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Rural Health
Resources by Topic: Care coordination

Leveraging Electronic Health Record EHR-Sourced Measures to Improve Care Communication and Coordination: Final Recommendations Report
Discusses recommendations developed by a multistakeholder committee for using electronic health record (EHR) data to improve the measurement of care communication and care coordination. Identifies challenges to collecting data in rural areas.
Date: 09/2022
Type: Document
Sponsoring organization: National Quality Forum
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Pride in Idaho Care Neighborhoods Roadmap - A Guide For Healthcare Communities
Presents a model for delivering culturally appropriate care to LGBTQ+ people living in rural areas. Discusses the application of this model to the state of Idaho and highlights recommendations for providers, and healthcare facilities in general, on how to provide comprehensive care to a marginalized group in a rural area. Includes a resource library for LGBTQ+ support programs and information.
Additional links: Resource Library
Date: 08/2022
Type: Document
Sponsoring organization: Cornerstone Whole Healthcare Organization, Inc.
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Improving Access and Quality of Maternal and Infant Services in Rural Iowa through a Regional Center of Excellence
Profiles St. Anthony Regional Hospital in Carroll, Iowa, which serves six counties in west central Iowa. Discusses the hospital's efforts to improve maternal health and birth outcomes, including improving care coordination, increasing access to support and behavioral health services, and promoting better access to care in the region.
Date: 08/2022
Type: Document
Sponsoring organization: American Hospital Association
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Advancing Primary Care Innovation in Medicaid Managed Care: A Toolkit for States
Designed to help states leverage their Medicaid managed care contracts and request for proposals (RFPs) to advance primary care innovation (PCI). Outlines strategies for states to conceptualize and design advanced primary care core functions and use managed care contract levers to drive uptake and spread. Provides examples of state approaches, with rural considerations, for identifying and addressing social determinants of health, integrating behavioral healthcare, developing team-based care, implementing technology to improve access, and more.
Date: 08/2022
Type: Document
Sponsoring organization: Center for Health Care Strategies
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Grantee Sourcebook: Rural Health Network Development Planning Program, 2021
Detailed descriptions of 20 Rural Health Network Development Planning Program grant projects funded in fiscal year 2021. Reports on each grantee's network infrastructure development, plans for sustaining the network after the grant, and program activities addressing topics such as integrated service delivery, creating efficiencies, integrating health services, chronic disease management, and care coordination. Grantee profiles identify the geographic areas served, network partners, and primary contact person.
Date: 07/2022
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
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BuchananCares Program: A Team-based Care Pilot Led by a Rural Community Hospital and Local Pharmacist
Describes BuchananCares, a collaboration among health professionals from the Appalachian College of Pharmacy, Buchanan General Hospital in rural Virginia, and the Virginia Department of Health. Designed to reduce patient readmissions and improve medication use for patients with COPD, diabetes, heart failure, and pneumonia.
Date: 06/2022
Type: Document
Sponsoring organization: Community Preventive Services Task Force
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Behavioral Health Screening and Care Coordination for Rural Veterans in a Federally Qualified Health Center
Highlights the VA's nurse-led Collaborative System of Care (CSC) program's work in connecting veterans at rural Federally Qualified Health Centers (FQHCs) to the VA's behavioral health services and discusses the role care coordination can play in connecting rural veterans to other healthcare services. Details the efficacy of the CSC program and outlines the program's structure and screening process.
Author(s): M. Bryant Howren, Debra Kazmerzak, Sheryl Pruin, et al.
Citation: Journal of Behavioral Health Services and Research, 49, 50-60
Date: 05/2022
Type: Document
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Veterans Health Administration Interdisciplinary Clinical Video-Telehealth for Geriatrics and Dementia
Highlights a model for delivering interdisciplinary clinical care via video-based telehealth for geriatric rural veterans with dementia. Presents methods for overcoming geographic barriers to provide dementia care for rural veterans with a team of professionals such as social workers, pharmacists, and geriatricians via remote consultations with rural providers.
Additional links: One-page Overview
Date: 04/2022
Type: Document
Sponsoring organization: Veterans Health Administration's Office of Rural Health
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Qualitative Analysis of Cancer Care Experiences among Rural Cancer Survivors and Caregivers
Examines cancer survivors and caregivers' perceptions toward cancer care in rural Nebraska. Discusses perceptions of community health status, sources of cancer information, cancer diagnosis, care coordination, provider communication and organizational support, and barriers to care, based on focus group data from 20 participants.
Author(s): Kendra L. Ratnapradipa, Jordan Ranta, Krishtee Napit, et al.
Citation: Journal of Rural Health, 38(4), 876-885
Date: 04/2022
Type: Document
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Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
Offers strategies to support development and integration of behavioral health services across healthcare and community-based organizations, including leveraging payment systems to support coordinated care for farm families and aligning federal grant programs to address mental health and substance use disorders. Features recommendations including integrating primary and behavioral care for initial treatment of mental health and substance abuse concerns, expanding the workforce to improve rural behavioral health services capacity, increasing telehealth services, and expanding private and public insurance coverage.
Author(s): Andrew F. Coburn, Alva O. Ferdinand, Alana Knudson, et al.
Date: 02/2022
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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