Connecticut State Office of Rural Health

2020 Northwest CT Health Enhancement Communities Data Scan and Community Engagement Report

2020 Northwest CT Health Enhancement Communities Expanded Engagement during COVID-19

2015 Connecticut Rural Health Assessment

Project Summary

PURPOSE. The purpose of this report is to identify current health related data to guide the strategic direction for the Connecticut - Office of Rural Health (CT-ORH). This data report will also assist the office with prioritizing initiatives and dedicating resources to areas and programs in most need of development to enhance access to quality and affordable health care for rural Connecticut residents.

METHODS. The methods used to identify data included systematic web-based reviews and contacting key personnel within government and/or non-profit agencies in order to obtain the most recently available data. Data that was identified was typically reorganized and/or reanalyzed in order to most accurately reflect the demographic and health status of the 68 rural towns of Connecticut. Where data was not available at the town level it is presented at the county, regional and/or state level.

DEMOGRAPHICS. Connecticut has a population of 3,583,561 residents of whom 326,132 (9.1%) live in rural communities. Compared to the rest of the state, in general, rural residents tend to be aged 65 years and older, with the exception of the southwestern region that has more persons less than 20 years of age. With respect to income, rural regions tend to have higher incomes and fewer families living in poverty when compared to the rest of the state, although there are rural towns scattered throughout the state and particularly in the Eastern region with families that are very poor.

HEALTH CARE DELIVERY. Rural areas in Connecticut continue to meet criteria for Health Professional Shortage Areas (HPSAs). There are currently 82 HPSA designations with 41 occurring in primary medical care, 24 in dental care, and 17 in mental/behavioral health. Every county in the state has Medically Underserved Areas or Population (MUA/P) designations with 29 designations covering all or part(s) of 31 towns.mographic and health status of the 68 rural towns of Connecticut. Where data was not available at the town level it is presented at the county, regional and/or state level.

UTILIZATION AND ACCESSThe majority of rural residents in Connecticut have health insurance coverage and have access to primary care. Through the efforts of the Affordable Care Act many families have been enrolled in Medicaid/Husky. In 2014, 25,000 residents were covered under Medicaid. With respect to dental care, 15% of rural residents did not seek care or delayed care due to cost.

For those living in rural settings utilizing federally qualified health centers (FQHCs) the rates of hypertension, diabetes and asthma were high and varied by center. Preventive screening for cervical and colorectal cancers varied and were generally low.

Health Related Behaviors

Physical Activity and Weight
Physically inactive and overweight/obese children and adults is a statewide problem and impacts those living in rural settings.
Lead Exposure
Although screening rates for young children is relatively high across the state, there are many rural towns with low screening rates. The rural settings in the eastern region of the state have a high number of confirmed lead tests when compared to other regions.
Tick Borne Illnesses
Lyme disease remains highly prevalent in Connecticut with approximately 3,000 new cases annually, although this number is recognized as a significant underestimate. The rates per 100,000 have increased substantially since 2010 with the rural regions of the state hit the hardest, particularly the eastern region.
Behavioral Health
The prevalence of heavy drinking, binge drinking and tobacco use is high among all counties in the state compared to the nation. For those that receive treatment for mental health and/or substance abuse, there are many more cases from the Eastern region of the state.
Pregnancy Related Risks
Smoking during pregnancy is highest in rural settings in the state particularly the north eastern region.

Health Status

Pregnancy and Birth Outcomes
The rate of births to teenage mothers as well as preterm and low birth weights is highest in Connecticut?s largest cities as well as in several rural towns in north and eastern regions of the state.
Chronic Disease
The prevalence of asthma among school-aged children is a major health issue among Connecticut?s largest cities as well as in many rural towns throughout the eastern region. Rural residents were more likely to have a self-reported diagnosis of cancer compared to their non-rural counterparts.
Tick Borne Illnesses
Lyme disease remains highly prevalent in Connecticut with approximately 3,000 new cases annually, although this number is recognized as a significant underestimate. The rates per 100,000 have increased substantially since 2010 with the rural regions of the state hit the hardest, particularly the eastern region.
Mortality
All-cause and premature mortality rates are slightly higher for the Connecticut river and eastern regions of the state. Heart disease and cancer are the leading causes of death in Connecticut. When compared to the state overall, heart disease mortality is higher across all rural regions of the state. Consistent with self-reported diagnoses of cancer being higher in rural regions, the mortality rates for cancer were reported to be higher in the rural regions of the state.

to top

Telehealth in Connecticut

Project Summary

PURPOSE. Telehealth refers to the remote provision of healthcare services and health education, mediated by technology. Telehealth encompasses a wide range of services such as: a) the remote provision of direct patient clinical care services or consultations between healthcare providers; b) web-based options for patient self-education and/or access to healthcare resources; c) home-based or remote monitoring services; and d) a rapidly expanding landscape of mobile health technologies and applications. The Connecticut Office of Rural Health (CT-ORH) and its Advisory Board identified telehealth as a transformative strategy to increase access to care, increase the quality of care, and lower healthcare costs in Connecticut?s rural communities.

METHODS. CT-ORH commissioned a telehealth study to better understand the baseline conditions for telehealth in rural Connecticut. The project involved three forms of data collection: a survey of healthcare providers who serve rural communities in Connecticut; a high level environmental scan to document the leading telehealth innovators in Connecticut; and targeted interviews with healthcare leaders and healthcare policy makers to understand factors limiting the advancement of telehealth in Connecticut.

FINDINGS. Four major findings emerged from the study:

Connecticut operates in a policy environment that limits widespread implementation of telehealth, particularly for poor and underserved communities. For example, Connecticut does not require insurers to pay for appropriate services delivered via telemedicine. Connecticut operates under the Medicaid State Plan which pays only for face-to-face encounters with limited exceptions.
Healthcare providers who participated in the survey did not implement telehealth services per se other than care coordination via telephone conversations. Factors limiting adoption of telehealth innovations related to lack of reimbursement and other priority matters such as transitioning to electronic health records and/or assessing options to affiliate with a larger healthcare organization or exit the market.
Many telehealth innovators exist in Connecticut across every level of the healthcare system ? providing an excellent foundation upon which to expand telehealth models. For example, insurance companies headquartered in Connecticut operate model telehealth programs in other States and on a limited basis for their private pay customers. Select hospitals and community health centers throughout Connecticut implement nationally acclaimed telehealth models in areas such as e-consultation for cardiology, chronic disease management, telestroke, hospital discharge planning and treatment plan adherence programs, as well as clinical training.
Healthcare and policy leaders acknowledge Connecticut remains behind other states in terms of awareness of the potential value of telehealth; updating telehealth-related policies (e.g., reimbursement, licensing and credentialing); and promoting best practices. These same leaders recognize Connecticut must take action beyond policies that support pilot projects or targeted innovations.

RECOMMENDATIONS. The Connecticut Office of Rural Health and its Advisory Board identified four action areas to support the advancement of telehealth in Connecticut:

Support telehealth policy change efforts by leveraging resources available from the Northeast Telehealth Resource Center. Model telehealth policy frameworks exist that Connecticut policy makers can adapt and the Connecticut Office of Rural Health will support. Healthcare leaders and stakeholders hope to introduce several policy changes in the 2014 legislative session. Topics under discussion include health insurance coverage of medical advice, diagnosis, care or treatment provided through telemedicine; telemedicine to avert unnecessary use of hospital emergency departments; and Medicaid coverage of home telemonitoring services.
Support activities that educate decision-makers and stakeholders on the benefits of telehealth. Over the past 20 years, over 10,000 peer review papers have been published supporting the clinical effectiveness and cost savings of telehealth. Telehealth leaders in Connecticut can organize low-cost approaches that facilitate access to relevant information such as increasing usage of the Northeast Telehealth Resource Center?s website page for Connecticut and sharing information through listservs, among others. Visit: http://netrc.org/connecticut/.
Support telehealth leaders and champions in Connecticut through virtual networks, by encouraging affiliations with affinity groups such as the American Telemedicine Association or the International Society for Telemedicine and eHealth, and by increasing awareness of and participation in telehealth events occurring within the northeast region of the country.
Support the advancement of innovative telehealth models serving residents of rural Connecticut by convening partners, providing targeted technical assistance and/or seed funding for telehealth innovation.

to top