A Digitally Capable Mobile Health Clinic to Improve Rural Health Care in America: A Pilot Quality Improvement Study.

Objective: To address the problem of limited health care access for patients in rural southern Minnesota, a digitally capable mobile health clinic (MHC) quality improvement initiative was launched in a rural community-based health system. Methods: This project was designed and implemented according to our institutional strategic plan, guiding principles for virtual community care, and existing approved standards of care. A quality improvement development and pilot implementation framework was rapidly developed using Agile methodology. Results: The resulting technology and equipment selection, overall clinic design, vehicle vendor selection, clinical schedule and workflows, staffing model, equipment and technology selection, and testing were achieved in 12 months. The pilot site communities were chosen on the basis of size, interest, and lack of existing access. Four underserved rural communities now have access to telehealth consultations, laboratory testing, and in-person primary care examinations. By April 30, 2022, the MHC had provided 1498 patient appointments while maintaining our standards of care. Newly established broadband internet access for these communities and their residents was a valuable secondary outcome. Conclusion: By designing and implementing an MHC quality improvement intervention that provides both in-person and advanced telehealth options for patients in rural communities, our institution rapidly provided a potential solution for the rural health care crisis. The MHC not only replaces traditional brick-and-mortar facilities but also expands service offerings and access to technology for rural communities and the people who live and work in them.

Outpatient Practice Reactivation in an Integrated Community Practice During the COVID-19 Pandemic.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care organizations throughout the world. The Southwest Minnesota Region of Mayo Clinic Health System, a community-based health care system, was not immune, and in March 2020, our outpatient services were deferred and decreased by 90%. Method: This article is a review of the approach we used to safely reactivate outpatient care, the tools that we developed, and the outcomes of these reactivation efforts. A novel Outpatient Practice Reactivation Framework was established and used that included Outpatient Clinic Appointment Dashboard, Decision Matrix, Access Management, Virtual Care, and Patient Safety. This framework was guided by patient demand for care and by safety principles, as recommended by state and federal agencies and our internal infectious disease department guidelines. Results and Conclusions: Over the course of 9 weeks, ambulatory visit volumes and clinic utilization rates returned to pre-COVID levels (Pre-COVID fill rate range: 87% to 94%, post-COVID fill rate range: 86% to 89%) exceeding target fill rate of 80%, as a result of establishing the initiative as a shared priority, committing to a robust schedule and decisive actions, creating and maintaining a well-defined structure, taking an inclusive approach, overcommunicating and providing sufficient data for transparency, developing guiding principles, and training and educating staff.

A Framework for Outpatient Infusion of Antispike Monoclonal Antibodies to High-Risk Patients with Mild-to-Moderate Coronavirus Disease-19: The Mayo Clinic Model.

The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, electronic health record (EHR) informatics, compliance, legal, medical ethics, engineering, administration, and other critical areas. Clear communication and a culture in which all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our patients with COVID-19 in the outpatient setting are met.