1. Caring for Maine’s Children:
A Grant to Improve Access to
Pediatric Primary Healthcare in
Western Maine
Nichole C. Martin RN, BSN, CEN
Husson University
2. Medical Home Model
Primary care that is accessible,
continuous, comprehensive, family-
centered, coordinated, compassionate,
and culturally effective
-American Academy of Pediatrics, March
2007
64% of Maine parents report healthcare for
their child as being received from a provider
that meets this definition
2010 Maine Children’s Growth Council Report: School Readiness
3. Research shows having a regular source
of preventive and primary care is
associated with:
– lower per person costs
– lower emergency room utilization
– fewer hospital admissions
– fewer unnecessary tests and procedures
– less illness and injury
– higher patient satisfaction
American Academy of Family Physicians
5. Facts on Health
Based on a 2009 study by the Muskie School of Public
Service:
• Maine emergency department (ED) usage was 31% higher
than the national average
• The Maine population age 0 – 1 years of age has the highest
rate of ED use AND the highest proportion of frequent ED use
(4 or more visits in a year)
• The Maine population age 1 – 4 years of age has the third
highest rate of ED use
• Maine children age 1 – 4 years showed a 25% increase in ED
use than the the national average for that age bracket
Analysis of 2006 Emergency Department
6. Facts on Health
• 28.2% of Maine children ages 10 – 17 are
overweight or obese
• 26.4% of Maine children ages 19 – 35 months are
not current on their childhood immunizations
• 18% of Maine high school students reported
smoking cigarettes in 2009
– increased from 14% in 2007 (a 29% increase…
yikes!)
– first reported increase since 1997
Maine Kids Count 2010 Data Book
7. Facts on Health
• 78.5% of Maine children did not receive
developmental screenings during well-child visits
• Parents of 32.2% of Maine children age 0 – 5 have
at least one concern about their child’s
development, learning, or behavior
• In 2008, 17% of Maine children had special needs
Maine Kids Count 2010 Data Book
8. Facts on Insurance
• 6% of Maine children are without health
insurance
• 9% of low-income Maine children are without
health insurance
• 53% of uninsured children in Maine are low-
income children who are eligible for MaineCare
coverage
Maine Kids Count 2010 Data Book
9. Rural Maine
• Less health care providers per
capita
– 20% of the nation’s population
live in an area designated as
rural
– 9% of the nation’s physicians
practice in rural areas
• Increased transportation
barriers
– Little or no public transportation
– Longer distances to travel for Healthy Maine 2010: Opportunities for
• Rural residents visit a physician less often and
later in the course of an illness
10. Rural Maine
• 60% of Mainers live in a rural area
• Rural counties in Maine tend to have a lower
median income and higher rate of poverty
“Family economic distress is associated
with negative social… and health
outcomes for children”
- Mather & Adams
USDA Economic Research Service via www.ers.usda.gov
Healthy Maine 2010: Opportunities for All
The Risk of Negative Child Outcomes in Low-Income Families
11. Facts on Poverty
The child poverty rate has become one of the most
widely used indicators of child well- being
• Maine’s estimated household income is $37,400, the
lowest in New England and below the national
average of $41,343
• 21.8% of Maine children under age 5 are living in
poverty, this is higher than the national average!
• 16.5% of children under age 18 are living in poverty
• Maine children living in small communities make up
72% of the population of impoverished children
Maine Kids Count 2010 Data Book
Healthy Maine 2010: Opportunities for All
12. Facts on Poverty
• Average income for
rural Maine is $32,500
• Franklin county is
among the most
impoverished counties
• In 2008
– 17.5% of Franklin
county lives in poverty
– 22.5% of Franklin
county children 0 – 17
years old live in
poverty
USDA Economic Research Service via www.ers.usda.gov
15. Focused Objective
Obtain funding to staff a
Family and Community Nurse
Practitioner (FCNP) with
strong experience in pediatrics
at the
Rangeley Family Medicine
practice in Rangeley, Maine
Photo courtesy of Rangeley Family Medicine
16. Why Rangeley, Maine?
• Sits among a rural and medically underserved region in
Maine
• Home to an existing FQHC
• Serves a large catchment area including:
– Rangeley − Madrid
– Oquossoc − Magalloway
– Dallas, Lincoln, and Sandy − Multiple unorganized townships
River Plantations
• Borders extend:
– west to the New Hampshire border
– north to the Canadian border
– east to the Carrabassett Valley region
– south to the Townships C, D, and E
17. Rangeley Family Medicine
• FQHC established in
1994
• Offers routine physicals,
chronic and acute medical
visits, laboratory services
and minor surgery
• Provided care to almost
1,700 local and seasonal
residents in 2009
• Currently staffed with 3
physicians board certified
in family medicine
www.healthreachchc.org
19. Southern Maine Regional Resource
Center for Public Health Emergency
Preparedness via smrrc.org
Maine is divided into
eight DHHS
districts, based on
population,
geography, county
borders, and
hospital service
areas
23. DHHS District 3 – Western
Maine
• Consists of Franklin, Oxford, and
Androscoggin counties
• 71 municipalities (incorporated local
governments): cities, towns, plantations
(unincorporated townships are a
recognized part of the District. A TWP is
officially served by the Maine CDC and
may be served by the local health officer
of an adjacent town.)
Office of Local Public Health via maine.gov
24. DHHS District 3 – Western
Maine
Franklin Oxford Androscoggi
n
Total population (2006 estimate)
29,850 56,461 107,011
Children under age 5 years old
1,401 2,864 6,746
Children 5 – 17 years old
4,688 9,097 17,663
Number of pediatricians, family
/general practitioners 22 24 67
Children participating in
MaineCare
3,452
(52.5%)
7,357
(58.6%)
13,735
(53.2%)
Maine Kids Count 2010 Data Book
2010 Maine Children’s Growth Council Report: School Readiness
25. Area Resources
• Hospitals
– Franklin Memorial Hospital, Farmington
– Redington-Fairview General Hospital,
Skowhegan
– Rumford Hospital, Rumford
• Pediatric Practices
– Pine Tree Pediatrics, Farmington
– RMA Pediatrics, Skowhegan
26. Going the distance
• Rangeley to Farmington 1 hour
• Rangeley to Rumford 1.25
hour
• Rangeley to Skowhegan 1.5
hour
courtesy Google maps
27. What will this grant do?
• Provide greater access to pediatric
primary care
• Improve completion of developmental and
behavioral screening in children
• Allow early identification of developmental
delays and behavioral problems
28. What will this grant do?
• Assist with early intervention for health
and wellness needs
• Increase childhood immunization rate in
Maine
• Improve referral rate to other needed
healthcare and community services
29. This overview
is presented
with special
thanks to the
Maine
Children’s
Alliance
Photo courtesy of Maine Kids Count 2009 Data Book
30. Much of the data
used in this grant
proposal was
obtained from the
2010 Maine Kids
Count Data Book
Funded by
The Annie E. Casey
Foundation
31. References
• American Academy of Family Physicians. Retrieved from www.aafp.org
• American Academy of Pediatrics. Retrieved from www.aap.org
• HealthReach Community Health Centers. Retrieved from www.healthreachchc.org
• Maine CDC - Office of Local Public Health. Retrieved from www.maine.gov/dhhs/boh/olph
• Maine Children’s Alliance. (2009). Maine kids count 2009. Augusta, ME: Author.
• Maine Children’s Alliance. (2010). 2010 Maine children’s growth council report: School readiness. Augusta, ME:
Author.
• Maine Children’s Alliance. (2010). Maine kids count 2010. Augusta, ME: Author.
• Maine Office of Rural Health and Primary Care. Retrieved from www.maine.gov/dhhs/boh/orhpc
• Mather, M., & Adams, D. (2006). The risk of negative child outcomes in low-income families. Retrieved from http://
www.aecf.org/KnowledgeCenter/Publications.aspx?pubguid={87AC5496-D08E-4EA2-8749-C1075F0EBBB0}
• Mills, D. A., & Leahy-Lind, S. (2002). Healthy Maine 2010: Opportunities for all. Augusta, ME: Author.
• Muskie School of Public Service. (2009). Analysis of 2006 emergency department use: A study conducted on behalf
of the emergency department use work group of the Maine advisory council on health system development.
Retrieved from http://www.maine.gov/tools/ whatsnew/attach.php?id=68564&an=1
• Southern Maine Regional Resource Center for Public Health Emergency Preparedness. Retrieved from
www.smrrc.org
• USDA Economic Research Service. Retrieved from www.ers.usda.gov
All photos taken by N. Martin unless otherwise credited