Health Center News

Innovation in Managing Chronic Disease Flourishes in North Carolina

Willie Riddick manages his health with the remote monitoring program.  Courtesy: Direct Relief
Willie Riddick manages his health with the remote monitoring program. Courtesy: Direct Relief

Innovation does not always have to come with a hefty price tag in healthcare.  That is what health centers prove every day in the communities they serve, sometimes in the unlikeliest of places.  Our yearlong celebration of the 50th Anniversary of the Community Health Center Movement brought us to rural Ahoskie, NC, where the Roanoke-Chowan Community Health Center (RCCHC) operates a remote monitoring system for patients with chronic conditions, like cardiovascular disease, diabetes and hypertension.

RCCHC serves 14,000 patients annually with four locations in northeastern North Carolina. There is no public transportation in the area and for some patients who need regular care that can pose a challenge.  There is also the cost factor: over half (53 percent) of patients struggling with incomes at or below 200 percent of the Federal Poverty Level. The remote monitoring program helps identifying patients with chronic conditions and providing them with monitoring equipment at no cost to them.  A nurse case manager sets up their equipment and connects it wirelessly to a server.  After a patient has done all the screenings (blood pressure, pulse, body weight and blood sugar), the readings and data are transmitted to the nurse care manager and primary care physician. The real value for providers is that there is hard data to work daily with in determining a patient’s health status, rather than trying to guess at what has happened in the intervening months between appointments. The results are also impressive: there has been a 75 percent reduction in hospital admissions and readmissions for patients in the program.

The program was entirely funded by grants, such as the BD Helping Build Healthy Communities Award, but it was Direct Relief, an organization that works in partnership with health centers and NACHC, that brought the program to our attention.  You can read their blog post about RCCHC by visiting this link.