date: 10/2016
Sponsoring organizations: Maine Health Access Foundation, Maine Rural Health Research Center
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Project ECHO's Complex Care Initiative: Building Capacity to Help "Superutilizers" in Underserved Communities
Describes a case study from the University of New Mexico's Project ECHO (Extension for Community Health Outcomes) program, which uses telehealth to support primary care clinicians in underserved areas. Focuses on a project targeting Medicaid beneficiaries with substance abuse and mental health issues, with details on two primary care teams being supported, including one in a rural New Mexico community.
Author(s): Martha Hostetter, Sarah Klein, Douglas McCarthy
Date: 08/2016
Sponsoring organization: Commonwealth Fund
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Describes a case study from the University of New Mexico's Project ECHO (Extension for Community Health Outcomes) program, which uses telehealth to support primary care clinicians in underserved areas. Focuses on a project targeting Medicaid beneficiaries with substance abuse and mental health issues, with details on two primary care teams being supported, including one in a rural New Mexico community.
Author(s): Martha Hostetter, Sarah Klein, Douglas McCarthy
Date: 08/2016
Sponsoring organization: Commonwealth Fund
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Integrated Care in a Frontier Community
Examines the Southeast Health Group (SHG) in La Junta, Colorado, which coordinates physical and behavioral health using patient-centered, wellness-based care coordination to empower patients and promote self-directed care. Focuses on hiring providers who share SHG's philosophy of care, using community resources, and engaging peer support specialists.
Date: 07/2016
Sponsoring organization: Rural Health Value
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Examines the Southeast Health Group (SHG) in La Junta, Colorado, which coordinates physical and behavioral health using patient-centered, wellness-based care coordination to empower patients and promote self-directed care. Focuses on hiring providers who share SHG's philosophy of care, using community resources, and engaging peer support specialists.
Date: 07/2016
Sponsoring organization: Rural Health Value
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National Healthcare Quality and Disparities Chartbook on Care Coordination
A summary of trends in Care Coordination from the National Healthcare Quality and Disparities Report (QDR) for 2015. Includes data and statistics by metropolitan statistical area with a focus on groups with disparities in care coordination regarding hospital and emergency department visits, discharge, readmission, use of ED for chronic healthcare, and potentially avoidable hospitalizations. Also highlights the use of electronic health records and electronic exchange and how that affects care coordination and quality.
Date: 06/2016
Sponsoring organization: Agency for Healthcare Research and Quality
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A summary of trends in Care Coordination from the National Healthcare Quality and Disparities Report (QDR) for 2015. Includes data and statistics by metropolitan statistical area with a focus on groups with disparities in care coordination regarding hospital and emergency department visits, discharge, readmission, use of ED for chronic healthcare, and potentially avoidable hospitalizations. Also highlights the use of electronic health records and electronic exchange and how that affects care coordination and quality.
Date: 06/2016
Sponsoring organization: Agency for Healthcare Research and Quality
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Integrated Behavioral Health In Montana: A Baseline Assessment of Benefits, Challenges, and Opportunities
Presents results from a baseline assessment of Montana's behavioral health system of care. Evaluates the possibility of addressing system deficiencies by implementing an integrated behavioral health model. Describes rural-specific benefits and challenges associated with system integration.
Additional links: Issue Brief
Author(s): Katie Loveland
Date: 04/2016
Sponsoring organization: Montana Healthcare Foundation
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Presents results from a baseline assessment of Montana's behavioral health system of care. Evaluates the possibility of addressing system deficiencies by implementing an integrated behavioral health model. Describes rural-specific benefits and challenges associated with system integration.
Additional links: Issue Brief
Author(s): Katie Loveland
Date: 04/2016
Sponsoring organization: Montana Healthcare Foundation
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Improving the Care of Dual Eligible Patients in Rural Federally Qualified Health Centers: The Impact of Care Coordinators and Clinical Pharmacists
Discusses a care coordination project that included 3 Federally Qualified Health Centers (FQHCs) and 502 patients in rural West Virginia and a tertiary care referral hospital in southern West Virginia to determine if expanded use of care coordinators and clinical pharmacists could improve the care experience and healthcare outcome of dual eligible patients.
Author(s): Daniel Doyle, Mary Emmett, Amber Crist, Craig Robinson, Michael Grome
Citation: Journal of Primary Care and Community Health, 7(2) 118-121
Date: 04/2016
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Discusses a care coordination project that included 3 Federally Qualified Health Centers (FQHCs) and 502 patients in rural West Virginia and a tertiary care referral hospital in southern West Virginia to determine if expanded use of care coordinators and clinical pharmacists could improve the care experience and healthcare outcome of dual eligible patients.
Author(s): Daniel Doyle, Mary Emmett, Amber Crist, Craig Robinson, Michael Grome
Citation: Journal of Primary Care and Community Health, 7(2) 118-121
Date: 04/2016
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