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Rural public health has been hit with a triple set of challenges: overstretched health care, poor health status, and limited public health capacities. MaineHealth, a nonprofit integrated 10-hospital health system, serves a mostly rural area with no local public health departments in its rural communities. By integrating primary care with public health and partnering with communities, MaineHealth has developed an infrastructure to successfully address these challenges. We believe this approach is worthy of consideration in other rural areas.
B y leveraging the resources of the health care system and by building partnerships, MaineHealth has developed a hub-and-spokes model for community health called the Center for Health Improvement (CHI) that has successfully addressed some rural disparities and built capacity for nonregulatory functions of public health. In this unique way, CHI is able to impact some challenges faced by rural public health.
INTERVENTION AND IMPLEMENTATION
MaineHealth CHI's hub is an organizational hub of resources that includes
e health data and analytics,
e agrants office,
e operational and management resources for program planning and strategy,
e program evaluation, and
e system-wide and statewide programs that work with other providers, state and federal government agencies, statewide nonprofits, businesses, and other partners across the system and state.
CHI's spokes are community health departments in each local hospital's service area that serve all of the residents of that area. The departments (spokes) consist of a community health director and other public health professionals who oversee partnerships with primary care clinicians, local government agencies, schools, and community-based organizations (CBOs; e.g., community action programs). These partnerships are guided by a multisector community coalition that forms a council that is convened by the community health director or a community member. With resources from the CHI hub, the local community health department teams facilitate community health needs assessments (CHNAs), foster partnerships, apply for grants (that include subawards to CBOs), and oversee strategies to address health issues that are prioritized by the CHNA.
The CHI team has developed welldefined roles and responsibilities of the hub and spokes derived from the 10 essential public health services framework, competencies for the community health departments derived from national public health competencies, and standards for the community health departments that include a multisector community council that guides the local...