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CT RURAL HEALTH REPORT
CT-ORH 2015 Annual Report
The CT Office of Rural Health’s (CT-ORH) seventh annual report provides an overview and summary of the office’s initiatives and activities. More detailed information is provided upon request by contacting the CT-ORH.

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An Assessement of Connecticut Rural Health: Overview, Obstacles and Opportunities
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
  1. Physical Activity and Weight
    Physically inactive and overweight/obese children and adults is a statewide problem and impacts those living in rural settings.

  2. 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.

  3. 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.

  4. 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.

  5. Pregnancy Related Risks
    Smoking during pregnancy is highest in rural settings in the state particularly the north eastern region.
Health Status
  1. 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.

  2. 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.

  3. 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.

  4. 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.

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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:
  1. 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.

  2. 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/.

  3. 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.

  4. 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.
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Rural Community Health in Connecticut: Challenges and Opportunities June 2006
  • Download the Complete Report (PDF/4.33MB)
  • View the Report Data (in HTML format). Includes data sources and downloadable spreadsheets of detailed data used in the assessment.
Project Summary

During March-June, 2006 CT-ORH commissioned research and data collection to (1) identify barriers to accessing healthcare services in rural Connecticut, (2) determine healthcare services available to Connecticut's rural residents and (3) support community efforts across rural Connecticut to improve the health status of residents. This report tells the "story" of rural health in Connecticut and provides data and tools that local healthcare providers, administrative bodies, and coalitions can use to address health issues facing Connecticut's rural areas. CT-ORH retained the firm of Holt, Wexler & Farnam, LLP (HWF) to assist in collecting and analyzing data in support of this project.

HWF assembled extensive health and related demographic data for this study for the 65 towns designated as rural by CT-ORH. The data is from numerous sources, with the intent to make it available to all rural health stakeholders. Data was compiled at the town level to the extent possible; some indicators however were only available at the county or state level. To examine the demographics, healthcare services, and health status of rural residents, rural Connecticut was divided into three zones based on location to facilitate examination of variances across rural areas. All indicators for which data is available at the town level are summarized by rural vs. non-rural areas and by three zones identified as the Northwest Region, the East Region, and the Connecticut River Valley. The conclusions regarding rural Connecticut have been drawn based upon data collected and summarized for the three regions.

Key Findings

The quantitative data revealed, and the interview data of opinion leaders confirmed the following three major themes about health status and health care services in rural Connecticut:

Disparities: In general, the economic health of rural residents remains stronger than non-rural residents. However, significant and growing numbers of individuals and families face substantial economic challenges and as a consequence, health challenges. Middle class families appear to enjoy solid access to healthcare systems. However, lower income - including retired elderly and families - experience a higher burden of health-related concerns.

Access to Healthcare: Two access issues present significant barriers to health care for a substantial subset of the rural population - cost and transportation. With respect to cost, availability of insurance coverage accepted by providers represents a limiting factor. Providers and consumers point out concerns especially for low-income populations in the areas of chronic disease management, oral health, and mental health. Transportation limitations prove equally significant. Getting to health appointments and especially to distant specialists has been identified as a significant challenge to maintaining health. Providers report a pattern of individuals who do not have access to transportation to see specialists for medical conditions often wait until their condition worsens and then rely on hospital emergency departments for services when their conditions become acute.

Capacity: The service system needs to increase its capacity to provide services in specific areas such as mental health, dental services, specialty services, and transportation services (or coordination). For example, a growing sentiment among providers exists that the current mental health prevention and treatment system can not address adequately the mental health service needs of the rural communities, particularly children, irrespective of economic status.
  • Download the Complete Report (PDF/4.33MB)
  • View the Report Data (in HTML format). Includes data sources and downloadable spreadsheets of detailed data used in the assessment.
Celebrating the power of rural health
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CT-ORH, Northwestern Connecticut Community College, Park Place East, Winsted, CT 06098-1798
Phone: (860) 738-6378  |  Fax: (860) 738-6443
This website is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Human Services (HHS) under grant H95RH00151, State Offices of Rural Health $179,871.
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