Challenges of EHR "Meaningful Use" in Rural Health Centers.

The Centers for Disease Control and Prevention (CDC) continues to promote the utilization of electronic health records (EHRs) to support population health management and reduce disparities. However, access to EHRs with capabilities to disaggregate data or generate digital dashboards is not always readily available in rural areas. With funding from CDC's DP-18-1815, the Division of Diabetes and Heart Disease Management (Division) at the South Carolina Department of Health and Environmental Control designed a quality improvement initiative to reduce health disparities for people with hypertension and high blood cholesterol in rural areas. With support from a nonprofit partner, the Division used qualitative evaluation methods to evaluate the extent to which practices were able to disaggregate data and report quality measures.

Virtual Expansion of the YMCA's Blood Pressure Self-Monitoring (BPSM) Program: Using Telehealth to Adapt an Evidence-Based Program to Reach Rural Communities in South Carolina.

CONTEXT: Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large. PROGRAM: The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions. IMPLEMENTATION: The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program. EVALUATION: A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure. DISCUSSION: Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.

Associations Between Social Vulnerability and Providing Evidence-Based Diabetes Prevention and Management Activities in South Carolina, 2019.

We assessed associations between social vulnerability (ie, external stressors negatively affecting communities) and the provision of evidence-based diabetes prevention and management activities (eg, National Diabetes Prevention Program) in South Carolina counties with high burdens of diabetes and heart disease. These associations were examined by using relative risk estimation by Poisson regression with robust error variance. Results suggest that social vulnerability may have differential effects on the provision of evidence-based diabetes prevention and management activities in South Carolina. Findings support calls to identify upstream social factors contributing to adverse health outcomes and provide several potential points for intervention.

Expanding Opportunities for Data Dissemination Through Collaborative Writing Teams in Public Health Practice Settings.

Government health departments at all levels make meaningful contributions to advancing the public health of communities, yet state health departments lack the time and infrastructure to share their findings with the broader scientific community. To address this gap in data dissemination, the South Carolina Department of Health and Environmental Control developed a "collaborative writing team" (CWT) pilot. As part of this pilot program, teams of staff members leveraged existing data to advance the public health knowledge base, with an emphasis on public health practice. The six steps of the CWT included (1) identify team members' skills/strengths, (2) discuss available data, (3) determine opportunities to share data, (4) divide responsibilities based on team members' strengths, (5) write and submit product, and (6) debrief. Between December 2019 and November 2020, the team had six abstracts accepted to two national conferences, one abstract accepted to a state public health conference, and one editorial published in a peer-reviewed journal. Feedback from participants indicated that self-efficacy in areas including writing, project facilitation, and analysis had increased among team. CWTs are a framework for people working within public health practice settings to disseminate findings.

An Analysis of the Social Determinants of Health in South Carolina's I-95 Corridor.

BACKGROUND: One in four South Carolinians lives in a county along a nearly 200-mile stretch of Interstate 95 (I-95). Stretching from North Carolina to Georgia, this region is among the most rural, economically depressed, and racially/ethnically diverse in the state. Research is needed to identify social factors contributing to adverse health outcomes along the I-95 corridor, guide interventions, and establish a baseline for measuring progress. This study assessed social determinants of health in counties in South Carolina's I-95 corridor relative to the rest of the state. METHOD: Data for South Carolina's 46 counties were extracted from the Centers for Disease Control and Prevention Minority Health Social Vulnerability Index (SVI), which grouped 34 census variables into six themes: socioeconomic status, household composition and disability, minority status and language, housing type and transportation, health care infrastructure, and medical vulnerability. Each theme was ranked from 0 (least vulnerable) to 1 (most vulnerable). Measures between regions were compared using the Wilcoxon-Mann-Whitney test. RESULTS: Compared with counties outside the I-95 corridor (n = 29), counties in the corridor (n = 17) scored higher on socioeconomic status vulnerability (.67 and .82, respectively) and medical vulnerability (.65 and .79, respectively). No statistically significant differences were found across other themes. CONCLUSION: Identifying social determinants of health in South Carolina's I-95 corridor is a crucial first step toward alleviating health disparities in this region. Interventions and policies should be developed in collaboration with local stakeholders to address distal social factors that create and reinforce health disparities.

Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties.

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.