The gap in positive health outcomes between those living in urban and rural areas continues to widen across the country, and South Carolina is no exception. Put simply, living in a rural or underserved urban area often means being sicker and dying sooner, and it could all be remedied by better health care access.
The United Health Foundation ranks South Carolina 42nd in health among all states. South Carolina saw approximately 7,400 potentially excess deaths in 2015 among the five leading causes of death, and almost half of these occurred among rural populations.
The Clemson University Joseph F. Sullivan Center is working to combat this. For nearly three decades, they have provided mobile health outreach to increase access for rural populations.
According to Sullivan Center Executive Director Paula Watt, as the need continues to increase, the center is expanding to meet it.
“It’s amazing to see just how much mobile health outreach has grown in just a couple of years,” Watt says. “As a land-grant institution, we are mandated not to compete with the private sector, but to fill gaps in service and research better ways to reach the underserved; I feel our center and its partners have accomplished that in a very short time from the mountains to the coast.”
Clinical encounters alone have grown 288 percent in that same decade, from 4,500 to more than 13,000, covering the Upstate and expanding into the Midlands and Lowcountry by working in conjunction with Clemson Extension and mobile units from the Medical University of South Carolina’s Hollings Cancer Center, Self Regional Healthcare and Servants for Sight.
According to Watt, these “health campaigns” have performed cancer screenings, cardiovascular screening and education, lifestyle education and general acute and chronic care across the state.
In 2018, the Sullivan Center celebrated its 40th anniversary. It marked the occasion with a record number of mobile outreach visits, and it also celebrated the culmination of years of work to increase connectivity across the state so that rural areas and mobile clinics alike could operate more securely and efficiently. Thanks to a one-of-a-kind vehicle made possible with help from S.C. Sen. Thomas Alexander and a steady string of successes, the Center is poised to do much more.
When Watt talks about the future and any one of the many things in the works for the center, it’s clear that she feels Clemson, the state and other organizations involved with mobile health outreach are just getting started.
Watt doesn’t picture what one vehicle can do anymore. She pictures a fleet.
Unveiled in November 2016, the Sullivan Center’s flagship mobile health clinic is truly cutting edge. It is the world’s first to operate completely off of solar power when parked, and it includes a variety of other features designed to optimize mobile health delivery. The larger, more efficient and more versatile vehicle allows the center to reach underserved communities more effectively.
In the two years since the center acquired its solar-powered mobile health clinic, the unit has acted as a roving billboard for Clemson’s commitment to medical innovation and community wellness. It is an off-road, four-wheeled example of the university fulfilling its land-grant mission, by bringing crucial health care services to people in underserved areas who would otherwise go without.
“We did immeasurable homework on what we wanted because the clinic needed to be a step up for the outreach we wanted to provide,” Watt said. “This vehicle has truly been a dream come true for Clemson.”
When parked, the clinic draws 100 percent of its power from a special solar battery system, which eliminates the noise and fumes from a traditional generator and decreases operation and maintenance costs. The unit features improved wi-fi connectivity over previous units that allows for improved security in handling patient medical records.
Megan Kyle, director of community outreach for the center, worked on the center’s last mobile clinic. She immediately saw the benefit to having more space for patients and staff. An extra exam room means nurse practitioners can see more patients, and flexible walls mean patients aren’t crammed into an intake area that’s too close to checkout.
The clinic features flexClinic™ technology, so that its walls can move and convert the main clinic into a space comprised of anywhere from one to five rooms. The clinic can be used as one large patient education room that fits 20 or a combination of rooms that serve lab, reception and exam room needs.
State impact one patient at a time
Watt ultimately credits much of the Sullivan Center’s success to S.C. Sen. Thomas Alexander. Sen. Alexander regularly champions outreach and access to care for underserved populations, and he has made clear that support given to the Sullivan Center was based on its track record of service and its longstanding emphasis on the importance of access to care.
“It’s critical that the state make it possible for organizations like the Sullivan Center to bring health care to folks who need it most,” said Sen. Alexander, adding that he believes mobile clinics will continue to provide evidence-based data showing their essential role in effective rural health care. “The state should support any mission that leads to better health outcomes, and the preventative and educational components provided by mobile clinics have proven time and again to do just that.”
According to the Mobile Health Map, a research network comprising organizations that run mobile health clinics, there are an estimated 2,000 mobile clinics located across the country. Data from many of those clinics reveals that mobile clinics provide accessible care at a cheaper cost to health care systems than emergency department visits; the group estimates that each mobile clinic results in 600 fewer emergency department visits every year.
Mobile clinics serve mostly uninsured, minority populations in both rural and urban areas. On average, mobile clinics save 65 quality-adjusted years of life during every year of operation. Each patient served saves an average of $1,600 in health care-related costs due to health education and prevention.
The patients aren’t the only ones benefitting. Health care systems enjoy more “bang for their buck” with mobile clinics. The Mobile Health Map reports that an analysis on return on investment for mobile clinics shows that for every $1 spent, organizations save $12.
The proven benefits that mobile clinics have had across the nation are why Alexander and Watt have been happy to see the center not limiting itself to Upstate counties. The staff’s “clinic campaigns” held in conjunction with other mobile clinics have stretched as far as the Lowcountry, and the center welcomes other mobile partnerships in the future.
“We treat and educate patients,” Kyle said. “We take care of the immediate needs and put them on a path to better health.”
A fleet of vehicles and a secure wi-fi connection doesn’t count for much if that connection is unreliable or nonexistent. While the center gears up for continued growth, it has already remedied the issue thanks to efforts to bring high speed broadband technology to 102 health care sites across the state. In summer 2018, Clemson received a funding commitment from the Universal Service Administration Company Rural Health Care Program to bring connectivity that would improve the efficiency of rural health outreach efforts.
The funding streamlines the way mobile clinics operate in rural areas. It also provides an economic boost to South Carolina companies tasked with hardwiring sites and mobile clinics. However, the real beneficiaries are people in underserved communities.
“Previously, technology tied our hands,” Watt said. “If patients came steadily, we could make it work, but if many came at once we often couldn’t see them because of delays in service. A more stable connection has changed all of that so that we can see more patients.”
James McElligott serves as medical director for the Medical University of South Carolina Center for Telehealth and as co-chair for the South Carolina TeleHealth Alliance advisory council. He explains that many gaps in care for diabetes, cardiovascular health and pre-term deliveries for pregnancies are due to lack of access to prevention and screening. Although MUSC has been involved in telehealth initiatives since 2005, McElligott has seen the number of related initiatives accelerate in the last five years.
“This is another reason to bring MUSC and Clemson closer together to collaborate and accomplish great things in the realm of public health,” McElligott said. “It gives us all more options when we strategize our delivery of health care to the people who need it. This is a tangible and real front that we can work on and further develop.”
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