Pikeville Medical Center (PMC) is leading efforts to establish the Rural Eastern Kentucky Pediatric Healthcare Network as part of its Federal Office of Rural Health Policy’s Rural Health Network Development Planning grant. In addition to PMC, network participants include United Medical Group, Pike County Health Department, and the Pike County School District. The network’s goal is to improve the health and mental outcomes for the 34,450 children in rural eastern Kentucky, focusing on children who are considered high-risk for poor health outcomes due to poverty, homelessness, and family instability. 

The Georgia Health Policy Center recently spoke to Kansas Justice, chief operating officer; Lisa Estep, vice president of development; and Shannon Deskins, executive director of marketing and public relations; from PMC about these efforts. 


To date, what has been an early accomplishment in your Network Planning program?  

Kansas: The PMC team began identifying pediatric health care services needs throughout our region with a comprehensive assessment in 2019. Following that assessment, our partners and community began discussions. We have recently opened the Appalachian Valley Autism Center and are anxiously awaiting the opening of our Children’s Hospital in December. This is a huge win for both the children in our region and the Network Planning Program. Having network partners allows PMC to identify services not offered by others in our area and grow specialty services. Otherwise, to access some of these specialty services, our pediatric patients and their families face a two to three-hour drive one way.  

Shannon: By working with network partners, our plan is that every child in our region has access to health care services. One goal set by the partners is to help drastically reduce the number of children coming into the emergency department for well checks who have been removed a home. A lot of our families are not your traditional families. There are many children being taken care of by grandparents or a legal guardian. The Pike County School District, which is also a network partner, has even created a homeless coordinator to help address the needs of these children. 


What is a tip that you would share with an organization launching a network planning effort?  

Lisa: I think the key to any network planning is the willingness to work with others. Even though we are the largest health care facility in our region, with the main focus being on hospitalizations, we want to make sure we are also taking care of the patients and the community — including those beyond the walls of our hospital. We have a great leader in our president and CEO, Donovan Blackburn, who was city manager for the City of Pikeville before coming to PMC. He brought with him a deep understanding of the region and a dedication to putting the community first. 

Shannon: I believe a key component to any successful venture is to avoid hesitation. Start early identifying initiatives based on the community needs assessment. The top health issues and priorities that were identified in our area included: economic stability, substance abuse, the need for pediatric services, obesity, overall wellness and the proximity and availability of services. In a rural area, you have to rely on partners to get things done. These partnerships are key to stepping outside of our walls and making sure the whole community is helped. 

Kansas: When we do our needs assessment every three years, we send out questionnaires throughout our region. We then gather roughly 30 of our strategic partners to determine if something truly is a gap or something that somebody else may offer.  

The best tip is to be key listeners. Identifying community partners and practicing effective communication is less about talking and more about listening. We really want to know what is out there and being offered by others to grow the region and serve our patients better. PMC can’t hold that entire weight on our shoulders. Right now, our network partners are looking at what we need to do to support the pediatric population in our community. Are there others we can partner with? Can we expand services through telehealth? What can we do to bring services here? 


How do you see participation in the Federal Office of Rural Health Policy’s Network Planning grant program impacting your broader health improvement efforts? 

Kansas: Our biggest goal is that we want our people to have access to health care — good quality, specialized health care — close to home. This grant is helping us to step out of our boundaries and grow those collaborations. It is also a great benefit to hear what other rural areas are doing. In our rural area, collaboration is key because poor road infrastructure and lack of dependable transportation directly impact access to quality healthcare for so many. Working with other health care providers allows each of us to extend the reach we would have by working alone. By partnering with other agencies, we increase the overall health care capacity of our entire region. In this scenario, everyone wins. 

Lisa: The key initiative right now is really looking at pediatrics as a whole and working to grow the full gamut of pediatrics. We need to make sure that we are making care as convenient as possible. In the last three years, PMC has doubled the size of the neonatal intensive care unit, added a pediatric friendly emergency department wing and established a successful telehealth program at schools. We saw a large number of children on the autism spectrum who really needed that early intervention, so an autism center at PMC opened in 2020. We recently moved our pediatric clinic to a high traffic shopping area, which has plenty of parking and is convenient. Overall, PMC and our network partners want our children to have access to the care they deserve in this region. Through these network partnerships, we are intently focused on all aspects of pediatric care from when the child is born until age 18.  


Do you have an example or story that illustrates the value of planning for a rural health network instead of a single organization at the helm?  

Kansas: We realize the economic impact of traveling to obtain care, especially with children, and the hardships brought about by this are increased when parents need to take time off work. PMC’s Partnership with UK HealthCare and the subsequent rerouting of current referral pathways from University of Kentucky specialists to the new Children’s Hospital will reduce transportation and distance barriers that families currently face, especially when there are other children at home. We are working with the University of Kentucky to bring specialty services here that we do not have. We are also looking at other initiatives, as we grow the children’s hospital, that will enable children to stay close to home for care.  

Shannon: Our telehealth program in two local school districts has been key to improving access to care for children in school.  In that program, we are also partnering with the Pike County school system and the Pike County Health Department, which is another reason we have such confidence in this task before us now. With the PMC Healthy at School telehealth program, we can treat children with mild illnesses right there in the school. They go in, see the nurse, perform a telehealth visit, get their medications, and go home without a parent leaving work for several hours. Here in Pike County, it can take an hour to get from one side of the county to the other. Our road infrastructure is not the best in the world, and if you add foul weather conditions to it, it can be enough to stop someone from getting health care. Whatever is going on with the child, whether it’s a need for specialty care or just a simple well-child visit, our partners are really dedicated to improving access.  


How will your network emerge stronger from the pandemic? 

Kansas: During the pandemic, we worked closely with our partners in public health and even other hospitals. We have been focused on educating the public with facts about COVID-19 and getting as much of our population vaccinated as possible, and we really came together to do that. The pandemic also pushed us hard to get our overall telehealth network established. We are now doing behavioral health via telehealth in our emergency department and general telehealth inside two of our local school systems. That has been a phenomenal change for us. There was a learning curve, but it really pushed everybody to work together. Ironically, we can definitely say some fantastic things came out of the COVID-19 pandemic.  

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