Rural COVID-19 Innovations: Providing Health Services

Examples of how rural healthcare providers and facilities are innovating to deliver healthcare services during the COVID-19 pandemic.

• Door-to-door screenings and education
  Arizona
  November 6, 2020 - The Hopi Health Care Center (HHCC), the Hopi Tribe Department of Health and Human Services (DHHS), and the CDC collaborated to visit every household in two villages. Five pairs of community health representatives and volunteers from HHCC, Hopi Tribe DHHS, or CDC went door to door to screen for COVID-19, recommend any needed testing, and provide education on how to prevent or mitigate the spread of COVID-19 within a household. The pairs screened a total of 141 people in under 10 hours, with only 5% of households refusing services.
  Source: Notes from the Field: Development of an Enhanced Community-Focused COVID-19 Surveillance Program – Hopi Tribe, June-July 2020, CDC Morbidity and Mortality Weekly Report (MMWR)
• Library increases access to internet and telehealth for community members
  Texas
  October 22, 2020 - Thanks to a grant, a local wireless internet service provider serving Pottsboro, TX, has put wireless equipment on water towers, and people in low-income households with students can check out portable Wi-Fi routers from the Pottsboro Public Library. A library network funded three neighborhood access stations for the community. The Pottsboro Public Library director even let patrons use her office for telehealth sessions. With an additional grant, the library is working on launching a telehealth program, including creating a room specifically for telehealth.
  Source: Commentary: Rural Public Libraries as Telehealth Providers During Covid-19, The Daily Yonder
• Free smartphones for mental health patients
  North Carolina
  August 7, 2020 - Partners Behavioral Health Management and Vaya Health in western North Carolina gave free smartphones with data plans to patients who weren't able to access mental health services via telehealth. A total of 1,000 patients served by the two agencies received phones. The agencies received the phones at no cost from a telecommunications company but had to pay for the data plans.
  Source: Free Phones, Masks in Parks: Rural Providers Get Creative with Mental Health Outreach Post-COVID, North Carolina Health News
• Flexing use of school-based telehealth equipment
  Indiana
  May 22, 2020 - By January 2020, Green County General Hospital, Linton, Indiana, had newly established school-based telehealth in 6 of the county's schools. With school closures secondary to COVID-19, the school-based telehealth equipment and appointment processes were flexed to meet the organization's COVID-19 surge needs. In the first several months of new demand, the organization was able to complete over 800 primary care, long-term care, and surgery telehealth visits.
  Source: My Virtual Clinic School-Based Telehealth Program
• Behavioral health support groups offered online
  North Carolina
  May 18, 2020 - Caswell Family Medical Center, with locations in Yanceyville and Eden, offers behavioral health support groups via telehealth. The four support groups are called Parents Coping with Covid, Caregiving through Covid, Hope in Healthcare (for healthcare workers), and Covid Connection (for teenagers). People who want to join a group but can't access these group video sessions can join a session by phone or schedule an individual appointment.
  Source: Glenn D. Field, Community Development Specialist, North Carolina Department of Health and Human Services
• Curbside services and telehealth
  Kansas
  April 27, 2020 - Wilson Medical Center (WMC) in Neodesha is offering curbside lab services and clinic care. Hospital patients do not need an appointment to drive up and access services from their vehicle, but patients completing lab work will need a lab order. Patients of WMC's three family medicine clinics need to make an appointment first. Patients can also make appointments for telehealth services; those who don't have the needed technology will receive a home visit from a nursing assistant who will bring an iPad.
  Source: Wilson Medical Center Implements Creative Care Alternatives to Address COVID-19, American Hospital Association case study
• Creating and expanding telehealth services, including tele-psychiatric
  Kentucky, Louisiana, Mississippi, Tennessee
  April 23, 2020 - Fast Pace Health, with 113 clinics across four states, added telehealth services by partnering with its electronic medical records vendor to create an online check-in process and implement a telehealth app (for face-to-face visits with providers). Patients can also receive tele-psychiatric visits with psychiatric nurse practitioners. Fast Pace Health implemented these services in its four-state service area and has now expanded into states without brick-and-mortar Fast Pace Health clinics.
  Source: Dana Keeton, Learning & Development Partner, Fast Pace Health
• Preparing for a surge of patients
  California
  April 23, 2020 - Marshall Medical Center (MMC) in Placerville created a surge plan in the event of inpatient capacity expansion by 50% to 100% of normal capacity. This plan, coordinated with El Dorado County Office of Emergency Services, addresses 1) facility and equipment needs, 2) medical professional support, 3) support staff such as pharmacists and respiratory therapists, and 4) COVID-19 patients and other patients. In addition, MMC developed plans addressing staff stress and burnout.
  Source: Four Stages of Planning and Implementation During COVID-19: One Rural Hospital's Preparations, American Hospital Association case study
• iPads donated to recovery centers
  Kentucky
  April 22, 2020 - The not-for-profit Fletcher Group helped arrange the donation by for-profit companies of 28 iPads to 14 Recovery Kentucky facilities (9 of which are in rural communities). The tablets allow residents in the substance use recovery facilities to communicate with their family members (since visitations are currently not allowed) and complete 12-step programming that would normally take place in person.
  Source: Richard Faylor, Communications Director, Fletcher Group
• Delivering healthcare and food to families
  Georgia
  April 19, 2020 - CarePartners, serving Emanuel and Candler counties, has mobilized a bus on loan from the Swainsboro fire department to deliver behavioral healthcare to families. With the THRIVE bus (Taking Hope, Recovery, Integrated care and Vitality Everywhere), a certified addiction counselor, a registered nurse, and a community support worker complete a basic medical and mental health screening and address any issues that come up, check patients for COVID-19 symptoms, and deliver food to families in need.
  Source: Bus Brings Behavioral Health Care to Rural Georgia Families, Albany Herald
• Hospital teams develop solutions, including community cloth mask initiative
  Wisconsin
  April 13, 2020 - Sauk Prairie Healthcare, a 36-bed hospital in Prairie du Sac, WI, created three workgroups called the Research, Innovation, Community Corps (RIC Team). The research team studies data and develops treatment plans and procedural best practices, the innovation team identifies potential equipment shortages to then prototype and develop needed equipment, and the community corps team mobilizes the public. One RIC Team project is the Social Distancing + Mask = Better campaign to engage community members in how to make cloth masks and why they are so important. The masks are for community members as well as healthcare employees who do not have direct patient contact.
  Source: Nathan D. Grunewald, Chief Innovation Officer, Sauk Prairie Healthcare
• Serving people with substance use disorders
  New Mexico
  April 13, 2020 - El Centro Family Health in Rio Arriba County is making adjustments to better serve people with substance use disorders during this pandemic. El Centro providers are able to prescribe buprenorphine over the phone, write month-long prescriptions instead of one- or two-week supplies, and have appointments over the phone instead of in person. People who need higher-level care, such as pregnant women on medication-assisted treatment, can still make in-person appointments. In addition, El Centro is offering group therapy sessions using a videoconferencing platform.
  Source: Rio Arriba Addiction Treatment, Harm Reduction Groups Adapt Amid Outbreak, Santa Fe New Mexican
• Providing information to immigrant communities
  Arizona
  April 9, 2020 - The Primary Prevention Mobile Health Unit-Tucson, which serves immigrant communities in Pima County, is calling clients to check in and is updating its Facebook page with Spanish-language posts about different local, state, and federal resources. The health unit also informs its clients that people who are undocumented can access COVID-19 testing and treatment without fear of losing the ability to gain citizenship under the public charge rule.
  Source: Public Health Workers Innovate Around Social Distancing Guidelines, High Country News
• Drive-through testing for COVID-19
  Illinois
  April 8, 2020 - The Katherine Shaw Bethea Hospital (KSB) in Dixon turned its four-bay ambulance garage into a drive-through testing location. Patients first complete a pre-screening by phone or the KSB telehealth platform; patients who are identified as potentially symptomatic then complete a drive-through test, available Monday through Friday. KSB partnered with Lee County and Whiteside County health departments to deliver test results to patients.
  Source: KSB Hospital Response for Coronavirus (COVID-19) - Katherine Shaw Bethea Hospital, Dixon, Ill., American Hospital Association case study
• Offering telehealth services through videoconferencing
  Minnesota
  April 8, 2020 - Riverwood Healthcare Center (RHCC) in Aitkin uses a videoconferencing service to complete telehealth appointments. RHCC trained provider-nurse teams in how to use the service. In addition, the center has been able to bring family members into the appointments, with the patient's permission. For example, a nursing home patient who isn't allowed to have visitors was able to have a family member join the telehealth visit.
  Source: Rapid Deployment of Telehealth Services for Rural Hospitals Fighting COVID-19, American Hospital Association case study
• Thinking beyond lab tests to diagnose patients
  Indiana
  April 8, 2020 - Margaret Mary Health (MMH), a Critical Access Hospital in Batesville, was hit with a surge of COVID-19 patients in the first half of March. Providers realized that their lab testing had a high rate of false negatives (saying people did not have COVID-19 when they actually did), so they instead relied on a physical exam, a chest X-ray or CT scan, and markers like low oxygen levels to diagnose patients. MMH also coordinated with neighboring hospitals to share staff when other employees were sick.
  Source: Rural COVID-19 Case Study: Surviving a COVID-19 Surge, American Hospital Association case study
• Moving to online and telephone-based health services
  New York
  April 1, 2020 - To adapt to offering services remotely, Cayuga Community Health Network in rural Cayuga County, New York, upgraded all its computers and adapted all its community programs so they can be offered via Zoom and Facebook Live. The network uses its website and Facebook page to provide weekly health tips and share information with community partners. One in-home program is now offered via telephone, so participants can complete health questionnaires over the phone and have health products delivered to them.
  Source: Shari Weiss, Executive Director, Cayuga Community Health Network
• Training and information provided at a distance
  Mississippi
  April 1, 2020 - To communicate with the public, Mississippi State University Extension curates resources from trusted organizations such as the World Health Organization and the Centers for Disease Control and Prevention. MSU Extension has also made resources covering various topics, such as ways to help children combat boredom and a 14-day meal plan with shelf-stable foods and ingredients that freeze well.
  Source: David R. Buys, State Health Specialist, Mississippi State University Extension