New Delivery Model for Rural Care Proposed

John Commins, August 10, 2017

Emergency physicians call for partnerships between emergency medicine and primary care to reverse the trend of failing health in underserved parts of the country.

The ongoing and well-publicized struggles of small, isolated hospitals to keep the lights on and the doors open has prompted calls for significant reforms for care delivery in rural America.

The latest proposal comes from a group of emergency physicians in Michigan, who have called for better coordination of care between emergency and primary care clinicians.

“The traditional urban model of healthcare has been ineffective at improving rural health," said Margaret Greenwood-Ericksen, MD, MPH of the Department of Emergency Medicine at the University of Michigan in Ann Arbor, lead author of a paper published online this week in Annals of Emergency Medicine. 

"Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community,” Greenwood-Ericksen said. “Rural hospitals can serve as a hub for emergency care, primary and preventive care, and social services for improving rural population health."

The model proposed by Greenwood-Ericksen would supplement – not supplant -- the existing outpatient rural safety net, comprised of federally qualified health centers and rural health clinics.

The paper cites Carolinas HealthCare System Anson in Wadesboro, NC as an example of a new rural hospital designed to provide both emergency and primary care, calling it "a test of a new model of rural healthcare delivery." The final design has no physical walls separating emergency and primary care.

Similar partnerships in other communities could optimize emergency care, meet unscheduled acute care needs, address rural social determinants of health across the care continuum, achieve financial solvency and support public health, Greenwood-Ericksen said.

"There is an urgent need for a rural-specific model of care aimed at improving the sharply declining health of rural Americans," she said. "The partnership we propose is novel yet practical and acknowledges that an emergency department might be the closest source of health care for rural patients. Emergency medicine-primary care partnerships can address rural populations' most pressing social and medical needs."

John Commins

John Commins is a senior editor at HealthLeaders Media.

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