It is historically difficult to manage, engage and increase self-support for complex care patients challenged by 1) multiple co-morbidities, exacerbated by SDOH; 2) rural environments, lacking infrastructure to accommodate and fill in gaps across the continuum of care; 3) provider shortages, notably behavioral health supports for psycho-social complexity; 4) low incomes; and 5) low health literacy. This patient/caregiver population often come from disadvantaged backgrounds and equate to high-need, high-cost patients that frequently utilize expensive acute care services, often in place of primary care, delaying an enhanced and/or optimized patient outcome. To address the needs of these complex care patients, health systems, communities, and value-based payment models have attempted and implemented patient-centered medical homes and integrated behavioral health and care navigation/coordination, including community health worker-led efforts to better stabilize patients and reduce fragmentation of supportive services. While these models have seen some success, they are rarely informed by patients who encounter actual lived barriers in rural America.
Unfortunately, due to the same barriers that often inhibit optimal care access, high-need, high-cost patients with complex medical and/or psychosocial needs have been particularly difficult to engage in patient-centered outcomes research (PCOR) and/or comparative effectiveness research (CER) on rural and frontier population care model effectiveness, providing little available evidence that incorporates the priorities and perceptions of patients and their caregivers.
To advance a thin evidence base, increasing patient, provider, policymaker, and payor knowledge about this vulnerable population, Logan Health, formerly Kalispell Regional Medical Center (KRMC) and the Flathead County community, located in northwest Montana, embarked on a research support project building preliminary capacity to conduct PCOR by engaging high-need, high-cost patients and their caregivers (B), providers/clinicians (A), and community health workers (C) in qualitative research methods to better understand attitudes and key barriers to patient-centered CER in a rural setting, gaining understanding of engagement priorities and learning how to best engage the population in the advancement of rural/frontier care model effectiveness.
In September 2019, Logan Health was awarded a Eugene Washington PCORI Engagement Award to “Build Capacity to Break Down Barriers to Complex Care Navigation in Rural America,” resulting in a 5-year roadmap, poster board, and fact sheet. The project was recently completed October 31, 2021.