Learning from Iran’s Community Health Example

The New York Times Magazine this past weekend had a really interesting cover story on applying Iranian healthcare principles to rural Mississippi. The story detailed the work done by Dr. Aaron Shirley, who in 2010 created HealthConnect in Mississippi to address the “disparities in health between its urban and rural populations,” and eventually integrated lessons learned from Iran to help improve Mississippi healthcare, which has some of the worst health statistics in the country. HealthConnect’s mission is to reduce the rate of readmissions to Central Mississippi Medical Center, and in one year the agency cut readmissions by 15 percent. It did this by employing nurses to perform home visits to coordinate health-related issues ranging from providing education on how to take diabetes medications to getting mold testing for an asthmatic’s home to giving moral support to chronic patients.Shirley was inspired by the primary healthcare system created in the 1980s in the Islamic Republic of Iran. “The Iranians built “health houses” to minister to 1,500 people who lived within at most an hour’s walking distance,” reported the Times’ Suzy Hansen. “Each house is a 1,000-square-foot hut equipped with examination rooms and sleeping quarters and staffed by community health workers—one man and one or more women who have been given basic training in preventive health care.” What was key to the success of these “health houses”  was the health workers, who would advise on nutrition, family planning, prenatal care, immunizations, would come from the villages they serve.Mohammad Shahbazi, an Iranian professor at Jackson State University helped Shirley forge a partnership with Shiraz University in Shiraz, Iran, that helped advise how many health houses should be set up in Mississippi.HealthConnect applied for, but did not receive, a Centers for Medicare and Medicaid Services (CMS) Innovation Center grant, so instead of embarking on a pilot for 15 health houses, Shirley will establish 11 health houses in schools. “To keep the houses running, Shirley says, they are staffed with certified nurse practitioners whose services can be billed to Medicaid,” the Times reports.Currently, The Affordable Care Act will give $11 billion to community health centers, which is a positive step in the direction of beefing up primary care to reduce emergency room utilization and readmissions. This inspiring story in Mississippi makes me wonder how patient engagement tools like personal health records and remote monitoring can be integrated with this community health approach to truly transform a population’s health.Many pilots have had success either using mobile devices to monitor patients or to promote self management for chronic diseases. Success stories like HEALTHeLINK, the Buffalo-based Beacon Community, which had early successes with its diabetes telemonitoring pilot to identify high-risk patients through mobile monitoring before they are hospitalized, or Chartered Family Health Center and George Washington Medical Faculty Associates that issued mobile devices for patients to store, and transmit in real-time their blood glucose data and other diabetes self-management information. It’s stories like these that will help drive this country forward toward reform.