ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Ohio Appalachia faces women's health disparities in chronic disease burden, maternal morbidity and mortality, and health care access, including preventive services. DESCRIPTION OF PROGRAM/INTERVENTION: Ohio Better Starts for All (BSFA), funded by the March of Dimes, provides in-person and telehealth care for women of childbearing potential within a 4 county region in Ohio Appalachia. After 18 months of regional engagement and a clinical partnership between Adena Health (community) and the Ohio State University (tertiary), Ohio BSFA began pilot in-person clinical and community education programs, prioritizing locations >20 minutes from established clinical sites. FirstNet, a first responder broadband network, helped us establish a mobile unit hotspot for patients to access subspecialty telehealth care starting in Spring 2022. Yet, regional infrastructure, workforce, financial resource, maintenance, and COVID-19 challenges limited scope and reach of clinical services. MEASURES OF SUCCESS: Ohio BSFA applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide program development, refinement, and expansion. To evaluate progress, we measured: number of clinics conducted;number of patients served;percentage of Ohio BSFA referrals served;demographics of patients served;and number of community partners. We next anticipate assessing quality of care (e.g. preventive services, depression screening, and tobacco cessation), number of telehealth visits, and patient satisfaction. FINDINGS TO DATE: Since the Fall 2021 launch, we conducted 14/19 scheduled clinics serving 52/86 (60.5%) of referred patients. We canceled 5 clinics due to inclement weather, mobile unit breakdown, or clinician COVID-19 infection. Data are available for 36 of 52 patients served to date (due to a monthly demographic reporting lag). Median age was 27 years;25% (9/36) were teenagers;92% (33/36) were White. 61% (22/36) had public insurance;31% (11/36) had private insurance;and 8% (3/36) were uninsured. We established 5 community partnerships, such as a county fairgrounds and a local employer, General Mills, to support mobile unit housing and clinic hosting. KEY LESSONS FOR DISSEMINATION: We have learned that a mobile hybrid in person/ telehealth clinical model can promote primary and specialty care access in rural communities. Using the RE-AIM framework in program implementation helps maintain focus on long-term community sustainability, even in early stages of program development. Continuous community partnership and coalition expansion is also critical for sustainability. While telehealth can facilitate rural subspecialty care access, telehealth success requires broadband access and established referral workflows. Clinical service disruption, such as staffing shortages and facility malfunction, can hinder patient engagement and program momentum. Agile and flexible responses to unanticipated challenges, compounded by the COVID-19 pandemic, facilitate continuation of clinical and community services necessary for increasing program impact and reach.