Meeting Medical Needs Through Convenient Care

To prevent illness and provide convenient health care away from traditional medical facilities, The Duke Endowment awarded 16 grants totaling $2.4 million between 1995 and 2000 to hospitals in the Carolinas for mobile medical units.

Insights

We used six key strategies in our mobile medical grants.  We invite others to use these as a starting point for their own efforts.

1. Successful outreach through mobile medical units required significant commitment from the hospitals involved. In some cases, the mobile medical units required underwriting by the hospitals.
2. A clear sense of purpose was critical. Many hospitals conducted careful market research and cost analysis before purchasing a mobile medical unit to establish goals, including determining potential uses for the unit and deciding if the unit's purpose is to generate hospital referrals or simply to provide community service.
3. Having several people trained to operate each unit helped ensure that it would be used more frequently. Because drivers need a commercial license, it was particularly important that several people be trained.
4. Identifying maintenance providers and replacement parts suppliers before service was needed was key to making sure the mobile units were out on the road as much as possible, and not out-of-commission waiting to be serviced.
5. Mobile units that partnered with community agencies and other health providers reached more people. Other suggestions for ensuring that the units reach their target populations included working with other agencies and health providers to identify populations with the greatest needs, avoiding "park and wait" sites, offering services to established audiences, and publicizing site visits through phone calls and mailings.
6. Accessible costs and locations helped make the mobile units successful. Most programs offered services without a fee and were unaware of patients' ability to pay.

Impact

Fifteen hospitals received grants to purchase and support a mobile medical unit from 1995 to 2000. Following the grant period, 12 of the 15 hospitals responded to a survey by The Duke Endowment, providing information about target populations, medical services, health problems identified, staffing and training, cooperative efforts, and lessons learned during mobile medical unit programs.

Survey findings included:

1. Services: Laboratory services, immunizations and health risk screenings were most frequently offered. Other common services included nutritional assessments and counseling, chronic disease management, gynecological care, hearing tests, mammography and dental care.
2. Health problems: The most common problems identified were hypertension, elevated cholesterol and glucose levels and diabetes. Some locations reported significant incidence of obesity and osteoporosis.
3. Staffing: Almost half of the programs employed a full-time RN and a person to help with patient registration. Most programs used other hospital staff on a part-time, as-needed basis. More than a third of programs employed full-time drivers with commercial licenses. Several used medical personnel with commercial licenses.
4. Schedule: All of the programs offered services on weekdays. Most also offered services on evenings and weekends. Most programs used their units between 11 to 15 days a month. Half of the units visited one site a day, and no program offered services at more than two sites a day.
5. Space/Equipment: Common features included space for a receptionist, phlebotomy, at least one exam room and mammography equipment. Almost half of the units had soundproof audiometric space.
6. Cost: Half of the hospitals conducted feasibility studies before purchasing their mobile medical units.
7. Partnerships: Most programs offered services with local health departments, churches and schools. Almost half worked with other hospitals, and almost half worked with for-profit employers. All programs regularly provided services at health fairs, and almost all provided services at workplaces.

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