A more collaborative and holistic system could help improve health outcomes in rural Maryland, a study released by the University of Maryland’s School of Public Health and the Maryland Health Care Commission finds.
The study recommended the creation of health care coalition across five Eastern Shore counties to address both disparities in care by bringing together health organizations and social organizations.
“This is broader than health care that we are recommending, but it is also coming with a recommendation that resources are needed to perpetuate this type of coalition and work,” said Dushanka Kleinman, associate dean for research at the School of Public Health.
The study looked at health disparities and outcomes in five rural Eastern Shore counties: Caroline, Dorchester, Kent, Queen Anne’s and Talbot. It was commissioned as part of the Rural Health Delivery Workgroup, looking at health disparities in these five counties.
A major portion of the study consisted of listening sessions with community stakeholders, including residents, community leaders and health workers.
“The listening part, I think, was a really big part of our work,” said Luisa Franzini, professor and chair of the Department of Health Services Administration in the School of Public health.
Through those sessions, the researchers found that there was already collaboration in these rural counties on a personal level. Whether that meant volunteering to help drive someone to the doctor or getting someone social services.
What Franzini and Kleinman recommend is a more systematic structuring that would bring multiple organizations together focusing on improving health outcomes.
And it would be more than just health. For there to really be an improvement of health disparities in rural areas, multiple services need to get involved. The report included recommendations for improving social services, mental health services and economic development.
Bringing together “what are siloed benefits at a community level by having them interact and hopefully integrating them, one could move a lot more aggressively in prevention and health promotion early on,” Kleinman said. “These efforts are a long-term investment, not quick answers to the problems that have existed over a period of time.”
The report found significant health disparities within the five counties studied. In the five counties, for every 1,000 residents there were an average of 495.77 emergency room visits. The statewide rate was 376.62.
The five counties also tended to have higher incidences of diabetes, heart disease and preventable hospital stays.
Some of these, including the emergency room visits, are likely to be caused by a lack of access to care and a lack of health literacy, the report found. Residents of poor and rural areas find it more difficult to get appointments during working hours or transportation to appointments.
Franzini and Kleinman found cases where patients used emergency medical services as transportation to appointments. In many cases, patients go to the emergency room when they could visit urgent care instead.
For many of these disparities, the study recommended improvements in health literacy and the health workforce. Other improvements could include more telehealth services.
The coalition will recommend further actions. It could initiate demonstration projects, and the collaboration would determine where resources should be directed.
The hope is that the model could also be exported to other rural areas of the state, like western or southern Maryland.
“(The recommendations) are more of a template on how to work together towards a solution,” Franzini said. “The work has to be done. This is just how the work could be done. … There is not magic wand to get this.”