Zsolt J. Nagykaldi
Research published in the Journal of the American Board of Family Medicine indicated that a county-level patient outreach pilot program that utilized a wellness coordinator improved the uptake of preventive services in rural areas and produced a return on investment for participating primary care practices and the county hospital.
“Very limited information is available about the feasibility and sustainability of county-level wellness programs in rural settings,” Zsolt J. Nagykaldi, PhD, associate professor and director of research at the University of Oklahoma Health Sciences Center and department of family and preventive medicine, told Healio Family Medicine. “Most similar studies that show some improvement in community health outcomes may not address the sustainability of the program, and as a result, the intervention is not maintained beyond project funding.”
The researchers implemented and evaluated a program where a wellness coordinator worked with primary care practices, a health information exchange organization and the county health department and hospital to assist residents in a rural county of Oklahoma. Residents were offered preventive services such as bone density screening, mammography, colonoscopy, well child visit, diabetes management, pneumococcal vaccination and smoking-cessation counseling.
An electronic community health registry which was developed by the investigators created alerts for patient-level preventive care gaps, tracked outreach efforts and recorded preventive services delivery. The wellness coordinator used the registry to call patients based on PCP-established priorities and tailored protocols. Researchers also estimated the return on investment for prioritized preventive services.
Overall, three primary care practices fully implemented the 1-year program beginning in mid-2015.
The results of the study indicated that the wellness coordinator made 5,034 outreach calls in the program’s inaugural year and 7,776 prioritized recommendations were offered to county residents when gaps in care were observed.
Researchers also found that 3,888 patients (78%) who received a call were due for at least one of the selected services. In addition, the participating health care organizations significantly improved their delivery of selected preventive services (mean increase across 10 services, 35%; range, 3-215; P = .004) and saw a mean return on investment of 80% for these services (range, 32-122). The health system where the wellness coordinator worked earned an estimated $52,000 in revenue and obtained a 40% return on investment.
Nagykaldi said that the findings suggest that a multifaceted, community-based approach to health care would help the well-being of rural population.
“Primary care practices, especially those that care for underserved populations, need to find ways to collaborate more closely with other health stakeholders in their environment to address community-level health problems, especially in the areas of preventive and behavioral health,” he said.
“Patients are key partners in the quest for addressing pressing community health gaps and they need to be at the table where innovative community programs are developed and continually improved. Primary care practices are already allied and engaged with patients in their communities, but they could do more to involve them further,” Nagykaldi added. – by Janel Miller
Nagykaldi reports the study was funded by an Agency for Healthcare Research and Quality grant. The other authors report no relevant financial disclosures.