由L.J. Fagnan, MD, founding director of the 俄勒冈州 Rural Practice-based lol竞猜app Network
卫生公平有许多方面. 我的经验是在农村实践, 它们在地理上是孤立的, 五分之一的美国人生活在资源匮乏的地区. People who live in rural areas are more likely to report poor access to primary care and experience a lower quality of care, 即使他们有更高的肥胖率, 高血压, 和烟草的使用情况.
我一生中大部分时间都在农村生活和工作. 我的组织, 俄勒冈农村实践lol竞猜app网络(ORPRN), seeks to reduce rural health disparities by lol竞猜apping and improving the quality of community-based primary care. 克里斯汀狄龙, a rural family physician and former ORPRN chair summarized why building quality improvement (QI) capacity is an ORPRN priority. “Our communities depend on us for a huge portion of their health care,” she said. “很多俄勒冈农村居民需要照顾, and we can’t serve them if we keep doing things in the same way.”
Cardiovascular health is a major issue for rural practices. One of ORPRN's most important recent collaborations was with lol竞猜app推荐健康lol竞猜app所 (KPWHRI) on Healthy Hearts Northwest (H2N). This project, funded by the Agency for Healthcare Quality and lol竞猜app and co-led by me and 迈克尔Parchman 在KPWHRI, is focused on building QI capacity into primary care practices so they can better help their patients reduce their cardiovascular disease risk with support from a practice facilitator.
ORPRN has found practice facilitation can be an effective way to help primary care practices improve care quality. 在这种方法中, trained facilitators build relationships with rural practices through in-person and virtual visits. 他们支持一个QI项目的所有方面, 从计划到测量对病人健康的影响, 专注于对每个实践有效的方法.
我们最近出版的 lol竞猜app using data from H2N — which includes more than 200 practices in Washington, 俄勒冈州, and Idaho — looked at how practices responded to the support offered by a practice facilitator by location (rural or urban) and ownership (health care organization or independent individual or small group). 我们发现, independently owned practices were most likely to accept our offer of support from a practice facilitator. 这些做法不仅更愿意报名, but their level of engagement was also higher than other primary care clinics working with facilitators. 除了, improvements in blood pressure control and support for smoking cessation were significantly greater for rural independent practices than other primary care clinics. 换句话说, 位置很重要.
Practice facilitators may be particularly suited for independent rural practices because they:
全国都在谈论基础设施, I propose that we consider practice facilitators as essential infrastructure for rural primary health care. They are as critical to supporting rural communities as broadband internet access.
A mechanism for funding practice facilitators is in the Affordable Care Act, 在初级保健推广计划中. Advancing this program would fund practice facilitators as welcome, effective allies for rural practices in building QI capacity and creating competencies essential to addressing rural health inequities and the survival of primary care practices in the communities they serve.
Healthy Hearts Northwest is helping patients receive better care for cardiovascular conditions thanks to collaborators like Dr. L.J. Fagnan.
How LHS Program practice facilitators work with KP Washington care teams to improve care.
A new lol竞猜app shows how a little supplemental support can result in big gains, 尤其是在控制病人的血压方面.