Skip to main content
Rural Health Information Hub

Rural Health
Resources by Topic: Care coordination

Study Protocol: Maintaining Preventive Care During Public Health Emergencies Through Effective Coordination
Presents a qualitative study protocol that examines screening rates at VA medical centers during COVID-19 to determine strategies that provide continued care during public health emergencies. Discusses selection of sites, which will be based on rurality, COVID-19 patient caseload, and performance related to cancer and mental health screenings. Highlights the importance of care coordination teams in regard to specialty care.
Author(s): Sylvia J. Hysong, Traber Davis Giardina, Jennifer Freytag, et al.
Citation: Implementation Science Communications, 4, 150
Date: 11/2023
Type: Document
view details
Community Care Hubs: A Promising Model for Health and Social Care Coordination
Examines the coordination of health and social needs by focusing on the community care hub model. Provides information on the types of organizations functioning as hubs as well as how the hubs operate, serve, and network within their communities. Includes case studies of hubs working within rural and underserved areas.
Author(s): Joshua Breslau, Petra W. Rasmussen, Nabeel Qureshi, Evan D. Peet
Date: 11/2023
Type: Document
Sponsoring organizations: Administration for Community Living, HHS Office of the Assistant Secretary for Planning and Evaluation
view details
Rural Health Network Development Planning Program: Sourcebook
Detailed descriptions of the 23 Rural Health Network Development Planning Program grant projects funded in fiscal year 2022. Reports on each grantee's network infrastructure development, plans for sustaining the network after the grant, and program activities addressing topics such as chronic disease prevention and management, behavioral health, and maternal child health. Grantee profiles identify the geographic areas served, network partners, and primary contact person.
Date: 10/2023
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
view details
Exploring Patient Care Navigation in the Medicare Program
Presents an overview of patient navigation programs through an environmental scan of literature published between 2013 and 2023 and discussions with key informants at four healthcare organizations. Describes the variety of patient navigation services, types of patients targeted, settings that offer navigation services, staffing, funding, clinical outcomes, and more. Includes a brief discussion of programs targeting patients in rural areas. Identifies implementation and policy considerations and potential barriers to supporting patient navigation services.
Additional links: Annex, Executive Summary
Author(s): Zachary Predmore, Joachim Hero, Stephanie Dellva, et al.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Health Care
view details
Rural Health Care Coordination Sourcebook, 2020-2023
Provides an overview of the ten initiatives funded under the Rural Health Care Coordination Program for the 2020-2023 period, with information on program accomplishments and reach. Detailed grantee profiles include contact information, consortium partners, population served, program outcomes and impacts, and lessons learned.
Date: 09/2023
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
view details
Cancer Survivorship Challenges of Rural Older Adults: A Qualitative Study
Examines the perspectives of rural, older cancer survivors regarding their experiences, challenges, and related recommendations. Provides feedback from 27 former cancer patients regarding survivorship care plans, communication with their healthcare team, and transportation, financial, psychological, diet, and physical health challenges.
Author(s): Evelyn Arana-Chicas, Laura M. Hincapie Prisco, Saloni Sharma, et al.
Citation: BMC Cancer, 23(917)
Date: 09/2023
Type: Document
view details
Care Coordination Between Rural Primary Care and Telemedicine to Expand Medication Treatment for Opioid Use Disorder: Results from a Single-Arm, Multisite Feasibility Study
Examines the feasibility of expanding access to medication treatment for opioid use disorder (MOUD) in rural areas through the use of telemedicine. Analyzes 6 rural primary care sites and their care coordination model. Includes data on patients referred to telemedicine and total number of patient-days on MOUD.
Author(s): Yih-Ing Hser, Larissa J. Mooney, Laura-Mae Baldwin, et al.
Citation: Journal of Rural Health, 39(4), 780-788
Date: 09/2023
Type: Document
view details
Rural Maternity and Obstetrics Management Strategies (RMOMS) Program
Describes a pilot grant program designed to improve maternal and neonatal health in rural communities by collecting data and supporting the development of financially sustainable and coordinated network models. Aims to make maternal and obstetrics care more accessible through increased use of telehealth and specialty care. Fact sheet provides information on the activities of 3 rural networks funded through the RMOMS program.
Date: 09/2023
Type: Website
Sponsoring organizations: Federal Office of Rural Health Policy, Maternal and Child Health Bureau
view details
Assisting Rural Consumers: Webinar Slides
Provides an overview of the Centers for Medicare & Medicaid's (CMS) frameworks for health equity and advancing health equity in rural, tribal, and geographically isolated communities. Outlines barriers for healthcare consumers living in rural areas, and offers tactics for healthcare assisters and navigators who help rural populations make healthcare decisions.
Date: 07/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Sourcebook: Rural Health Network Development Program, 2020-2023
Provides brief program descriptions and overviews of the sustained impact of the 44 rural health networks funded during the 2020-2023 grant period. Programs used integrated rural healthcare networks to address health needs including behavioral/mental health, care coordination, chronic disease, social determinants of health, and telehealth. Grantee profiles include a network overview, program outcomes, partners involved, and program sustainability.
Date: 07/2023
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
view details