Telehealth Network Grant Program - The organization proposes to establish the Rural Midwest Telehealth Nutrition Network to expand access to evidence-based nutrition services for adults living in rural and medically underserved communities. The project will serve adults with hypertension, prediabetes, diabetes, obesity, food insecurity, and other nutrition-related chronic disease risk factors, with a focus on Medicare, Medicaid, dual-eligible, uninsured, and underinsured populations. The service area includes rural communities in the Midwest that experience high rates of chronic disease, poverty, food insecurity, transportation barriers, provider shortages, and limited access to registered dietitians and nutrition services. Many residents in these communities face challenges that negatively affect their ability to manage chronic conditions, including limited access to healthy foods, long travel distances to care, medication affordability concerns, low health literacy, social isolation, and barriers related to aging and mobility. These factors contribute to poorer health outcomes, increased emergency department utilization, avoidable hospitalizations, and health inequities. The project will establish a telehealth nutrition network supported by two registered dietitians and one community health worker integrated within an existing population health infrastructure. Participants will receive individualized Medical Nutrition Therapy, nutrition assessments, telehealth counseling, chronic disease self-management education, food insecurity screening, social determinants of health assessments, care coordination, and referrals to community resources. Services will be delivered through a multidisciplinary model that includes care managers, pharmacists, primary care providers, and community-based organizations. The project will leverage telehealth technology, electronic health records, population health analytics, patient education resources, and remote patient monitoring tools to improve access to care and support patient engagement. Community partnerships will help address social needs by connecting participants to food assistance programs, medication assistance programs, transportation services, aging services, public health resources, and other local supports. Telehealth services will be available through video, telephone, and other accessible formats to reduce barriers associated with geography, transportation, mobility limitations, and workforce shortages. The project’s goals are to increase access to nutrition services, improve food security and resource connections, and strengthen self-management of hypertension and diabetes utilizing telehealth services. Anticipated outcomes include increased utilization of nutrition services, improved blood pressure and diabetes control, improved medicine adherence, enhanced chronic disease self-management skills, improved access to community resources, improved patient satisfaction, and reduced barriers to care. By integrating nutrition services with clinical and social care supports, the project will advance health equity and improve health outcomes for rural and underserved populations in the Midwest.
