In an increasingly turbulent medical care system, business training is one way doctors and medical students are seeking to redefine their ability to lead and wield influence. Changes in the health care system have fostered the need for physician executives with business training who can serve as liaisons between administrative and clinical personnel. As the development of integrated delivery systems has combined clinical and administrative functions, the roles of physician executives have increased, as well as the demand for related training of physician leaders. Growth in the number of physician executives is expected to continue as such individuals demonstrate their ability to facilitate provider-physician relations and lend unique expertise and perspective in the health care de- livery system. 1 The transition from clinical roles to administrative functions can be challenging for physician executives. 2,3 Moving into administra- tive roles presents challenges different from those inherent in med- ical training and practice. 4 If the physician manager is to be con- sidered an effective asset to an organization, the new role requires distinct shifts in thinking, philosophy, attitudes, and behavior. 5 Be- cause traditional clinical training of physicians contrasts with man- agement training and functions, few physicians are prepared for the requirements of management roles. 6

Access to comprehensive and quality health care services is difficult for socioeconomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisciplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as Promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural health care initiatives targeting minority groups. This paper reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei).

Background: In the United States, 38.4 million people have been diagnosed with diabetes, and it continues to rise. The increasing rate of diabetes has become a significant public health challenge due, in part, to the association between diabetes and decreased levels of physical and emotional well-being. Currently, there are few assessments of the impact of diabetes self-management programs on individuals with diabetes quality of life and social vulnerability. This study examined pre- to post-program quality of life outcomes for participants in a community-based diabetes-self management and support (DSMS) program and assessed the association between the change in quality of life pre- to post-program and social vulnerability. Methods: Health Extension for Diabetes (HED) is a 4-month, community-based DSMS program delivered in the Southeast region of the United States. HED includes standardized education and personalized support to help participants manage their diabetes. The 12-Item Short Form Health Survey (SF-12) was utilized to assess participants’ physical and mental quality of life pre- and post-program participation. The Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index (SVI) was used to determine individuals’ social vulnerability level (low: 0–0.25, low-to-moderate: 0.2501–0.5, moderate-to-high: 0.501–0.75, high: 0.7501–1.0). Wilcoxon sign-ranked tests assessed changes in SF-12 pre- and post-HED and linear regressions examined the association between quality of life and social vulnerability level. Results: SF-12 scores indicated significant positive changes in physical and mental quality of life for all program participants (N = 1,006). All SVI subgroups were observed to have significant improvements in physical health scores. Individuals with moderate-to-high and high SVI scores showed significant improvement in mental health scores, while individuals with low and low-to-moderate SVI scores did not. Conclusion: Participants of the community-based diabetes self-management and support program experienced improvements in quality of life across varying levels of social vulnerability, as measured by the SVI. While integrating upstream social determinants of health considerations into DSMS program design and delivery addresses health disparities, future research should consider the implementation of more general mental health resources to address the psychological burden associated with living with chronic disease.

RRH: Rural and Remote Health. Published article number: 402 - Educational and health services innovation to improve care for rural Hispanic communities in the USA