Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts, according to recent studies from the Centers for Disease Control and Prevention.

Some characteristics associated with rural communities, such as long travel distances to specialty and emergency care centers, can affect health outcomes. Furthermore, many rural hospitals have reduced the types of services offered to patients, according to John Cullen, MD, a family physician in Valdez, Alaska, who evaluated health care systems and hospitals as a member of the National Advisory Committee on Rural Health and Human Services for the Centers for Medicare & Medicaid Services. “Sometimes it’s just not working out in some communities because of economics,” he says.

Using a Rural Lens
Importantly, patients in rural communities should not be stereotyped. “Rural communities aren’t all the same,” says David Schmitz, MD, president of the National Rural Health Association. For example, popular retirement destinations attract more affluent residents and, in turn, might have trouble recruiting health care providers because housing prices are too high, Schmitz adds.

Schmitz advises rural health care providers to use a rural lens when applying best practice interventions to their specific communities. “It’s not about reinventing the wheel in your own rural community; it’s about, ‘How does this tip or tool work well in the context of my rural community?’” Schmitz says.

Efforts to Improve Patient Outcomes in Rural Areas
Targeted Rural Health Education (TRHE) Project. Resident physicians and students at the University of North Dakota School of Medicine & Health Sciences access community needs assessments for rural communities across the state. They then use that information to create patient education materials on the most common community health needs. “In one community it might be use of seat belts, and in another it might be teenage alcohol use or smoking during pregnancy,” says Schmitz, who founded the project.

Project Extension for Community Healthcare Outcomes (ECHO). This new model of continuing medical education helps physicians provide better care to patients in rural and underserved areas. Through regularly scheduled teleECHO clinics, primary care clinicians are linked to specialists who can provide support to jointly manage both complex and common illnesses, such as cancer, chronic pain, and addiction and substance abuse. Partner organizations have created 85 Project ECHO hubs at academic medical centers, community health centers, military health centers, and prisons across the country and around the world.