March 2000

Grant Results

National Program

Practice Sights: State Primary Care Development Strategies

SUMMARY

From 1993 to 1994, staff from the State of Arkansas Department of Health sought to develop the Arkansas Primary Care Access Project, in which primary care group practices would serve as "hubs" in communities with populations below 10,000. The hubs would then develop "spoke" sites in surrounding underserved areas.

While it was thought that the hub and spoke model might prove very suitable for Arkansas, too little progress was made during this planning phase to win continued RWJF support.

The project was part of the Robert Wood Johnson Foundation (RWJF) Practice Sights: State Primary Care Development Strategies national program.

Key Results

  • The Rural Health Advisory Council identified five potential hub sites.
  • The state completed needs assessment surveys for various practitioners and began to develop a locum tenens program to provide coverage.

Funding
RWJF supported this project through a grant of $100,000.

After the Grant
While it was thought that the hub and spoke model might prove very suitable for Arkansas, too little progress was made during this planning phase to win continued RWJF support.

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THE PROBLEM

At least part of every county in Arkansas is a federally designated Medically Underserved Area (MUA), and 77 percent of the counties lie entirely within such areas. Approximately 20 percent of the generalists practicing in underserved communities are over 65 years of age. The state's one medical school, the University of Arkansas for Medical Sciences, in Little Rock, graduates only 30 family physicians a year, and most establish their practice within 25 miles of where they trained during medical school or residency. Group practices are rare, and physicians have been reluctant to collaborate with mid-level practitioners. High poverty levels combined with high uninsurance rates hold down practice revenues in rural areas, and transportation difficulties further inhibit access.

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THE PROJECT

With the planning grant (ID# 022256), the Arkansas Primary Care Access Project sought to develop primary care group practice models to serve as hubs in communities with populations below 10,000. Once the hub sites were adequately staffed with a team of physicians and mid-level practitioners, they would develop spoke sites in smaller underserved communities in the surrounding areas, thus addressing the more serious shortages in smaller rural areas. The models would respond to unique local needs and become permanent health resources in these communities. The project concentrated on developing private, for-profit models, although public community health centers were also considered.

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RESULTS

  • The Rural Health Advisory Council evaluated 21 communities for participation in the hub and spoke pilot project and selected five sites that demonstrated both significant need and local commitment to preserving and expanding their rural health care systems. Each of these five potential hub sites demonstrated a willingness and ability to provide professional leadership in the establishment of their regional spoke sites.
  • The University of Arkansas for Medical Sciences and the state Office of Rural Health began the cooperative development of a locum tenens program to provide coverage.
  • The grantee completed needs assessment surveys of registered nurses and nurse practitioners, as well as rural physicians. Key barriers identified included the lack of prescriptive authority for nurse practitioners and low Medicaid reimbursement rates.

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AFTER THE GRANT

While it was thought that the hub and spoke model might prove very suitable for Arkansas, too little progress was made during phase one to win continued RWJF support. The state planned to continue to develop the hub and spoke sites as funds became available.

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GRANT DETAILS & CONTACT INFORMATION

Project

Arkansas Practice Sights

Grantee

State of Arkansas Department of Health (Little Rock,  AR)

  • Amount: $ 100,000
    Dates: May 1993 to July 1994
    ID#:  022256

Contact

Charles McGrew
(501) 661-2940

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Report prepared by: Robert Narus
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: Michael Beachler

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