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Program Abstracts
Mobile Mammography: Keeping Pace With Technology & Finding The Funding To Do So
Shirley A. Hampton, RN, Development Director, Nevada Health Centers, Inc., Carson City, NVNevada Health Centers, Inc. (NVHC) is a non-profit community health center that has twenty-five medical and dental centers spread throughout the state of Nevada. Our mission is to provide quality health services throughout Nevada; we believe that everyone, regardless of where they live or their ability to pay should have access to health care. Nevada is a very diverse state that is composed of territory that is still labeled “frontier” and it is also home to the fastest growing city in the nation, Las Vegas.
Many people who live in rural and frontier areas of Nevada are more than 200 miles from the closest mammography center. The typical woman who lives in rural Nevada lives on a ranch or a farm; she is independent in nature and would not likely travel the distance or take the time for a screening test like a mammogram. The urban area of Las Vegas, on the other hand is a magnet for low-income and undocumented workers who are attracted to the casino and service industries. The growth of Las Vegas is outpacing the ability for health services to keep up with the demands. Nevada ranks near the top of the nation in regards to the number of uninsured with more than 18% of the population lacking health insurance.
In response to the geographic isolation in the rural area and the influx of the uninsured in our cities, Nevada Health Centers, Inc. developed a state wide mobile mammography program that provides free mammograms to those in need. We have been serving the women (and a few men) in Nevada with screening and diagnostic mammography since 2000. We have provided more than 22,000 mammograms and diagnosed 65 women with breast cancer. Providing mobile mammography services is not without its challenges but the rewards are well worth the trials.
The van that was built in 2000 began to show serious signs of wear and tear last year. NVHC launched a capital campaign in 2007 to raise money for a new Mammovan. Over $1,000,000 was raised and we now have a new Mammovan (it is actually a truck and a trailer) that has state of the art digital equipment.
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Objectives:
- Understand the rewards and challenges of operating mobile mammography throughout a diverse state with a diverse population
- Understand the basics of how and why to transition from analog mammography to digital mammography
- Learn how an organization can operate a mobile mammography van without a radiology department
- Understand funding opportunities to support mobile mammography
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Outline:
- Brief history of how and why mobile mammography was started in Nevada
- Community need
- Community support
- Taking the plunge
- Stories from the Road
- Out-reach activities
- Patient appreciation
- Challenges
- Transitioning from analog to digital
- Cost
- Transferring data
- Working with a radiology group
- Fundraising
- Launching a capital campaign
- Who gives?
- Rewarding funders
Two and a half years after Hurricane Katrina devastated areas along the Gulf Coast, families are still in dire need of medical care, especially pregnant women, new mothers and babies. The March of Dimes has responded by securing funding mom & baby mobile health center® to bring much-needed care directly to women and their children. Upon fulfillment of March of Dimes Foundation's goal to raise $5 million with a Hurricane Assistance Fund, four mobile health centers were purchased and fully equipped to provide prenatal and well-baby care. The fund also allowed for operating costs for all four mobile health centers through June 2009, one in Mississippi and three in Louisiana. Funding for the Louisiana vehicles was provided through a gift from the people of Qatar as part of the $100 million Qatar Katrina Fund. The mobile health centers in Louisiana alone will perform an estimated 4,000 well-baby visits and 8,000 prenatal visits. A community partner, local to each of the sites, has been
contracted to provide and oversee medical care services. The partner provider will employ and insure all medical and support staff. Each of these partners has unique dimensions of their programs. After a general overview, representatives from three of the four mobile programs will discuss challenges, accomplishments and expectations of their respective programs.
Areas served: urban - New Orleans mid-city, Kenner; Staffing model: nurse midwife, nurse project manager, driver/assistant, PT administrative help (employee splits time between projects); all staff are bilingual; Locations: mostly churches or community organizations already interacting with patients, Delivery, high-risk and follow-up: cooperative agreements signed with OBs from several hospitals; Target population: uninsured and underinsured, primarily Hispanic immigrants, with limited English.
Areas served: rural urban – four separate sites surrounding the Gulf Coast area of Biloxi; Staffing model: Nurse practitioner, driver/assistant/outreach worker, PT off-site project manager. Contracts with an external source for sonographer to be present on vehicle for ultrasounds; Partners: Locations: clinics not currently providing OB services, pregnancy crisis center and K-Mart parking lot; Delivery, high-risk and follow-up: preceptor/cooperative agreements signed with local OB's from several hospitals; Target population: uninsured, underinsured and limited number of providers as main barrier to access. Increasing number of Hispanic immigrants.
Areas served: rural – four separate small towns in rural areas surrounding Lake Charles; staffing model: Nurse practitioner, LPN assistant, driver/assistant/outreach worker, PT off-site project manager. OB resident to provide services 1 day per week; Locations: community hospitals or clinics not currently providing OB services, Delivery, high-risk and follow-up: cooperative agreements to be singed with local OB's from several hospitals; Target population: uninsured and underinsured, mostly Caucasian women with transportation as the main barrier to accessing care due to distance to nearest provider.
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Objectives:
- Understand the role of March of Dimes mom & baby mobile health centers® within their communities.
- Be able to discuss and differentiate models used for implementation of mobile health programs and challenges.
- Be able to identify and discuss ways to address unique challenges to implementing a prenatal mobile health program.
This session will address how to get communities to “Buy In” to bring your services to their communities. The funding is never too great to raise for any size community. You will be given some ideas on how to get the communities involved in their own fund raising.
This session explained how an affiliation with the mobile dental team in their community becomes a truly positive endeavor. The number of underserved is not always recognized. Having accurate data and statistics will quantify your program. If a program does not have a full-time dentist on board, finding creative ways to engage dentists for either volunteering or reimbursement can be a challenge.
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Objectives:
- Community “Buy Ins” - How to get communities to pay site partner fees - Who are your best bets
- Recruitment of dentists without a full-time staff dentist - How to recruit for a day and/or a week
- Statistics to quantify program - Truck - Production $$$ - Procedure tally - Patient Info - Age - Ethnicity - Income - Dental history
A minority population that is frequently overlooked is rural residents. Mobile clinics in rural areas generally serve communities that are isolated geographically. Some rural locations cannot support a medical provider because there simply is not enough demand to support a full-time medical practice. Periodic services, such as those available from a mobile van, are a lifeline for these communities.
The Rural Health Clinics Program is a special Medicare certification that provides cost-based reimbursement for services provided to Medicare and Medicaid patients. Clinics meeting three criteria are eligible to apply for this certification: they must be located in non-urbanized areas; the area must have been designated by the federal government as a health professional shortage area or medically underserved area; and the clinic must employ a nurse practitioner, a nurse midwife or a physician assistant.
Central Valley Family Health – Mobile is one of fourteen Rural Health Clinics operated by Central Valley Family Health in Hanford, California. Kings County's economy is largely agricultural and services are focused in a few population centers. The county has the highest mortality rate due to diabetes and there are pockets where nearly half of residents live in poverty and others where over 95% of residents are Hispanic and many are monolingual. The mobile clinic has served a number of communities without medical services, and continues to be the only source of medical care in Stratford and Kettleman City.
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Objectives:
- Have a basic understanding of what Rural Health Clinic certification entails
- Know more about one mobile Rural Health Clinic's operations
- Acquire resources to assist in further investigation of Rural Health Clinic certification
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Outline:
- What is a Rural Health Clinic?
- How does a clinic become certified?
- What are the advantages? Are there disadvantages?
- Central Valley Family Health – Mobile
- How can you learn more about RHCs?
Mobile Health Services was born in the late 1980's as the result of a large donation from the Cheney Foundation, contributions from other donors, and the purchase of 1989 Winnebago at cost from a local recreational vehicle dealership. The requirement from donors was that their gifts be used to meet needs of the medically underserved in our community many of whom live around the foothills of Mount Rainier. With no “real budget”, but the support of a community oriented health care facility, the creativity of a social worker/program director, commitment of a large group of talented senior volunteers, and the expertise of licensed nursing staff, this committed group set out to make a difference in people's lives. The goal: provide health promotion, disease prevention activities in eastern Pierce County by improving access to healthcare to improve our community's health.
With a 36 foot recreational vehicle modified by volunteers and the program director to accommodate medical services, staff set out to offer blood sugar, blood pressure, cholesterol testing, body composition evaluation, and seasonal flu shots. Children's and adult immunization services were added followed by helmet fitting, health education programs and other activities. Mobile Health Services flourished and now operates out of shopping centers, community centers, schools, businesses and often from a new specially designed 36 foot mobile medical vehicle with two exam rooms, again made possible as the result of generous donations from interested parties. Members of our community now count on this very popular program for certain healthcare needs. It is a thriving and vital component of the health care services offered at Good Samaritan. Participation in this program will offer a demonstration of a viable model for the delivery of certain health care services. Successes and challenges learned along our 18 year journey will be discussed.
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Objectives:
- Recognize the value of community partnership and participation in Mobile Health Service programs.
- Recognize the role of volunteerism in the delivery of affordable healthcare services.
- State examples of service types valuable to community members of all income levels via mobile services especially in medically underserved areas.
- Recognize budget issues/challenges of this mobile health program
- Recognize the marketing value of a highly visible hands-on health service.
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Outline:
- History of Good Samaritan Mobile Health Services
- “Grass roots” beginnings
- Services type provided and why.
- Operations
- The role of Senior Volunteers
- The flexibility factor
- Budget challenges
- Managing on a “shoestring budget”
- Donors
- Value to Community members
- Community volunteers
- Patient feedback
- Marketing Value for Good Samaritan
- Future directions