Emergency medicine-primary care partnership seeks to improve health of rural populations

Emergency physicians in Michigan propose a new health care delivery model for rural populations that depends on a partnership between emergency medicine and primary care and seeks to reverse the trend of failing health in underserved parts of the country. Their proposal was published online yesterday in Annals of Emergency Medicine ("An Emergency Medicine-Primary Care Partnership to Improve Rural Population Health: Expanding the Role of Emergency Medicine").

"The traditional urban model of health care has been ineffective at improving rural health," said the paper's lead author Margaret Greenwood-Ericksen, MD, MPH of the Department of Emergency Medicine at the University of Michigan in Ann Arbor. "Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community. Rural hospitals can serve as a hub for emergency care, primary and preventive care, and social services for improving rural population health."

The model proposed by Dr. Greenwood-Ericksen would not replace the existing outpatient rural safety net, comprised of federally qualified health centers and rural health clinics. It would supplement it.

The paper cites Carolinas HealthCare System Anson in Wadesboro, N.C. as an example of a new rural hospital designed to provide both emergency and primary care, calling it "a test of a new model of rural health care delivery." The final design has no physical walls separating emergency and primary care.

In other communities, similar partnerships could optimize emergency care, meet unscheduled acute care needs, address rural social determinants of health across the care continuum, achieve financial solvency and support public health.

"There is an urgent need for a rural-specific model of care aimed at improving the sharply declining health of rural Americans," said Dr. Greenwood-Ericksen. "The partnership we propose is novel yet practical and acknowledges that an emergency department might be the closest source of health care for rural patients. Emergency medicine-primary care partnerships can address rural populations' most pressing social and medical needs."

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