Bridging Gaps to Better Health in Montana

Lesly Starling, BA, BSN, is a registered nurse leading an enhanced care team called a ReSource Team at Kalispell Regional Medical Center in Kalispell, Montana. While her nursing background has been shaped by most levels of care, she has found her passion in helping patients overcome barriers to optimal health outcomes in a vast, rural setting.

“I had the opportunity to attend the 2017 ABIM Foundation Forum this past summer as a rural representative of complex care coordination from Montana, sharing in the participation and discussion of extending care beyond hospital walls. The Forum, appropriately titled ‘Bridging Gaps to Better Health,’ offered a collaborative dialogue on the congruency of Social Determinants of Health (SDOH) and patient outcomes. It was a privilege to witness the growing awareness and accepted consensus that the two are interlaced and to enhance one, we will collectively, as a system, have to impact the other.

Flathead County serves as the backdrop for Kalispell Regional Medical Center and encompasses some of our country’s most beautiful and pristine landscapes. Unfortunately it provides little compensation for the individual who discovers that finding themselves on the bottom tier of Maslow’s Hierarchy of Needs proves to be an obstacle not easily disabled on one’s own in the management of complex care impacted by SDOH.

During the development and implementation of the Kalispell intensive outpatient program, it became glaringly obvious that Social Determinants of Health do not maintain an exclusivity to more heavily populated areas, but are a universal hurdle that transcend geographic density. And though some barriers to care might present with different variation in the Big Sky state, they are no less authentic.

Within the confines of rural America a lack of infrastructure and the basic means and ways to support some of our most behaviorally and socially compromised patients prevail. As a nurse in rural America, the creativity that must be conjured to connect patients to resources providing basic needs can at times be supported only by the generosity and grace that a community can provide.

With boots on the ground in our expanse, we learned that our grassroots effort must involve community-wide collaboration and be supported by the architecture of patient, provider, nurse, community health worker and volunteer relationships. The benefits of this is patient-driven, holistic-care coordination. Through the process of relationship- and trust-building, and the empowerment that comes from recognizing care does extend beyond the hospital walls, we are improving  patient outcomes one patient at a time and simultaneously creating before and after stories that are worthy of sharing. We are thereby ‘bridging gaps to better health.’

In the beginning of this project, it was not difficult to identify that an individual living with a part wolf-dog, in a broken down car, in the middle of a bitterly cold Montana winter was more honed in on meeting basic needs than locating a place to plug in a nebulizer, charge an oxygen concentrator and/or maintain medication compliance to avoid an exacerbation of COPD and a trip to the Emergency Room.

What was difficult to identify was that it would simply take time and human investment to break down barriers to care. More than actual strained effort or monetary cost, time is needed to devote to community-wide collaboration to discover barriers. Dedication is also required to investigate innovative solutions to help patients with SDOH challenges.

A wise person once told me when I was struggling with the time commitment required to go back to college for my nursing degree, ‘time would pass anyway.’  Well, ‘time passed anyway’ and the above-mentioned patient’s story is real, as are countless other patients in the United States. But her ‘after story’ no longer relies on the Emergency Department for warmth, electricity and an occasional sandwich. Through time, health care provider relationships and community, this patient will house her dog and make her own sandwich beneath her own roof, which ultimately reflects a sustainable and more permanent solution to a problem that is not going to disappear if we choose not to look.

I was asked how I will change my practice upon returning to my beautiful home state of Montana. Upon reflection, I will proceed in this endeavor fueled with even more intensity and commitment, because I received something wonderful when I left the ABIM Foundation Forum: I received and was surrounded by validation.”


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