The University of Maryland School of Nursing

Serving the Needs of Western Maryland: Access to Care Challenges to, Resources for, and Threats Facing the Health of Populations in Rural Areas APHA Annual Meeting 2001 Sheila Green, MS, RN Manager, Wellmobile Services

Western Maryland Total of 234,991 people (4.5 percent of the state of Maryland population) square miles (covers 13% of the state) Mountainous terrain, part of the Piedmont Plateau Province and the Appalachian Chain. Harsh winters that last October through March.

Western Maryland Socially and economically depressed region of the state of Maryland. Average household income is $31,845 compared to the statewide average of $50,040. Per capita income is $12,007 compared to the statewide average of $18,353. Percentage of uninsured residents is 16.5% compared to the statewide average of 13.5%. Percentage of persons receiving medical assistance is 11.3% compared to the statewide average of 9.4%.

Health Issues of Western Maryland Leading cause of death includes: –Heart disease, cancer, stroke and diabetes 20 percent of children are not adequately immunized by two years of age. Teen pregnancy and low birth rates are higher than the state averages. 18 percent of the population are age 65+. Access to care issues include: –Lack of public transportation –Inadequate health education –Absence of health centers

Confounding Factors Confounding Factors Portions of Washington and Allegany counties are Primary Care Health Professional Shortage Areas as well as Medically Underserved Areas. Allegany County is designated as a Dental Health Professional Shortage Area. Western MD suffers from a greater shortage of professional nurses than the remainder of the state.

Available Services Available Services Health care is centered in two cities: –Hagerstown in Washington County Washington County Health System –Cumberland in Allegany County Western Maryland Health System Limited outpatient clinical services and support. Two FQHC provide services in the tri- state region of MD, VA, and PA.

An Attempt to Reduce Disparity An Attempt to Reduce Disparity Use of a mobile health care outreach program to provide “curb-to-curb service and promote health care to the rural population. Built upon the commitment and resources of community healthcare providers and partners. Linked to community resources for “wrap around services”.

University of Maryland’s Governor’s Wellmobile Program To provide primary health services to the underinsured and uninsured populations in Western Maryland. To work with the local health departments, community organizations, and hospitals to improve the health status of residents of Western Maryland. To provide health education and promotion to diverse populations.

History of the Governor’s Wellmobile Delegate Marilyn Goldwater Began in 1994 as a private/public partnership with funding from the State of Maryland, Merck, Kaiser Permanente, Prudential, MAMSI, Giant Food and others. Managed by the University of Maryland Serves as one of the principle training sites for the School of Nursing.

Current Statistics Operating in two regions: Eastern Shore and Central MD. In 2000, 639 patient visits at 11 sites throughout the state. –Primary Diagnosis: Hypertension and Well Child Checks In 2001 to date, 886 patient visits at 15 sites throughout the state. –Primary Diagnoses: Hypertension and Health Assessments Western Maryland will open this November as the third region in the state of Maryland.

Services of the Governor’s Wellmobile Physical Examinations Immunizations Well-child Care Vision and Hearing Screenings Early Detection for Cancer Health Education Lab testing and Diagnosis Community Assessment

Program Model: Governor’s Wellmobile Mobile treatment unit to deliver primary and preventive health services to underserved communities. Staffed by: –Full time faculty FNP –Full time nurse care coordinator –Full time driver/office assistant Travel to local community sites to deliver services.

Strategic Partnership Program Model Mission compatibility in care to the underserved – FQHC preferable partner. Mutual desire to serve hard-to-reach sites. Utilize Wellmobile as an extension of partner provider system to reach strategic locations and populations. Wellmobile becomes “modified satellite primary care center” of partner system. Partner system provides back up medical, specialty and ancillary support services.

Partnership Roles Wellmobile –Provide and fund all on-site primary health care services. –Manage, operate and staff Wellmobile services. –Identify patients eligible for MCHIP or other insurance programs and enroll as appropriate with partner provider system. –Complete encounter forms and other registration/data collection information as mutually identified between SON and partner.

Partnership Roles Western Maryland Health Systems –Develop physician collaborative agreement with Wellmobile FNP. –Accept referrals for follow-up medical and specialty services. –Accept new patients inappropriate for Wellmobile services. –Assist in providing referrals for patients needing additional diagnostic and laboratory services. –24 hour medical back-up.

Established Services Three days a week in Washington County Provider sites include: –Fire Station –Senior Care Center –Local community church Relationships with established community groups to assist in marketing and referrals to the Wellmobile: –Health Right –Mountain Side Coalition

Partnership Opportunities Provide greater comprehensiveness and continuity of care for uninsured patients served by Wellmobile in designated communities. Increase enrollment of MCHIP and other new insured patients to local health systems. Expand primary care services through Wellmobile to additional sites that currently can not support a full time medical practice. Collaborate on development of fourth Wellmobile for Southern Maryland.

Future Plans of the Governor’s Wellmobile Expand services to a total of five mobile clinics throughout the state of Maryland. Development of partnerships throughout the state to collaborate, coordinate, and expand services. Enhance current data collection system necessary for patient tracking and outcomes management.