For years, Daniel Spoon, MD, has had a vision about building a better model to support innovation in rural healthcare — one that does not rely on ideas imported from large academic medical centers far removed from the daily realities of delivering care in remote areas.
Many of the solutions developed at large AMCs are designed in environments with ample resources, staffing and infrastructure that simply do not exist in most rural communities, Dr. Spoon, chief medical officer of Providence Montana and director of cardiovascular research, told Becker’s. It is a fundamental challenge he said continues to impede progress in improving rural health outcomes.
“One of the downsides about rural medicine is, for the most part, no large academic medical centers are located in rural environments or truly understand the difficulties of caring for patients in these areas,” Dr. Spoon said. “No one from a large AMC is coming to save rural America.”
His vision is beginning to take shape through a new partnership between Providence St. Patrick Hospital and the University of Montana, both based in Missoula. The initiative, known as Resolve, launched in November and brings together the research capabilities of a major academic institution, the clinical reach of Renton, Wash.-based Providence, and on-the-ground insights from rural providers.
The university and health system have described the collaboration as unique. What makes it stand out is that Montana, like many rural states, lacks an in-state academic medical center. The goal of Resolve is to fill that gap by creating a model in which clinicians, researchers and communities can share resources and co-develop solutions that directly address challenges in rural healthcare delivery.
“The data capacity of a system like Providence is unimaginable,” Dr. Spoon said. “If you can bring together these researchers at the academic flagship institution, the local expertise and care that is provided at our hospital, and the horsepower and large datasets, then we can create the environment that allows us to take the lead on rural health issues and rural healthcare delivery.”
At the heart of the initiative is a belief that rural health solutions must be driven by those who understand the challenges best.
“The content experts about how one would improve care in rural America are rural Americans,” he said. “It is the nurses, the techs and the administrators at our critical access hospitals that truly understand their barriers, but they don’t have the time, the FTE, the bandwidth, the data capabilities to do the science and implement the program. So what we’re really trying to do is be that machinery.”
In its early stages, Resolve has focused on building philanthropic support to fund its infrastructure. Dr. Spoon said the model was designed to become self-sustaining over time, with its foundation strong enough to attract external grants and research dollars. That moment is now arriving, as clinicians and researchers begin applying for collaborative grants and expanding project pipelines.
Early projects are largely focused on identifying and quantifying the unique challenges facing rural providers and patients, which Dr. Spoon said is a necessary first step before building and testing tailored solutions. Among them are systemwide studies led by Providence clinicians and UM researchers examining variations in cardiovascular outcomes between rural and urban hospitals. In Montana, UM researchers and local clinicians have already published a study linking elevated blood pressure levels to periods of heavy wildfire smoke — a finding with growing relevance as climate change drives more frequent and intense fire seasons.
Dr. Spoon describes these efforts as “just the tip of the iceberg.” He sees Resolve’s structure as exactly what is needed to accelerate innovative, locally driven solutions to persistent challenges in rural healthcare.
A long-term goal of the collaborative is workforce development and retention. Dr. Spoon hopes Resolve will inspire future nurses, techs and advanced practice providers to not only train in rural areas but also stay, by embedding them in the development and implementation of solutions that directly affect their communities.
“There’s a lot of brain drain from rural America, and so when you build something like Resolve, we’ve got the ability to incorporate that in educational programs … and hopefully inspire the next generation of people to build a skill set and then be very passionate about continuing to practice in rural America,” he said.
Looking ahead, Dr. Spoon envisions Resolve evolving into a shared, statewide and potentially national platform open to all hospitals, universities and organizations committed to improving rural healthcare delivery.
“I don’t feel rural America benefits from silos and strong, ruthless competition in healthcare because there isn’t enough that we can duplicate service lines in these large areas, so that’s been a foundational ethos of our program,” he said. “We want anyone who wants to be a part of this to be involved.”
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