North Dakota makes strides in innovative care
North Dakota makes strides in innovative care
North Dakota faces health care challenges common to many rural areas of the United States, but the state is facing them with an innovative, cooperative approach that has implications for other rural and even urban areas, a recent Commonwealth Fund report emphasizes.
"When you're talking about health care, people sometimes assume that 'bigger is better.' This report finds just the opposite," says Mary Wakefield, PhD, associate dean for rural health and director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. Dr. Wakefield also serves on the Commonwealth Fund's Commission on a High Performance Health System. "Highlighted here are excellent rural examples of how health care can be improved, based on cutting-edge innovation in payment policy, technology applications, and a spirit of cooperation rather than competition. Features of high performance in health care can be found in rural America, just as they can be found in urban America."
North Dakota has a population of approximately 640,000 people, with more than half the counties containing six or fewer people per square mile. Most of the population is white (92%), with a small minority of Native Americans (5%) representing four tribal nations. In addition, North Dakota cities have seen a recent influx of immigrants from Slovenia and Bosnia, as well as from Central and South America. Like other rural areas, North Dakota's population in general is older (the state has the highest proportion of people over 85 years old) and has lower average income than the population of urban states. "In general, rural people tend to be less active, more obese, and have higher rates of smoking and alcohol use than their urban counterparts," the report notes. "These health behaviors in turn act as 'trip wires' for chronic diseases such as diabetes, hypertension, and coronary artery disease. These population and behavioral differences contribute to a different context for medical care in rural vs. urban areas. For example, a common challenge facing rural areas is an inadequate array of health care resources such as skilled staff, facilities, equipment, and pharmacies."
To help overcome those challenges, health care providers in rural North Dakota have established various cooperative arrangements and networks to share resources and expertise. Those efforts can be compared to the regionalization in public education where one school or district serves several small rural communities. For example, six integrated delivery systems provide the majority of the health care in North Dakota through regional clinic networks and small rural hospitals linked to urban hospitals. Virtual networks built on telemedicine and telepharmacy also promote integration, extend the rural work force, and enhance communication by allowing physically distant providers and facilities to transmit and receive critical patient data instantaneously.
The lessons are particularly relevant to rural America but also have implications for how health care can be delivered in urban parts of the United States.
"Health care providers, payers, and policy-makers in rural North Dakota have learned that only through cooperative, interdependent relationships and a willingness to innovate in both the organization and regulation of services can they achieve the reach, care coordination, and economies of scale that are necessary for delivery of quality and efficient care in rural settings," the report notes.
The full report, "The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation," is available at: http://ruralhealth.und.edu/pdf/Commonwealth_North_ Dakota_Experience.pdf.
North Dakota faces health care challenges common to many rural areas of the United States, but the state is facing them with an innovative, cooperative approach that has implications for other rural and even urban areas, a recent Commonwealth Fund report emphasizes.Subscribe Now for Access
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