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Home HEALTH A rural Kansas FQHC brings remote patient monitoring to the underserved

A rural Kansas FQHC brings remote patient monitoring to the underserved

Southeast Kansas Community Health Center in Pittsburg, Kansas, is a federally qualified health center and nonprofit corporation.

CHC/SEK provides medical, dental, behavioral health, addiction treatment, case management and pharmacy services to all, regardless of ability to pay, serving around 65,000 patients with more than 220,000 visits per year, making the organization the largest FQHC in Kansas. and one of the largest of all rural FQHCs in the United States.

THE PROBLEM

CHC/SEK has clinics in Allen, Linn, Bourbon, Crawford, Cherokee, Labette and Montgomery counties in Kansas and in Ottawa county in Oklahoma. Consistently, according to the Robert Wood Johnson Foundation County Health Rankings, southeastern Kansas and northeastern Oklahoma have some of the worst health outcomes and factors in their respective states.

All counties served by CHC/SEK are in the bottom quartile of the top two categories, and all are rural (and in one case designated “border”) and classified as federal health professional shortage areas , or HPSA.

“CHC/SEK serves an underserved rural area in southeastern Kansas and northeastern Oklahoma,” said Leah Gagnon, director of patient engagement at the Community Health Center of Southeast Kansas. “Many of our community members lack home internet and smart devices, and face economic barriers to transportation or the ability to purchase a device such as a blood pressure cuff.

“According to our internal survey data, between 15% and 20% of our more than 65,000 patients have inconsistent access to reliable transportation to and from their appointments,” he continued. “Therefore, in an area with high rates of chronic disease, many patients may not be able to travel to the clinic for weekly blood pressure checks with the nurse, even though these appointments are free and prompt.”

Many lack the resources to purchase a necessary blood pressure device for home use, he added.

“The COVID-19 pandemic amplified the health challenges facing our patient population, but HCC/SEK quickly adapted to the changing environment,” Gagnon recalled. “We worked with our EHR provider, eClinicalWorks, to implement integrated telehealth solutions in just a few days.

“Since then, we have provided more than 28,000 alternative or telehealth visits to continue patients’ access to care from home,” he continued. “With these new services, we have learned more about the huge technological and digital access barriers that many of our rural patients face. There is a wide disparity in which patients can access alternative visits, and as our population ages, more patients cannot leave their homes.

This led CHC/SEK to create a Community Health Action Team (CHAT), which is dedicated to outreach to patients, home visits and, more recently, the installation of telehealth services in patients’ homes.

“With a recent grant, CHC/SEK received remote monitoring devices, such as sphygmomanometers, scales and glucose meters, to assist in telehealth appointments and care management programs,” said Gagnon. “These medical devices, while valuable in their own right, can be better utilized if we can ensure that the patient receiving the device has access to some form of Internet service and access to download related applications for a smart device, such as an IPAD.

“This allows for remote monitoring of patients, access to telehealth appointments with your provider, and easier access to view your medical information and schedule appointments online,” he continued. “These services are only possible with internet access and iPads and would have a dramatic impact on access to care for our most vulnerable patient populations, particularly those living in social isolation.”

All of this led the provider organization to contract with provider CareSimple, which offers 4G-enabled blood pressure cuffs and scales, as well as CHC/SEK remote patient monitoring nurse-monitored software.

Physicians can refer their patients to CHAT, which helps them set up their device at home. The RPM nurse then works with the patient over the phone, monitoring their readings and coordinating with clinical care teams.

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MEET THE CHALLENGE

“The most exciting part of CareSimple for us was the 4G connected devices and realizing that 4G coverage was sufficient for our part of the world,” said Gagnon. “Having blood pressure readings connected directly to the software, without any additional action on a smart device by a patient, was a huge win for everyone.

“The FCC telehealth grant we received helped us buy these devices and get them to our patients who might not otherwise have them,” he added.

From a clinical perspective, the software could be customized to set value-based alerts. This allows the RPM nurse to set the criteria on which she wants to be notified and allows her to monitor a larger group of patients. The software also allows you to quickly see patient trends over time, and you can then work with the patient’s primary care team to make adjustments to the treatment plan.

RESULTS

“We are still in the early stages of our RPM journey, but we look forward to more robust data on the impact connected devices have on health outcomes,” Gagnon said. “Certainly, we will prevent significant health care events for these connected patients because they have a device and know that their trusted RPM nurse is monitoring their values.

“In the meantime, we’ve connected more than 3,000 patients to a device who might not otherwise have access to one, and nearly 100 patients are enrolled in CareSimple software,” he added.

An anecdotal example is the story of a patient of nurse Heather Mooneyham.

“My patient was diagnosed with probable terminal cancer,” he reported. “I am currently contracting with a radiation oncologist and specialist at the University of Kansas Hospital. The patient is very shy and does not ask for anything despite his needs.

“And while weight loss during treatment is common, weight loss negatively affected strength and endurance,” he continued. “We placed him with Karen Bennett, a nurse at RPM, to monitor his weight more closely.

“Throughout their relationship, he shared that he could rarely find the food and protein drinks he liked,” she concluded. “She gained 6 pounds in almost a month. She couldn’t have been successful at this with office visits alone.”

USE OF FCC AWARD FUNDS

The Southeast Kansas Community Health Center received $366,167 from the FCC’s telehealth grant program to provide in-home Internet service for 12 months and a tablet to qualifying households.

This was to supplement a much larger earlier grant that enabled the organization to purchase thousands of Bluetooth-enabled devices (ie, blood pressure bracelets and scales) and a limited number of devices from CareSimple. CareSimple devices come with 4G and related software.

The organization purchased more than 4,000 blood pressure monitors, 3,000 scales, 600 glucose meters and 500 pills. More than 400 of the devices were CareSimple devices.

“We know that many of our patients, especially in more rural settings, are often homebound and socially isolated, making it even more difficult to access the care and resources they need to thrive,” Gagnon explained. “Of course, the pandemic only placed these populations at greater risk of missing out on care opportunities.

“We dedicate these funds to connect unconnected homes with Internet access through CrawKan and cover monthly payments for a year,” he continued. “Our patient engagement team reached out to patients who had missed multiple annual wellness and behavioral health visits. We also reached out to current CrawKan families who might be deciding which bills get paid and which don’t get paid up to $50 a month for your bill for next year.

A community member shared with CHC/SEK that his father was recently diagnosed with cancer and the number of specialty providers and frequency of appointments tripled. She moved into his home in a rural Crawford County town to better support his care needs.

“He had never had access to the internet prior to this show and was excited to not only complete a portion of his dating online, but also do his shopping from home,” Gagnon wrote. “We were able to establish a total of 180 households in CrawKan with better connectivity.

“The devices have expanded our telemedicine program by creating an RPM program and expanding access to telehealth visits like annual Medicare wellness visits,” he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is published by HIMSS Media.


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