Recent statistics show residents of the Arkansas Delta live an average of 10-12 years less than residents in other regions of the state.

The Challenge

Drone shot of a single car on Arkansas Highway 33 crossing cotton fields in Prairie County, near the city of Biscoe. Storm clouds are gathering far away across the flat landscape.Health disparities are driven by a complex web of economic, social, cultural, and medical influences, the details of which may vary from location to location, but the consequences are uniformly crippling. Nowhere is this more evident than in the Arkansas Delta Region (ADR), where economic prosperity remains elusive mainly due to struggles in providing the infrastructure, skilled workforce, quality of life, and good-paying jobs needed to maintain and grow the local economy; and enabling households to generate enough income to support their families.

The primary culprit of health outcome disparities, cardiovascular disease (CVD), disproportionately impacts underserved, low-wealth communities despite improvements in management over the past 50 years. Over the years, many health improvement projects led by dedicated, hard-working people have been implemented in the ADR. Unfortunately, most of these projects were unsuccessful for several reasons. The traditional healthcare system is unable or unwilling to develop and maintain community-level interventions targeting communities with poor health outcomes; and grossly underfunded Public Health Departments presiding over a cadre of fragmented programs that proved minimally effective.

The Team

Irion “Chip” Pursell, MPH, RN, BSN

Irion “Chip” Pursell, MPH, RN, BSN

HHC team members recognize the devastating impact of chronic disease in rural areas and know a “medical only” solution to the problem will not succeed. The HHC team is domiciled in UAMS Cardiology but is led by Irion W Pursell, Jr., RN, BSN, MPH. Mr. Pursell is the Cardiology Division’s Director of Primary Cardiovascular Disease Prevention – the first public health practitioner in the nation to lead primary prevention efforts in a clinical medical division.

Community Health Workers (CHW) are the foundation of our intervention. CHWs have typically trusted community members, ideally positioned from the same cultural and linguistic backgrounds and life experiences, to provide tailored resources and responsive interventions. HHC is leveraging this strategic model in the rural ADR to support the evolution from a health care system focusing only on medical care to proactively focused onconcentratetion and social determinants of health.

Other team members include

  • Jessica Barnes, Ph.D.
  • Mark Massing, M.D., Ph.D.
  • Sam Sears, Ph.D.
  • Clarence Potter
  • Sean Young, Ph.D.
  • Allison Caballero, MPH

The Approach

HHC challenges the long-held assumption that underserved, minority, rural, and socially isolated populations are unwilling or uninterested in participating in improving their health and the health of their family and community. Our hypothesis is that given the opportunity, ‘early adopters’ will engage and experience benefits disseminated through their sphere of influence given a chance. Through first-hand knowledge of a positive outcome in the life of someone they know and through trust-building relationships with CHWs, the second tier of individuals will engage in a team scenario to realize similar benefits for themselves and their families. The team mentality is critical; research shows participation in a team for a common goal is far more impactful than offering someone help. HHC understands the fundamental importance of that team approach for not only individual health but also community health.

With an understanding of previous shortcomings and challenges, HHC was developed over the last decade as an intervention model targeting underserved, low wealth Arkansas communities with health outcomes disparities to address previous flaws preventing the rebalancing of rural health equity. HHC focuses on a community health worker (CHW)-based patient-centered and community-focused care team with a holistic approach equally valuing disease prevention and acute medical care. The hypothesis is a successful CVD prevention strategy prioritizing community engagement, access to safe and effective CVD risk reduction, and long-term focus on overall well-being in underserved communities will yield measurable results.

The fee-for-service healthcare funding model has created a shadow population of individuals characterized by social isolation, substance abuse, and chronic disease leading to poor health outcomes. These individuals tend to cluster in low wealth underserved communities. Therefore, designing a prevention/intervention strategy using a geospatial approach that targets specific geographical areas makes sense.

The Intervention

HHC is a novel cohesive approach to improving health and wellness via community relationships enabling long-term fundamental change in individual and community health. CHWs are the face of the HHC intervention. Our CHW team is deployed using a geospatial approach targeting the high-risk neighborhoods to assess and address the needs of residents in each household in the target area. CHWs are local community members with focused health care training and form the interface between healthcare systems and communities to identify and address social needs and improve health care access, quality of care, and cultural competence. In each geospatially specified neighborhood, CHWs engage every resident 18 years or older. For enrollees, CHWs activate a portfolio of programs and resources to address and manage social and medical factors leading to CVD while populating a ‘living registry’ with data enabling the examination of HCC’s impact on social and medical variables and critical metrics, including health outcomes in the target neighborhoods.

We hypothesize that although the top 10-15 overall needs may be the same, their ranking may vary widely due to differing local cultural, environmental, economic, historical, and social influences. HHC’s structure, yet flexibility and focus on local resources allow adaptation to each locale as their needs evolve. This project expands horizontally (from neighborhoods in PC to other ADR counties) and vertically (as neighborhood-specific needs change from baseline) as the effects of resource utilization and improvements in personal and community health improvements advance over time.

The Resources

Our CHWs are supported by a team of experts with years of experience in their respective fields:

The Goals

A high priority of HHC is that infrastructure, efforts, and critical stakeholders established with this project remain a fixture in the community, where long-term engagement is vital for continued improvements in health equity. Project data will be showcased and shared with county and state political figures, as well as other researchers in local, regional, and national forums, in hopes similar programs can be adopted in other areas where severe health disparities are ravaging rural communities as well as areas of social isolation and economic despair.

It is the goal of HHC to make CHWs the go-to people for health and wellness advice.

The Metrics and Measures of Success

As HHC progresses over the first six months, an initial evaluation of enrollee engagement and utilization data from social services referrals, the 20Lighter cardiometabolic health program, HSI wellness optimization application, and telemedicine visits will be undertaken. The analysis will also reveal the number of HHC enrollees introduced to the program via word of mouth from family, friends, and neighbors and those enrolled after CHW engagement at their doorsteps. To further hone the model and ensure the portfolio of offerings adequately addresses the enrollee’s needs, structured interviews with CHWs, enrollees, and community focus groups will help evaluate HHC’s effectiveness and identify opportunities to improve relevance. This data, in aggregate, serves as the first look at overall HHC performance. Qualitative data serves two purposes: first, as an indicator or proxy for as-yet unmeasurable clinical outcomes, and second, to collect information on the target population’s needs and preferences, which may vary by location and from the general need assumptions made at the HHC outset. The latter is essential contravention to promote engagement, aligned with enrollees’ needs and priorities, and identify the best delivery method.