Dr. Luisa Franzini

January 11, 2017

Dr. Luisa Franzini, chair of the Health Services Administration department, is leading a Maryland Health Care Commission-funded study ($450,000), in partnership with the Walsh Center for Rural Health Analysis at the National Opinion Research Center (NORC) Bethesda, to help lawmakers decide on the best ways to deliver healthcare to five counties on Maryland’s eastern shore. It is hoped that this study will be used as a model for delivering care in rural areas of the state.

The study was launched in response to a strong community reaction when a proposal was made to change Kent County Hospital in rural Chestertown, Maryland from an acute care hospital to a different kind of medical facility. The news triggered a significant local reaction, including the formation of a citizens’ “Save Our Hospital” group. As a result, the Maryland state legislature passed a bill that froze any changes to the hospital for now, and called for a study on how best to deliver health care, not just in the area served by Kent County Hospital, but also in the five rural eastern shore counties of Maryland.

Maryland is one of the few states that compiles information in a database outlining all insurance claims. Every single insurance company and large employer that processes health care payments for patients in the state, must report their payment figures to this database. Thanks to an agreement with the state of Maryland, the University of Maryland School of Public Health has access to this database in order to carry out research projects, like this one, that help guide policymakers in their thinking about how best to deliver healthcare to Marylanders.

The aim of the project is to understand how residents access health care in rural areas of Maryland. Researchers will look at where all residents in the counties get all of their care—not just hospital care.

The research will focus on vulnerable populations, Dr. Franzini said, and for this they will also need to examine Medicare and Medicaid data. Access to these data sets is in process, and the whole project is moving quickly: the research needs to be complete by next summer, so that the resulting report can be compiled to meet an October deadline.

Hand-in-hand with the data analysis will be five focus groups, public hearings, and also a series of interviews to hear directly from people in the communities about their healthcare practices and their needs.

“We are expected to deliver some option models for how to deliver care” using all of this input, Dr. Franzini said, noting that NORC has expertise in models of rural healthcare. Based on both the data and the interview processes, they will evaluate the different available methods and perhaps develop new models of care

When the Maryland state legislature funded this project, Dr. Franzini said, they also created a Rural Health Workgroup of about 35 lawmakers, hospital CEOs, county school officials, and healthcare business people. This group will consider the research findings of Dr. Franzini’s team and the Walsh Center, and come up with the recommendations that will be considered by the legislature.

Joining Dr. Franzini on this project are Drs. Lori Simon-Rusinowitz, Min Q. Wang, Jie Chen, and Dushanka Kleinman.

Among the issues Dr. Franzini said they would be considering are vulnerable populations, mental health, telehealth options, and transportation issues. “The point was made repeatedly that the area differs by season because of tourism,” Dr. Franzini said, referring to the heavy flow of summer beach traffic up and down Route 50—the region’s major north-south artery. Even though much of the eastern shore is rural farmland, the heavy traffic on any given beach weekend may be a literal roadblock to someone trying to access care.

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Luisa Franzini, Lori Simon-Rusinowitz, Min Qi Wang, Jie Chen, Dushanka V. Kleinman