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Browse best practices by state:

Alabama

Providing Quality Health Care to the Working Poor
A partnership between the University of North Alabama College of Nursing and the Florence Housing Authority is providing quality health care to the working poor in five northwestern Alabama counties. Students and faculty at the nursing college conducted a door-to-door survey in Florence public housing districts in 1996, which found that many uninsured or underinsured residents needed accessible and affordable quality health care. Close to 60 percent of residents in the overwhelmingly minority areas have incomes below the national poverty level.

The college, the housing authority, and other community groups founded the nonprofit Northwest Alabama Community Health Association to establish a nurse-managed clinic. The Florence Housing Authority provides space for the facility, which opened in 1997. The clinic offers primary health care services, as well as health education in schools, churches, shelters, and recreation centers. Additional support, including a grant from the Appalachian Regional Commission, has allowed the clinic to expand its operating hours, add an additional 900 square feet to its facility, and offer dental services.

Kentucky

Training Health Care Providers for Appalachia
While Appalachia has made substantial progress in health care in recent decades, a chronic shortage of medical professionals still exists in many rural areas. To increase the number of locally trained physicians and improve health care in Central Appalachia, the Appalachian Regional Commission has provided major support for the Pikeville College School of Osteopathic Medicine, a new medical training facility in eastern Kentucky. The Commission has helped renovate and expand school facilities and purchase additional equipment. The school, which opened in the fall of 1997, saw its first class of 53 students graduate in May 2001. Many of the new graduates expect to practice in Appalachia.

Mississippi

Improving Health Care through Rural Community Clinics
In 1978, the only health care in Hickory Flat, a small town in Benton County, was provided by a public health nurse one day each month in one room of a dilapidated clinic building. A community committee, established that year with support from the Appalachian Regional Commission, soon organized as the Hickory Flat Clinic Association to rehabilitate, properly equip, and operate the old clinic. A full-time nurse practitioner was hired, and the renovated clinic reopened in 1979.

Over the years, the clinic has become a mainstay of health care and an access point into the health care system for many patients who would otherwise avoid seeking care until serious health problems arose. An infant mortality project includes classroom education by a clinic nurse practitioner, who also serves as a health teacher at the Hickory Flat School. The Hickory Flat Clinic averages 3,500 patient visits each year and also provides home health visits and periodic community health screenings. It is a model for other community clinics and has provided clinic experience and training for over 40 new nurse practitioners.

New York

Using Technology to Expand Health Care
In southeastern New York, home health care can be costly for those with limited mobility due to chronic or terminal illnesses. Community-based nurses cannot provide the optimal number of home visits because of heavy caseloads, strained resources, and long distances. With the help of a grant from the Appalachian Regional Commission, Delaware, Otsego, and Schoharie Counties are working to remedy the problem. Using televisions and telephones, homebound patients and their nurses will soon be able to conduct telehome visits, allowing health care professionals to monitor a patient's condition via a video system. These video visits require only a fraction of the time and money needed for at-home monitoring, allowing nurses to consult with a greater number of patients over the system.

The grant provides funds to train more than 70 health care professionals at four clinics and three hospital emergency rooms for this service, which continues to benefit over 100 chronically ill patients with diverse needs. This is of value not only to community health nurses but also to nurse practitioners and physician's assistants working in primary care.

North Carolina

Creating a Model for Community Health Care
Providing health care through a community corporation was a new idea in the early 1970s, as was using nurse practitioners and physician's assistants as primary clinic staff. Launched by two nurses in 1971, Madison County's Hot Springs Health Program proved a trailblazer and model for health care in many other communities. A five-year grant from the Appalachian Regional Commission in 1972 helped finance the program, which was originally housed in a small, formerly abandoned physician's office. It now includes multiple medical and dental clinics and a staff of over 120, including more than 12 physicians and three nurse practitioners. It is the sole provider of primary care in the county and a principal area employer.

Hot Springs has gradually evolved: in 1986, the board of directors decided the program should become self-supporting. Today it remains a community-based organization providing the first line of care to residents who once had no community health services. In early 2002, the program opened the Mashburn Medical Center, an expanded health care center with space for five providers as well as administrative offices for the medical, home care, and hospice services.

Sharing Health Information to Improve Care
In northwestern North Carolina, emergency medical service (EMS) providers were frequently unable to make informed decisions concerning a patient's prehospital care because regional health programs did not share medical records. This lack of data led to more expensive, less efficient patient care throughout the state's Appalachian counties.

Through a grant from the Appalachian Regional Commission, local health officials developed a new telehealth database that allows 17 different medical facilities to distribute data concerning patients' medical care throughout a five-county area, coordinating health programs, saving costs, and improving the delivery of services. Patient information is delivered via the Internet and maintained in a private network database, which EMS providers can access through computers installed in their response vehicles. Additionally, health care facilities are now able to get full file information on patients as soon as they are admitted.

Improving Dental Health Among Young Children
The chances of tooth decay have declined dramatically among 1,800 Appalachian youngsters in North Carolina as a result of an innovative program called Smart Smiles. The Appalachian Regional Commission supported a project that has recruited and trained pediatricians and their nurses, among other health professionals, to treat the teeth of preschool children with fluoride during regular health checkups. Many young children in Appalachia suffer from severe tooth decay because their drinking water comes from wells not treated with fluoride. With a severe shortage of dentists in many rural Appalachian counties, health officials have turned to local pediatricians to offer the new fluoride treatment as part of a child's regular checkup routine.

Ohio

Improving Training in Health Care
Discouraged by the small number of students enrolling in medical and dental training programs at the Scioto County Joint Vocational School in Appalachian Ohio, area health care advisors recommended that the school emphasize health care training and upgrade its equipment to meet training needs. The Appalachian Regional Commission has helped the school purchase new equipment including an X-ray machine, dental chairs, treatment consoles, and dental lab stations. As a result, 200 11th- and 12th-grade students and 400 adult students are benefiting annually, enrolling in a variety of courses focusing on nursing, administrative health care, dentistry, and home health care.

Providing Access to Dental Care for Low-Income Residents
With assistance from the Appalachian Regional Commission, the Southeastern Ohio Dental Clinic in Washington County was created as a full-service clinic providing corrective and preventive dental services to low-income residents who have no other access to dental care. Serving residents of Athens, Monroe, Morgan, Noble, and Washington Counties, the clinic employs a dentist, a dental hygienist, and a dental assistant and handles more than 4,900 patient visits a year. The program has strong community support, with ARC funding matched 2-to-1 by local and state funding.

Tennessee

Meeting a Critical Dental Health Need
In the 1996–97 school year, an oral health assessment of schoolchildren in Cocke County found tooth-decay rates 67 percent higher than the state average. Almost 30 percent of the children needed restorative or surgical treatment. These needs were not surprising given the county's poor education and poverty levels, indicators that frequently correlate with poor dental health. Clinical dental services at the Cocke County Health Department were first launched in 1991; a second dentist was added in 1997. To underscore the importance of maintaining two dentists, county officials note that the two are the only dental providers in the county for TennCare, the state-managed care program in which close to 40 percent of all county residents are enrolled. With support from the Appalachian Regional Commission, the Cocke County dental program provides education and preventive treatment and serves an average of 60 patients each month. County officials plan to expand building space for the dental facilities and offer services on a full-time basis.

West Virginia

Managing Chronic Disease in Appalachia
Building on efforts to combat diabetes, the Chronic Disease Management Program created an effective, integrated approach to managing this and other related chronic diseases in four distressed counties. The program focused on community-based management, with prescribed and supervised exercise, individualized meal planning by a dietician, weekly support groups coordinated by professional and lay educators, periodic cooking schools, and service coordination by registered nurses. Ebenezer Medical Outreach, in association with Marshall University, established this program to focus on health problems prevalent in the African-American community. Community consultation was conducted through the Black Pastors' Association and a community diabetes forum, and partnerships were created between rural health centers and community-based groups.

With approximately 20 client support groups in each county and approximately 1,300 clients assisted monthly, this program produced significant improved the health of its clients. The program was so successful that a "how-to" manual for other centers replicating the model has been prepared with support from the Appalachian Regional Commission.

Improving Health through Targeted Programs
With support from the Appalachian Regional Commission, state and local health officials launched a coordinated effort to improve health care in McDowell County, one of the poorest counties in West Virginia. The project is composed of four health care initiatives: a free pharmaceutical program for uninsured and low-income residents; a folic-acid education pilot program for women of childbearing age; a children's health outreach program; and an emergency medical services communications enhancement program.

The four initiatives have proven successful as individual components of a holistic, multifaceted approach designed to address the unique health needs of the people of McDowell County and the surrounding areas. The pharmaceutical program has provided free medicine to hundreds of county residents; the folic-acid education pilot program has distributed thousands of bottles of multivitamins with folic acid to women of childbearing age; and the children's health outreach program has enrolled hundreds of county children. Additionally, the county has improved emergency medical services by creating new communications links between previously isolated areas and a regional medical command hospital.

State officials view the health initiative as part of a larger, comprehensive capacity-building plan designed to provide long-term solutions and build strategic partnerships that will address the county's economic and human development needs. Together the initiatives are expected to reach as many as 12,000 county residents.

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