How 3 Rural Safety Net Clinics Integrate Care for Patients

Abstract

Background Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients’ needs. Currently, little is known about care integration for rural patients. Objective To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Research Design Qualitative case study. Participants Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Methods Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Results Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Conclusions Care integration was supported by 2 fundamental changes to organize and deliver care to patients—(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.

Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process

“…; Derrett et al. ). In addition, the results are based upon a conceptual model rooted in the wider literature, as well as an accumulated series of thematic, cross‐case, and QCA analyses.…”

“…The demonstration also consisted only of FQHC sites, which may similarly constrain the generalizability of results. However, the number of sampled sites and our use of a stratified random sampling procedure provides a more generalizable sample compared to previous case-based analyses (Bitton et al 2012;Derrett et al 2014). In addition, the results are based upon a conceptual model rooted in the wider literature, as well as an accumulated series of thematic, cross-case, and QCA analyses.…”

Assessment of the relationship between rural location and performance of Patient-Centered Medical Home processes among veterans health administration primary care clinics

“…21 Geographic distance compounds difficulties accessing specialty care for many rural residents. 24 Issues with access are likely to contribute to "lower rural utilization of preventive health care services and higher rural rates of potentially avoidable hospitalization for conditions where timely and appropriate ambulatory care can reduce the frequency of hospital admission." 22 All of these factors create challenges for clinics working to provide access to coordinated, comprehensive services tailored to meet the needs of individual patients.…”

“…6 A multiple-case study of three rural clinics participating in the Safety Net Medical Home Initiative (a four year intervention supported by The Commonwealth Fund to implement and evaluate the PCMH in 65 safety net clinics in five states) examined the challenges to care integration in rural safety net clinics and strategies to address these challenges. 24 The three rural clinics, located in Colorado and Oregon, included two rural health centers with system affiliations and one federally qualified community health center.…”

“…Among the clinics studied, challenges with limited access to specialty services for Medicaid and uninsured patients, difficulty communicating with external providers, and limited support for care integration activities among payment models were reported. 24 Researchers found that geographic isolation and provider scarcity seemed to compound these challenges. Findings from this study point to two fundamental changes that can facilitate care integration, including empanelment with a designated group of patients being cared for by a provider, and using a multidisciplinary team able to address rural issues.…”