By Dan Heuchert

The National Institutes of Health have awarded the School of Nursing a five-year, $1.4 million grant to establish a Rural Health Care Research Center. The goal: find ways to improve health care for those living in rural Virginia — and beyond.

Residents of rural areas face many obstacles to receiving optimal health care, said Elizabeth Merwin, associate dean for research and professor of nursing, who will direct the center. They must travel longer distances to receive care — and should they require the services of a specialist, travel time is often even longer. Unemployment and uninsured rates also are higher in rural areas, she said.

Many rural Virginia residents must travel far distances to receive even routine health care. Because of this, patients are often sicker when they finally receive health care, thus raising mortality rates, lengthening hospital stays and causing more costly treatment.

“People do put off seeking care for financial reasons, as well as difficulties of transportation,” Merwin said. “It’s often a long trip, and you have to take a day off work to get specialty care.”

The result: patients are often sicker once they finally seek care, leading to higher mortality rates, longer hospital stays and more expensive treatments.

But there are some members of the health care community who are well-positioned to make a difference for those patients. “Nurses are providers who are available in every community,” she said, “and usually it will be nurses who totally know that community.”

The center’s mission is to examine and test new methods of extending health care to rural areas, often seeking ways to employ the latest technology. Center-funded researchers will work across disciplinary lines to conduct their research.

One of the center’s first grants will go to Bonnie Jerome D’Emilia, assistant professor of nursing and the Nursing School’s distance-learning coordinator, for mammography training.

There is a trend among African-American women in rural areas to not seek mammography screening as recommended. Consequently, they have higher rates of mortality from breast cancer because they are diagnosed at later stages.

Similar to a North Carolina program that trains lay people to talk up the benefits of mammography in rural communities, D’Emilia and her husband, Richmond-based surgical oncologist John D’Emilia, plan to train rural nurses to educate their patients on the importance of getting regular mammograms. The six-week training, they say, will be delivered live from the University to rural community health centers via an online telemedicine link. The couple then will collect data to see if the additional efforts have an effect.

“We’re hoping that if this works, it will be a way to connect in the future for other training,” Ms. D’Emilia said.

The center is funding another study, which focuses on using hand-held computers to screen patients for depression while they sit in caregivers’ waiting rooms.

Inspired by an electronic self-ordering system at a fast-food convenience store, Sarah Farrell, associate professor of nursing, saw a way to use technology to address a major need. A World Health
Organization study identified depression as the No. 2 source of “disease burden,” though it largely goes undiagnosed.

“My work is saying that there are people out there with depression who could be treated, and if treated effectively, could be more productive,” said Farrell, whose research team will include Dr. John Schorling, a U.Va. Primary Care Center doctor; Tim Sigmon, who heads the Advanced Technology Group in the University’s Division of Information Technology and Communications; Stephanie Guerlain, an assistant engineering professor who specializes in human-computer interfaces; and associate nursing professor Emily Hauenstein, an expert on depression in rural areas.

The center is funded by the National Institute of Nursing Research through June 2009, and continues the School of Nursing’s long-standing interest in caring for rural residents, said Dean Jeanette Lancaster.

“The center is yet another important step forward in meeting the goals of both the School of Nursing and the University in providing more informed services to people who live in rural areas,” she said. “Our
researchers believe that many of the health care practices and interventions that are successful in tertiary care settings can be used in rural areas.”

The grant also helps accelerate another trend at the Nursing School. The school jumped from 28th to 16th in the national rankings of nursing schools receiving NIH funds in fiscal 2003.

“I am thrilled and so pleased that our faculty have been so successful,” Lancaster said. “This is especially noteworthy since we have a small faculty compared to our peers who have gotten more grants.” The Nursing School has about 25 full-time faculty with doctoral preparation — a typical prerequisite for NIH funds, she added.