Small Health Care Provider Quality Improvement Program: Promise Community Health Center  

The Georgia Health Policy Center recently spoke to Stephanie Van Ruler, population health manager at the Promise Community Health Center (Sioux Center, Iowa), about how addressing social determinants of health has become a focal point of quality improvement. 


To date, what has been the biggest accomplishment or win in your program?  

The biggest win has been related to assessing our patient’s social determinant of health needs and beginning to connect with community resources to meet these needs. We have a really amazing partnership with our local food pantry. When we started with the grant three years ago, we began a partnership with our local food pantry in hopes of being able to provide some educational services and outreach to the clients who were coming through. We imagined this might look like doing some blood pressure screenings and providing nutritional information as people were getting their food boxes. For the first few months of partnering with them we were able to do those things.  

Then, the pandemic hit, and we were not really sure what was going to happen; however, we were able to continue on a weekly basis serving as a resource for food pantry clients. We were able to give out information about the COVID-19 pandemic and educate people on how to keep themselves and their families safe in an immediate and tangible way. When everybody else was separating from people, we were able to check in on people’s mental health status and provide them with telehealth options. It continued to build by providing resources on vaccinations and testing. We have been able to continue our partnership with them to address client barriers related to transportation. Currently, we are working on implementing a program for food box delivery. It has been incredible to see where things have gone and how it shifted from what we thought it was going to be. 


What is a tip or early learning that you would share with an organization launching a similar program?  

My biggest piece of advice is do not limit what you think something is going to be. If you had told me what this program was going to evolve into, I would not have believed you or thought that it would be as beneficial to our patients with chronic conditions as it is. Just be open to what you think something can be and can evolve to.  


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

This grant has been huge for helping us to meet broader health improvement goals. Assessing social determinants of health needs has taken a primary spot in our grant implementation and we have seen incredible health improvements in our chronic conditions by beginning to take small steps to improve these needs. We started with screening our patients who were meeting with our health coaches. We then added in new obstetric patients. However, we stopped shortly after because we were doing screenings and we did not have anything in place for what happens when a screening had positive needs identified and what local resources were available. Once we got those plans in place, we began adding in more patients we were screening. As of the first of the year we are screening every patient in the health center over the age of 18 annually. I would advise others to have that process in place; we kind of put the horse before the cart and needed to pause, back up and formulate a plan for responding to needs.  

We have seen incredible improvements in our patients’ chronic conditions. For many of our patients with uncontrolled chronic conditions we have been able to identify that there is a social need impacting their health outcomes and we are able to help them break down this barrier. We also have implemented a transportation program where we provide free transportation services to our patients to and from the health center.  


What will your organization be doing more of or differently to emerge stronger from the pandemic? 

I think we will emerge stronger by thinking outside of the box. Telehealth is a much more available option for our patients.  Previously it was just something that so many of us were hesitant to consider. We also are moving forward with increased screenings to help improve our identification of patients with mental health concerns. We ramped up and revised how we screen patients and who we screen for anxiety and depression.  

How we reach and communicate with our patients is another way we are emerging stronger. We are adding a texting platform for our patients. We have a lot of patients who want to be able to access their nurse and provider teams, health coaches, or social workers quickly and easily. The pandemic allowed us to look broadly at how we can make these improvements. 

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