Community Health Center of Southeast Kansas in Pittsburg, Kansas, is a federally qualified health center and a not-for-profit corporation.

CHC/SEK provides medical, dental, behavioral health, addiction treatment, case management services and pharmacies to all, regardless of the ability to pay, and serves about 65,000 patients for 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's County Health Rankings, Southeast Kansas and Northeast Oklahoma have some of the worst health outcomes and health factors in their respective states.

Every county that CHC/SEK serves is in the bottom quartile for both major categories, and they are all rural (and in one case designated as "frontier") and classified as federal Health Professional Shortage Areas, or HPSAs.

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

"Based on our internal survey data, as many as 15%-20% of our over 65,000 patients have inconsistent access to reliable transportation to get to and from their appointments," she continued. "Therefore, in an area with high rates of chronic disease, many patients may not be able to travel to the clinic for a weekly blood pressure check with the nurse, even though these are free and quick appointments."

Many lack the resources to purchase a needed blood pressure device for at-home use, she added.

"The COVID-19 pandemic amplified the health issues faced by our patient population, but CHC/SEK quickly adapted to the changing environment," Gagnon recalled. "We worked with our EHR vendor, eClinicalWorks, to implement integrated telehealth solutions within a few days.

"Since then, we have provided more than 28,000 alternative or telehealth visits to continue patients' access to care from their home," she 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 large disparity in which patients can access alternative visits, and as our population grows older, more patients are unable to leave their homes."

This led CHC/SEK to create a Community Health Action Team (CHAT), which is dedicated to patient outreach, home visiting and, more recently, setting up patients' homes for telehealth services.

"With a recent grant, CHC/SEK received remote monitoring devices, such as blood pressure cuffs, scales and glucometers, to aid in telehealth appointments and care management programs," Gagnon said. "These medical devices, while valuable on their own, can be better utilized if we can ensure the patient receiving the device has access to some type of internet service and has access to download related apps for a smart device, such as an iPad.

"This allows for remote patient monitoring, access to telehealth appointments with their provider, and easier access to view their medical information and schedule appointments online," she continued. "These services are only made possible with access to the internet 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 then led the provider organization to engage vendor CareSimple, which offers 4G-capable blood pressure cuffs and scales as well as software monitored by CHC/SEK's remote patient monitoring nurse.

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

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MEETING THE CHALLENGE

"The most exciting part of CareSimple for us was the 4G-connected devices and realizing that the 4G coverage was sufficient for our part of the world," Gagnon said. "Having the blood pressure readings connect right to the software, without additional action on a smart device from a patient, was a huge win for everybody.

"The FCC telehealth grant we received helped us purchase these devices and give them to our patients, who would otherwise go without them," she added.

From a clinical perspective, the software was customizable to set alerts based on values. This allows the RPM nurse to set the criteria in which she wants to be notified and allows her to monitor a larger pool of patients. The software also allows her to quickly see trends for the patient over time, and she can then work with the patient's primary care team to make treatment plan adjustments.

RESULTS

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

"In the meantime, we have connected more than 3,000 patients with a device who would otherwise not have access to one, and nearly 100 patients are enrolled in the CareSimple software," she added.

One anecdotal example is a patient story from nurse Heather Mooneyham.

"My patient was diagnosed with likely terminal cancer," she reported. "I am currently co-treating with an oncology/radiation and a University of Kansas Hospital specialist. The patient is very timid and will not ask for anything despite needs.

"And while it is common to have weight loss during treatment, the weight loss was negatively affecting strength and endurance," she continued. "We set him up with Karen Bennett, RPM nurse, to monitor weight more closely.

"Through their relationship, he shared he was seldom able to find the food and protein drinks he likes," she concluded. "He gained 6 pounds in nearly one month. I would not have been able to be successful at this through only office visits."

USING FCC AWARD FUNDS

Community Health Center of Southeast Kansas was awarded $366,167 from the FCC telehealth grant program to provide household internet service for 12 months and a tablet to qualifying households.

This was to complement a previous, much larger grant that allowed the organization to purchase thousands of Bluetooth-enabled devices (namely blood pressure cuffs and scales) and a limited number of devices from CareSimple. The CareSimple devices come with 4G and their related software.

The organization purchased more than 4,000 blood pressure cuffs, 3,000 scales, 600 glucometers and 500 tablets. More than 400 of the devices were CareSimple devices.

"We know several of our patients, especially in the most 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 higher risk of missing opportunities for care.

"We dedicated these funds toward connecting disconnected households with internet access through CrawKan and covering monthly payments for a year," she continued. "Our patient engagement team reached out to patients who had missed multiple annual wellness and behavioral health visits. We also sought out current CrawKan families that might be deciding which bills get paid and which ones don't to cover up to $50 a month toward their bill for the next year."

One community member shared with CHC/SEK that her father was recently diagnosed with cancer and his 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 internet access before this program and was excited to not only complete a share of his appointments online but also order his groceries from home," Gagnon reported. "We were able to establish a total of 180 households in the CrawKan with better connectivity.

"The devices have expanded our telemedicine program by creating an RPM program and expanding access to telehealth visits like Medicare Annual Wellness Visits," she concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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