Letter
It Takes a Region: Rural-Academic Partnerships to Decrease Health Inequity During the Pandemic

https://doi.org/10.1016/j.jpainsymman.2021.01.130Get rights and content

Introduction

Health inequities and injustices burdening rural Native Americans are staggering.1 Limited surge capacity and access to specialty services at rural hospitals, including critical care,2 leads to high rates of interhospital transfers. As a result, rural Native American patients, particularly those that are critically ill and near the end-of-life, often receive care far from home at distant referral centers that are ill-equipped to provide culturally responsive care.2 Programs to improve regional access to palliative and culturally appropriate care are scarce.2 We present the experience of a regional partnership to improve the care of rural Native American patients hospitalized in New Mexico during the COVID-19 pandemic.

Section snippets

Background

COVID-19 has disproportionately affected Native Americans in New Mexico (NM). Although Native Americans comprise approximately 10.9% of NM's population, as of July 2020, 35.7% of the state's COVID-19 cases and 60.6% of the state's residents who died from COVID-19 were Native American.3 A majority of these people were Diné (members of the Navajo Nation).4

Gallup Indian Medical Center (GIMC) is the largest Indian Health Service hospital treating Native American people in New Mexico.5 When

Developing Culturally Responsive Communication Tools

Communication scripts tailored to the care of Diné patients: The GIMC team identified a need for culturally appropriate tools to facilitate serious illness conversations among patients with COVID. Based on feedback from the community, patients, Diné staff, and experience, the GIMC team adapted publically available communication scripts7,8 that address serious illness care through avoiding metaphors, emphasizing speaking positively, and avoiding using negative language directed at the patient,

Conclusions

Creating the GIMC-UNMH COVID Collaboration, a rural-urban medical partnership in New Mexico, has helped improve the care of rural Native Americans affected by COVID-19. The collaborative has created clinical, educational, and system-level changes, and enhanced patient and family experience at both rural and academic centers. In addition, the collaboration has led to enhanced professional comradery and support at a time when traditional connections have been strained by physical distance. Future

Disclosures

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declare no conflicts of interest.

Acknowledgments

The authors acknowledge the contributions of the full COVID Collaboration team. Gary Smith, PhD, Director of the Office for Continuous Professional Learning at UNM, created our cloud-based app to enable the Collaborative to share resources regionally.

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    Transfers to acute care hospitals at the end of life: do rural/remote regions differ from urban regions?

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    Rural matters—coronavirus and the Navajo nation

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  • Indian health services 2021

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There are more references available in the full text version of this article.
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Both Dr. George and Dr. Lee contributed equally to the development of this manuscript.

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