FINAL EVALUATION REPORT 

King’s Daughter’s Medical Center 

April 2014 
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FINAL EVALUATION REPORT 

King’s Daughter’s Medical Center

April 2014 

Acknowledgements 

This report was developed under grant #10SIHKY001 
King’s Daughter’s Medical Center 

Final Evaluation Report

Contents 

Executive Summary.................................................................................................................... 3 

Background ........................................................................................................................... 3 

Methods ............................................................................................................................... 3 

Results—Implementation ........................................................................................................ 3 

Results—Impact ..................................................................................................................... 4 

Discussion ............................................................................................................................. 4 

Recommendations ................................................................................................................. 4 

Background............................................................................................................................... 5 

Poor Health in Rural Eastern Kentucky....................................................................................... 5 

Overview of Project ................................................................................................................ 6 

Screenings............................................................................................................................. 7 

Education on Risk Factors ........................................................................................................ 7 

Cardiac Testing ...................................................................................................................... 8 

Referrals ............................................................................................................................... 8 

Timeline................................................................................................................................ 8 

Methods................................................................................................................................... 8 

Changes from Evaluation Plan .................................................................................................11

Results: Project Implementation .................................................................................................11

Screenings............................................................................................................................11

Cardiac Testing .....................................................................................................................12

Results: Project Outcomes and Impact .........................................................................................13

Discussion................................................................................................................................13

Recommendations ....................................................................................................................14

Bibliography.............................................................................................................................14

Appendix: Implementation and Impact Evaluation Tables ...............................................................14
 

Executive Summary 

Background 

Rural Eastern Kentucky counties have high poverty, low education, and low health insurance coverage, 

as well as a short supply of healthcare providers. These factors contribute to significant barriers to 

healthcare access in this area, which are associated with poor health outcomes, including obesity, 

smoking, physical inactivity, poor nutrition, and ultimately cardiovascular disease. 

The Mobile Health Services for Rural Kentucky project was a program designed to reduce premature 

death due to heart disease and other preventable diseases among residents of eight rural Eastern 

Kentucky counties within the Kings Daughters Medical Center catchment area (Elliott, Floyd, Johnson, 

Lewis, Magoffin, Martin, Morgan and Rowan). In order to accomplish this, the program aimed to 

increase access to health care, increase knowledge of controllable risk factors for heart disease, reduce 

unhealthy behaviors, and improve health outcomes. Activities planned included implementing a mobile 

service to provide free health screenings and education to the target population, provide fee-based 

cardiac testing for individuals found to be at-risk during screenings, and refer individuals screened and 

tested who need additional care to physicians for follow-up care. 

Methods 

Data collection for the Mobile Health Services for Rural Kentucky project began with development of an 

evaluation plan and obtaining Internal Review Board approval in April, 2013. Implementation evaluation 

data were collected from April, 2013 through September, 2013, when KHFI funding was ended. Impact 

evaluation was assessed through tracking referrals and it covers the time period of six months following 

the implementation period, from October, 2013 through March, 2014. Baseline data were collected for 

all participants screened from April, 2013 to September, 2013 and included an intake form before they 

received screening tests. Follow-up data were collected on only those individuals referred for follow-up 

care using a phone survey six months after they were screened, from October, 2013 to March, 2014. 

Results—Implementation 

During the implementation evaluation period, 50 heart and vascular screening days were held in 29 

unique screening sites throughout the eight target counties. Screening sites included grocery stores, 

pharmacies, and churches. During these events, 678 unique individuals were screened. Of the 

individuals screened, 92% were given information on heart health, tobacco cessation, and stroke. Of the 

678 individuals screened, 345 (51%) were found to have elevated levels of either blood pressure 

(systolic >=140 or diastolic >=90), elevated total cholesterol levels (240 or above), or elevated blood 

sugar (greater than 126 mg/dL). Of the 678 individuals screened, 122 (18%) were marked that follow-up 

care was needed based on screening results. However, an accurate number of those needing follow-up 

care is not available due incomplete data collection during screening and from cardiologists who also 

took part in making decisions about the need for follow-up care. 
Also during the implementation evaluation period, 1,091 people received a cardiac test from the Mobile 

Health Services for Rural Kentucky project. Of these individuals, program staff found that 57 (5%) had 

been previously screened on the mobile unit, as a part of the Mobile Health Services for Rural Kentucky 

project. This was found by program staff manually looking up each individual screened in the cardiac 

testing database. 

Results—Impact 

During the impact evaluation period, 25 individuals who were screened and referred for follow-up 

services were contacted via phone for completion of the follow-up survey by program staff. Of these, 8% 

said they saw a healthcare provider, as recommended. These two individuals were already on 

medication when they saw a provider, so were not recommended any further actions. These two 

individuals did indicate they would continue seeking care from the primary care physician they were 

referred to during the screening. 

Challenges to completing the evaluation plan included no or limited data availability due to the decision 

to end KHFI funding. Implementation data that was not collected includes information on the strength 

of the partnerships and perceptions of staff. Complete information on referrals made during screenings 

was also not collected by program staff. Impact data collected in limited number includes the follow-up 

survey. Medical record and outside provider data was not collected to provide follow-up data on health 

outcomes, such as blood pressure, blood sugar, and cholesterol. 

Discussion 

The Mobile Health Services for Rural Kentucky project was successful in promoting the screening and 

cardiac testing events through advertising in local newspapers and flyers placed in local businesses and 

public venues. The project also worked with partners to establish successful locations to hold screening 

and cardiac testing events with the mobile unit. However, the time period for data collection of 

implementation and impact was truncated due to the program’s decision to end KHFI funding. The small 

number of people reached for follow-up reduces the ability to make inferences regarding program 

effectiveness in ensuring that individuals with abnormal screening results received recommended 

follow-up care. 

Recommendations 

Recommendations for other programs interested in conducting a health screening and cardiac testing 

mobile unit project include that programs work with IT departments to establish procedures to 

electronically connect screening data to medical records. This will decrease the burden on staff to 

manually track referral information of screened individuals, as well as assist in monitoring information 

on screened individuals. 
Background 

Poor Health in Rural Eastern Kentucky 

Appalachian counties in Eastern Kentucky are high in poverty, low in educational attainment and have 

poor health outcomes. Rural isolation, lack of medical providers, and financial burden contribute to the 

problem of healthcare access in these counties. Rural areas in Kentucky often have a short supply of 

healthcare providers, and this can lead to low detection and treatment of chronic diseases. 

Socioeconomic issues of the eight rural Eastern Kentucky counties within the Kings Daughters Medical 

Center (KDMC) area (Elliott, Floyd, Johnson, Lewis, Magoffin, Martin, Morgan and Rowan counties) are 

presented with the selected indicators in Table 1.Median household income ranges from $22,097 

(Elliott) to $31,604 (Rowan), both lower than Kentucky and the nation. The poverty rate in the selected 

counties ranges from 22% (Johnson) to 37% (Elliott), both higher than the state and nation. All eight 

counties have lower rates of high school graduation or completing a GED than the state and nation. The 

percentage of adults under age 65 who are lacking healthcare coverage is higher in the selected counties 

than the state and nation, with a range of 23% (Johnson, Magoffin) to27% (Morgan). 

Table 1 Socioeconomic Indicators of Target Counties County Population < High school grad

Median 

Household 

Income

Poverty Level

Population 

Density 

(ppl/mile2)

Unemployed

Uninsured 

Adults (<65 ) 

Elliott 7,707 30% $22,097 37% 34 12% 26%

Floyd 39,207 31% $27,907 28% 100 10% 25%

Johnson 23,396 32% $30,820 22% 89 10% 23%

Lewis 13,878 34% $28,376 28% 29 14% 26%

Magoffin 13,216 34% $22,779 30% 43 16% 23%

Martin 12,751 35% $25,173 33% 56 10% 24%

Morgan 13,943 31% $30,229 24% 37 12% 27%

Rowan 23,582 23% $31,604 30% 83 9% 25%

Kentucky 4,369,356 19% $41,576 18% 110 10% 18%

U.S. 311,591,917 15% $51,914 14% 87 9% 16%

Source: U.S. Census Bureau, 2011 (population), 2006-2010 (education, income, and poverty), 2010 (density), 2009 (insurance) 

and Bureau of Labor Statistics, 2011 (unemployment). 

Eastern Kentucky counties have high risk factors for cardiovascular disease, as well as a high death rate 

due to cardiovascular disease. Many of the KDMC counties have higher rates than state and national 

rates for adult obesity, smoking, lack of physical activity, and cardiovascular disease deaths (Table 2). 
Table 2 Health Indicators of Adults for Target Counties Compared to Kentucky and U.S. 

County Obesity (%) Smoking rate (%) Lack of Physical 

Activity (%)

Heart Disease 

Deaths

(/ 100,000)

Elliott 44 28 41 139

Floyd 37 26 40 291

Johnson 41 18 33 298

Lewis 30 38 31 232

Magoffin 29 35 44 207

Martin 42 27 41 359

Morgan 34 39 33 216

Rowan 39 24 30 222

Kentucky 27 29 31 224

U.S. 27 18 25 251

Source: Kentucky data: kentuckyhealth facts.org, accessed 10/15/12. U.S. behavioral data: cdc.gov/brfss, accessed 10/15/12. 

U.S. heart disease data: Morbidity and Mortality 2012 Chartbook nhlbi.nih.gov, accessed 10/15/12. Behavioral data are from 

combined years 2008-2010 for counties and state and from 2009for U.S. Heart Disease data are from combined years: 2003 -

2007 for counties and from 2007 for U.S. 

Overview of Project 

In 2011, KDMC received funding from the Kentucky Healthy Futures Initiative (KHFI) to implement the 

Mobile Health Services for Rural Kentucky project. This project works to decrease premature death due 

to heart disease and other preventable diseases in the eight rural Eastern Kentucky counties of the 

KDMC area: Elliott, Floyd, Johnson, Lewis, Magoffin, Martin, Morgan and Rowan. The goal of this project 

is to reduce the risk of heart disease through screening, cardiac testing, education, and referral to 

physicians. The target population of this project is adults living in the eight counties, which are areas of 

high poverty, low insurance, and high risk factors for cardiovascular disease. 

Prior research provides evidence that mobile health care can be successful in providing health care 

services to rural populations. Findings show that mobile health clinics can be an alternative access to 

health care for medically underserved populations (Oriol, 2009), (Edgerley, 2007), (Diaz-Perez MJ, 2004). 

Earlier research provides a preliminary level of evidence that mobile health care can increase healthcare 

access, as well as improve health outcomes for participants. Individuals who visited a mobile health unit 

showed increased breast and cervical cancer screenings and influenza, pneumonia, and tetanus 

immunization rates. These participants also showed decreased emergency department use (Alexy BB, 

1998). 

The Mobile Health Services for Rural Kentucky project brings cardiologists, diagnostic services and free 

preventive health screenings into medically underserved counties in the KDMC catchment area. 

Individuals with heart disease and diabetes are identified through screenings, and those with high risk 

factors are assisted with connecting with either a local family practitioner or a cardiologist, and given 

diagnostic testing close to home, if needed. The project is operated on a mobile unit, and fixed locations 

for the cardiologist have been established in selected counties over the project period. 
Previously, KDMC provided mobile health services to selected counties using an older mobile van. A 

donation from a local Ashland foundation provided funding to cover the cost of a new mobile unit and 

KHFI funding has enabled KDMC’s current mobile health care work to grow by providing funds for 

equipment for the unit. With these resources, as well as staff and volunteers from KDMC, the Mobile 

Health Services for Rural Kentucky project was able to expand farther into Eastern Kentucky to provide 

access to diagnostic and cardiology services for the eight target counties’ residents. 

The overarching goal of the Mobile Health Services for Rural Kentucky project is to reduce premature 

death due to heart disease and other preventable diseases among the target population. The program’s 

objectives to accomplish this goal are to 1) increase access to health care; 2) increase knowledge of 

controllable risk factors for heart disease; 3) reduce unhealthy behaviors, such as smoking, physical 

inactivity, and lack of fruit and vegetable consumption; and 4) improve health outcomes, including 

decreases in high blood pressure, blood sugar, and cholesterol. 

The activities of the Mobile Health Services for Rural Kentucky project that were planned to reach the 

objectives above include the following strategies: 

1. Implement a mobile service to provide free health screenings to the target population in 

eight counties and provide education on controllable risk factors for heart disease. 

2. Provide fee-based cardiac testing for individuals found to be at-risk during screenings. 

3. Refer individuals screened and tested who need additional care to physicians. 

Screenings 

After production delays outfitting the mobile units, the first step of the project was holding screening 

events. The project proposed conducting at least one screening event in each of the eight target 

counties each month. It was planned that project staff would contact partners, such as pharmacies, and 

schedule to have the mobile health unit in the parking lot for screenings. Screenings would be 

advertised in the local newspapers and through the placement of flyers. Screenings would be free and 

open to anyone age 18 and older. At each screening, participants would fill out a screening form on their 

own or with help from KDMC staff, if needed. Screenings would include total cholesterol, random blood 

sugar, blood pressure, blood oxygen, and electrocardiogram (EKG) test. Results of the screenings would 

be delivered to the nearest KDMC cardiologist for review. 

Education on Risk Factors 

Screened participants would be given health education during the screening process, based on their risk 

factors and screening results. KDMC staff would provide each individual with written information that 

pertained to their specific heart disease risk factors. The health education provided would include: 

 Tobacco cessation 

 Physical activity 

 Nutrition 
 Cancer screening (gender specific) 

 Heart disease 

 Stroke 

 Diabetes 

Cardiac Testing 

Another piece of the planned project was to provide cardiac testing on the mobile health unit. Project 

staff would schedule days for the mobile unit to specifically provide cardiac testing in four of the target 

counties, twice per month. Individuals who needed cardiac testing would be referred to the mobile unit 

by their health care provider. Cardiac testing would include electrocardiography, echocardiography, 

ultrasound, Holter (ambulatory electrocardiography device) monitoring and stress testing. The mobile 

health unit would include a treadmill suite to allow for stress testing. 

Referrals 

The project also planned to include a component to refer at-risk individuals to health care providers for 

further care. First, individuals with abnormal results from the screening who need further care would 

receive assistance from KDMC staff to locate the appropriate provider for the follow-care they need and 

KDMC staff would send a follow-up letter reminding individuals to share their results with their 

healthcare provider. Second, for those needing assistance, KDMC staff would help schedule 

appointments. Finally, screening results would also be provided to a KDMC cardiologist for review and 

recommendations, such as follow up tests, appointments for cardiology or even referral to primary care 

provider. 

Timeline 

The Mobile Health Services for Rural Kentucky project began with funding from KHFI in October, 2011. 

However, the evaluation plan was not fully developed and approved until March, 2013. Internal Review 

Board (IRB) approval for evaluating the project occurred in February, 2013. With the approval of the 

evaluation plan and IRB, revised data collection forms were in place in April, 2013. Therefore, 

implementation evaluation covers the time period from April, 2013 to September, 2013, when KHFI 

funding was ended. Impact evaluation covers the time period of six months following the 

implementation period, from October, 2013 to March, 2014. 

Methods 

During year one of the evaluation of the Mobile Health Services for Rural Kentucky project, a preliminary 

level of evidence was expected to be attained because the program was in an early implementation 

stage. The evaluation of the implementation for the project was designed to document and monitor the 

processes involved with conducting activities. Data collection for this part of the evaluation includes 

collecting information on screenings held, individuals screened, and cardiac testing events and 

participants. 
The impact evaluation for the Mobile Health Services for Rural Kentucky project was designed to collect 

data to assess the initial effectiveness of the project. This includes data collection at the screenings and 

through follow-up that occurred six months after screening for those individuals who are referred based 

on results. 

Implementation and impact questions designed to help focus the evaluation of the project are shown 

below. These questions were established in the subgrantee evaluation plan approved in March, 2013. 

However, because implementation and impact data collection was a short period (six month each), 

some evaluation questions cannot be answered with available information. 

Implementation Questions 

1. Was Mobile Health Services for Rural Kentucky implemented as planned? 

a. How many community screening events were implemented and how many 

people received these services? 

b. How many people received education materials on controllable risk factors for 

heart disease? 

c. How many people received cardiac tests? 

2. How many individuals screened were found to be at-risk for coronary heart disease? 

3. Did those needing follow up care receive a referral to a physician? 

a. How many patients were referred? 

4. Is the Community Advisory Committee building and maintaining partnerships to help 

this project succeed? 

5. What factors contributed to successful program participation by individuals? 

6. What barriers prevented successful program participation by individuals? 

Impact Questions 

a. Confirmatory 

1. Did access to healthcare increase for individuals screened who were referred? 

a. Did referred individuals keep appointments they were referred to have? 

b. Were the reasons that referrals were made addressed during follow-up 

appointments for referred individuals? 

c. Did the referred individual take any action based on follow-up recommendations? 

d. Did the number of people with a primary care physician increase? 

2. Did knowledge of risk factors for heart disease increase among individuals screened who 

were referred? 

3. Did unhealthy behaviors decrease for individuals screened who were referred? 

b. Exploratory 

1. Did healthy outcomes increase for individuals screened who were referred?
a. Did blood pressure, blood sugar, cholesterol and EKG tests improve for referred 

individuals? 

2. Did hospital admissions decrease for referred individuals? 

a. Did cardiac hospital admissions decrease for referred individuals? 

b. Did hospital visits for non-emergency care decrease for individuals who were 

referred? 

The data collection methods used for the project are shown in Table 3. Baseline data was collected for 

all participants screened from April, 2013 to September, 2013 with a screening intake form before they 

received screening tests. This data was filled out by hand by the individual screened, or with assistance 

from the program staff or volunteers, if needed. These forms were sent to the evaluators and entered 

into an Access database. The program staff kept a recorded list of those individuals who were referred 

for follow-up care, based on screening results, and used this list to collect follow-up data. Follow-up data 

was collected using a phone survey six months after referred individuals were screened, from October, 

2013 to March, 2014. 

 Table 3: Data collection methods 

Method Sample Purpose How it was 

collected

# of respondents

Screening Intake 

Form

All patients 

screened

To get baseline 

and demographic 

data on screened 

individuals

Given by Mobile 

Health Unit 

staff/volunteers at 

time of screening 

(from April, 2013 to 

September, 2013)

678

Follow-up survey Individuals 

referred 

based on 

screening 

results

To identify if 

referred 

individuals 

received needed 

follow-up care; to 

identify if 

patients’ 

outcomes 

improved

Collected by project 

staff via phone calls

6 months after 

screening (from 

October, 2013 to 

March, 2014)

25
Changes from Evaluation Plan 

The evaluation plan stated that the follow-up survey would conducted by phone, email or a mail, 

depending on the individual’s preference indicated on the screening intake form. However, errors in 

addresses and people moving made it necessary to conduct follow-up surveys via phone only. 

The evaluation plan also stated that follow-up data would be collected through KDMC medical records, 

for those referred to KDMC physicians, and eventually contacts made with outside providers. However, 

medical record data was not readily available for project staff. Staff would need to get access to medical 

records, which they did not currently have. Conversations between the evaluation contractors, staff and 

KDMC IT took place during the early part of year one, but KDMC changes and the decision to not move 

forward with KHFI funding prevented further exploration into medical record access. 

Other changes in the evaluation of the project took place because of organizational changes and the 

ending of project participation, as described above. Funding ended for the evaluation contractor in 

September, 2013. Therefore, the focus group with project staff did not take place at the end of year one, 

as planned. Also, the planned partnership survey at the end of year one to assess if partnership helped 

build and strengthen the project did not take place. 

Results: Project Implementation 

Screenings 

The implementation evaluation period for the Mobile Health Services for Rural Kentucky project began 

in April, 2013. Screening data collection began at this time and continued through September, 2013. 

During this time period, 50 heart and vascular screening days were held in 29 unique screening sites 

throughout the eight target counties. Screening sites included grocery stores, pharmacies, and churches. 

During these events, 678 unique individuals were screened. Of these, 33% were male and 67% were 

female. Most individuals were between the ages of 40 and 64 years (59%) and were white/Caucasian 

(99%). Data on income and payment type shows that many screened individuals did not answer the 

income or payment type questions (36% and 21%, respectively). Of those individuals who did answer 

the income question on the screening intake form, 51% are above 200% of the federal poverty level 

(FPL), followed by 18% who are between 101% and 150% of the FPL . Most individuals had private 

insurance (54%), followed by 25% who had Medicare and 17% who did not have any insurance (selfpay). 

Individuals who were screened were given educational information and program staff discussed the 

information at that time. Of the 678 individuals screened, 92% were given information on heart health, 

tobacco cessation, and stroke, 91% were educated on diabetes, 7% were educated on physical activity, 

and 5% were provided information on nutrition. Educational bags were given to a small number of 

individuals screened (2%). 
Of the 678 individuals screened, 51% had elevated levels of either blood pressure (systolic >=140 or 

diastolic >=90), cholesterol (240 or above), or blood sugar (greater than 126 mg/dL).Following is a 

breakdown of the number and percent of screened individuals who had elevated blood pressure, 

cholesterol, or blood sugar. 

1. 38% (258/678) had high blood pressure 

2. 17% (116/678) had high cholesterol 

3. 9% (64/678) had high blood sugar 

Of the 678 individuals screened, program staff indicated that 18% (n=122) needed follow-up care. 

However, information on referrals made for these individuals is limited due to incomplete data. The 

revised screening in-take form included space for program staff to indicate if a follow-up appointment 

was made or if a referral was made to a doctor or other service, but this part of the form was not filled 

out by the program staff or volunteers during screenings. The evaluators began having discussions with 

the program administer about this issue, but these discussions were not completed due to the ending of 

KHFI and evaluation funding. Further, the need for follow-up care at times was decided by a cardiologist 

after review of screening results. These decisions are not included in the screening data. Therefore, an 

accurate number of screened individuals who needed follow-up care is not available. 

Cardiac Testing 

Implementation data collection for cardiac testing also began in April, 2013 and continued through 

September, 2013. During this time period, 1,091 people received a cardiac test from the Mobile Health 

Services for Rural Kentucky project. Of these people tested, 44% were male and 54% were female. 

Similar to those screened, the majority of individuals tested were between the ages of 40 and 64 years 

(49%) and most were white/Caucasian (96%). Most individuals receiving cardiac testing had private 

insurance (48%), followed by 33% who were covered by Medicare. Income data was not available from 

the cardiac testing data. 

Of the 1,091 people who received cardiac tests during the time period, program staff found that 55 (5%) 

had been screened as a part of the Mobile Health Services for Rural Kentucky project. This data was 

collected by program staff looking up each individual screened in a database provided from the cardiac 

testing department at KDMC. Program staff did not have direct access to KDMC medical records and 

were not able to identify a specific referral source for those patients receiving cardiac testing. Further, 

the cardiac testing database included services not limited to cardiac testing, such as surgery and 

specialist consultation. The data available to program staff was not categorized by services received. 

Instead notes were made in the database to identify what service was received, which was not always 

clear. The program evaluators and program staff met with the staff from the KDMC IT department to 

discuss getting access to KDMC medical records for more complete data availability, as well as electronic 

linkage of screening data medical records, including cardiac testing data. Progress was made with the IT 

group; plans were made to build a “department” for the Mobile Health Services for Rural Kentucky 

project that would enable program staff to enter all information from individuals screened that was 

collected with the new screening in-take form into a database within the KDMC medical records. The 
evaluators shared a listing of data elements needed, and the IT group started work on the “department” 

in May, 2013. However, this work was halted when IT revealed that a social security number or medical 

record number was needed in order to enter a new patient record in the KDMC medical record system. 

Screened individuals were not asked to provide social security numbers as a part of the project. 

Results: Project Outcomes and Impact 

The impact evaluation period for the Mobile Health Services for Rural Kentucky project began with 

follow-up data collection on individuals who were screened and referred. This data collection began in 

October, 2013 and continued through March, 2014. Twenty-five individuals who were screened and 

referred for follow-up services were contacted via phone for completion of the follow-up survey by 

program staff. Of these, 8% said they saw a healthcare provider, as recommended. These two 

individuals were already on medication when they a provider, so were not recommended to start any 

new medication, nor were they recommended to see a specialist. The two individuals did indicate that 

they would continue taking medication after seeing the healthcare provider. Also, the individuals stated 

they plan to continue seeking care from the primary care physician they saw based on the 

recommendation they received during the screening. 

Follow-up data is not available from KDMC medical records or outside providers, as planned in the 

evaluation plan. Work was started on medical record access for program staff and a specific 

“department” for entering screening data, so that screening data would be linked to all medical records 

in the KDMC system. This was not completed due to reasons described above. Contacting outside 

providers was planned as a “next step” in follow-up data collection, and the ending of KHFI funds 

prevented this from taking place. 

Discussion 

Results from the implementation evaluation of the Mobile Health Services for Rural Kentucky project 

show that screening events and individuals screened were implemented as planned. During the six 

month implementation data collection time period, 678 individuals were screened and most were 

provided with educational information that promoted heart health, tobacco cessation, and stroke 

prevention. During the time period, 1,091 people received cardiac tests and 57 of those tested had been 

screened through the project. 

The Mobile Health Services for Rural Kentucky project was successful in promoting the screening and 

cardiac testing events through advertising in local newspapers and flyers placed in local businesses and 

public venues. The project also worked with partners to establish successful locations to hold screening 

and cardiac testing events with the mobile unit. 

Data collected during screenings showed that 122 people were referred to have follow-up care based on 

screening results. However, detailed data regarding referrals made for follow-up appointments is not 

complete. Data collection forms were designed to collect information on the type of follow-care 

recommended based on screening results, but the information on the forms was not complete. 
The time period for data collection of implementation and impact was truncated due to the program’s 

decision to end KHFI funding. Follow-up data includes 25 individuals who completed screening and 

received referrals. This small number reduces the ability to make inferences regarding program 

effectiveness. 

Recommendations 

Based on the results of the evaluation of the Mobile Health Services for Rural Kentucky project, 

recommendations can be made for other programs interested in conducting a health screening and 

cardiac testing mobile unit project. 

Engaging with partners to establish a variety of locations for the mobile unit to be located for the 

screening and cardiac testing events can be a useful way to reach many people in different areas where 

healthcare providers are not available. This program was quite successful in engaging local populations 

and providing screening. 

The ability to confirm that referrals for follow-up care from screening are completed is a major challenge 

for programs such as the program that is the subject of this report. With the advent of Electronic 

Medical Records (EMR) it is theoretically possible to efficiently track individuals screened and capture 

referrals. However, the challenges of working with EMR systems are considerable and it is 

recommended that programs work with IT departments to establish procedures to electronically 

connect screening data to medical records. This will decrease the burden on staff to manually track 

referral information of screened individuals, as well as assist in monitoring information on screened 

individuals. 

Bibliography 

Alexy BB, E. C. (1998). Rural mobile health unit: outcomes. Public Health Nursing, 15 (1), 3-11.

Diaz-Perez MJ, F. T. (2004). A program to improve access to health care among Mexican immigrants in 

rural Colorado. J Rural Health, 20 (3), 258-64.

Edgerley, L. E.-S. (2007). Use of community mobile health van to increase early access to prenatal care. . 

Maternal andChild Health Journal, 11 (3), 235-9.

Oriol, N. C. (2009). Calculating the return on investment of mobile healthcare. . BMC Medicine, 7(27); 

electronic version:http://www.biomedcentral.com/1741-7015/7/27. 

Appendix: Implementation and Impact Evaluation Tables
Implementation 

Evaluation Questions

Indicator(s) Data (include quantitative & 

qualitative data as appropriate)

Explanation/context (e.g., is this more or 

less than expected? How is it significant? 

Were there issues with data availability, 

quality or completeness?)

1. Was Mobile Health 

Services for Rural 

Kentucky implemented as 

planned?

a. How many screening 

and screening events 

were implemented 

and how many 

people received 

these services?

b. How many people 

received education 

materials on 

controllable risk 

factors for heart 

disease?

c. How many people 

received cardiac 

tests?

1. # of screening days that occurred in each 

target county

2. # of unique screening locations

3. # of people screened

4. # people provided health and risk reduction 

education

a. # of people who received 

education: Heart

b. # of people who received 

education: Tobacco

c. # of people who received 

education: Stroke

d. # of people who received 

education: Diabetes

e. # of people who received 

education: Physical Activity

f. # of people who received 

education: Nutrition

g. # of people who received 

education: Other

5. # of people receiving cardiac testing

a. Of those who were referred from a 

screening on the mobile unit?

b. Of those who were referred from 

other providers?

1. 50

2. 29

3. 678 

4. # provided education 

a. 622 (Heart)

b. 622 (Tobacco)

c. 621 (Stroke)

d. 618 (Diabetes)

e. 47 (Physical Activity)

f. 46 (Nutrition)

g. 11 (Other)

5. 1,091

a. 57

b. Data not collected

The data is from six months of screenings, April, 

2013 to September, 2013. April, 2013 is when data 

collection began with revised screening in-take 

forms after IRB approval and evaluation plan 

approval. The number of screening days and 

individuals screened was on-target with program 

expectations. In 2009, the mobile unit program held 

42 screening events with 910 individuals screened, 

and 60 cardiac testing days with 1,394 individuals 

tested. It was difficult to get complete data on the 

reason individuals received cardiac testing (referral 

source). Cardiac testing data did not contain this 

information.

2. How many individuals 

screened were found to 

be at-risk for coronary 

heart disease?

1. # of individuals screened with abnormal test 

results for coronary heart disease risk 

factors

1. 344 had high blood pressure, 

cholesterol, blood sugar, or low 

blood oxygen.

a. 258 had high blood 

pressure (>=140/90)

b. 116 had high cholesterol

(>=240)

c. 64 had high blood 

sugar/diabetes(>126)

d. 1 had low blood oxygen

(<90%)
3. Did those needing 

follow up care receive a 

referral to a physician?

a. How many patients 

were referred?

a. # of individuals screened who 

were referred to a physician.

i. # of individuals who 

were referred for cardiac 

testing 

ii. # of individuals who 

were referred for other 

reasons

b. # of individuals screened who 

received assistance making an 

appointment

a. 122 individuals were marked as 

follow-up needed during 

screenings; 

b. Data not available

The revised screening in-take form included three 

spaces for program staff to complete follow-up 

information during screenings. These sections were 

1) if a follow-up appointment was with a healthcare 

provider, including provider name and date, 2) if the 

individual was referred to a provider, including the 

provider name, and 3) if the individual was referred 

to other healthcare. However, during the time 

period of data collection, this information was not 

completed by program staff. The evaluators 

initiated discussions with the program administrator 

about addressing this with program staff and 

volunteers conducting the screenings, but these 

discussions were not completed with the ending of 

the program. Further, the need for follow-up care at 

times was decided by a cardiologist after review of 

screening results. These decisions are not included 

in the screening data. Therefore, an accurate 

number of screened individuals who needed followup care is not available.

4. Is the Community 

Advisory Committee 

building and maintaining 

partnerships to help this 

project succeed?

a. # of partners who are members of the 

Community Advisory Committee

b. # of partners who feel Community Advisory 

Committee has helped project succeed

c. # of outside providers that KDMC is in agreement 

with to contact to get follow-up information on 

referred individuals

Data not available Due to the program ending the KHFI project prior to 

the end of the first year of the evaluation, the 

partnership survey that was due to be conducted in 

spring, 2014 was not completed. 

5. What factors 

contributed to successful 

program participation by 

individuals?

a. Elements of the program or surroundings that 

staff perceived as factors to successful program 

participation.

Data not available Due to the program ending the KHFI project prior to 

the end of the first year of the evaluation, the staff 

focus group that was due to be conducted in spring, 

2014 was not completed. 
6. What barriers 

prevented successful 

program participation by 

individuals?

a. Elements of the program or surroundings that 

staff perceived as barriers to successful program 

participation.

Data not available Due to the program ending the KHFI project prior to 

the end of the first year of the evaluation, the staff 

focus group that was due to be conducted in spring, 

2014 was not completed.
Impact Evaluation 

Questions Indicator(s) Data (include quantitative & qualitative data 

as appropriate)

Explanation/context (e.g., is this more or 

less than expected? How is it significant? 

Were there issues with data availability, 

quality or completeness?)

1. Did access to 

healthcare increase for 

screened individuals 

who were referred?

a. Did referred 

individuals keep 

appointments they 

were referred to have?

b. Were the reasons 

that referrals were 

made addressed 

during follow-up 

appointments for 

referred individuals?

c. Did the referred 

individual take any 

action based on 

follow-up 

recommendations? 

d. Did the number of 

people with a primary 

care physician 

increase?

1. #/% of individuals screened who 

were referred who saw a 

healthcare provider as 

recommended.

i. Measured by followup survey

ii. Measured by accessing 

KDMC medical records 

(for those who saw a 

KDMC provider)

iii. Measured by 

contacting outside 

providers

2. #/% of individuals referred 

whose follow-up care included 

recommendations to:

i. Take medicine

ii. See a specialist

iii. Other action

3. #/% of individuals referred who 

made changes based on followup care recommendations:

i. Started medicine

ii. Saw a specialist

iii. Other

4. #/% of referred individuals who 

are going to continue care with 

the primary care physician they 

were referred to

1. #/% of individuals screened who were referred 

who saw a healthcare provider as recommended

i. 2/25 (8%) (measured by follow-up 

survey)

ii. Not available

iii. Not available

2. #/% of individuals referred, who saw a provider 

as recommended, whose follow-up care included 

recommendations to:

i. 0/2 (0%) Take medicine

ii. 0/2 (0%) See a specialist

iii. 1/2 (50%) Other action (keep taking 

medicine)

3. #/% of individuals referred, who saw a provider 

as recommended, who made changes based on 

follow-up care recommendations:

i. 0/2 (0%) Started medicine

ii. 0/2 (0%) Saw a specialist

iii. 2/2 (100%) Other (continued medicine)

4. #/% of referred individuals, who saw a provider 

as recommended, who are going to continue care 

with the primary care physician they were referred 

to: 2/2 (100%)

Data is from follow-up surveys conducted six 

months after implementation data collection. 

Follow-up surveys were administered from October, 

2013 to March, 2014.

It was difficult for program staff to reach individuals 

who were referred due to errors in addresses and 

phone numbers that individuals listed on the 

screening intake form, as well as individuals moving 

or disconnected phone numbers.

While progress toward program staff getting access 

to KDMC medical records was made with meeting 

between program staff, IT, and evaluators, a barrier 

of IT requiring a social security number prevented 

this from being accomplished. Due to the program 

ending the KHFI project prior to the end of the first 

year of the evaluation, further progress was not 

made with accessing medical records or with 

contacting outside providers for follow-up data 

collection, which was planned to occur in later years 

of project funding. 

2. Did knowledge of risk 

factors for heart 

disease increase 

among individuals 

screened who were 

referred?

a. #/% of individuals screened 

who were referred who are 

aware of heart disease risk 

factors at baseline and 

follow-up.

a. At baseline, 228/678 (34%) were aware of all 

heart disease risk factors on screening in-take 

form.

At follow-up, 9/25 (36%) were aware of all heart 

disease risk factors on survey.

Specific individuals screened were not tracked 

through follow-up because of the limited time span 

of the project.
3. Did unhealthy 

behaviors change for 

individuals screened 

who were referred?

a. #/% of individuals screened who 

were referred:

i. Who are current smokers

ii. Who were physically active, 

such as running or walking, 

in the past month

iii. Who eat 5 or more servings 

of fruit and vegetables 

each day

a. At baseline, 

i. 121/678 (18%) Current smokers

ii. 432/678 (64%) Physically active in past 

month

iii. 48/678 (7%) Eat 5 or more servings of 

fruit and vegetables each day

b. At follow-up,

iv. 2/25 (8%) Current smokers

v. 14/25 (56%) Physically active in past 

month

vi. 0/25 (0%) Eat 5 or more servings of fruit 

and vegetables each day

Specific individuals screened were not tracked 

through follow-up because of the limited time span 

of the project.

4. Did healthy outcomes 

increase for individuals 

screened who were 

referred?

a. Did blood 

pressure, blood 

sugar, cholesterol 

and EKG tests 

improve for 

referred 

individuals?

a. #/% of referred individuals who 

have

i. Average blood pressure 

(120/80)

ii. Average blood sugar (70-126)

iii. Desirable cholesterol (under 

200)

iv. Normal EKG

a. At baseline, 

i. 110/678 (16%) Blood pressure is normal 

(<120/80)

ii. 384/678 (57%) Blood sugar is normal

(70-126)

iii. 342/678 (50%) have desirable 

cholesterol (<200)

b. Not available

Follow-up data not available due to ending of KHFI 

funding. 

5. Did hospital 

admissions decrease 

for referred 

individuals?

a. Did cardiac hospital 

admissions decrease 

for referred 

individuals? 

b. Did hospital visits 

for non-emergency 

a. Rate of hospital admissions for 

heart conditions for each 

target county

b. #/% of hospital admissions for 

non-emergency care for each 

target county.

From KY MONAHRQ 

a. Discharges for diseases and disorders of the 

circulatory system, 2011 (rate per 1,000 persons):

Elliot 19.6, Floyd 26.8, Johnson 32.3, Lewis 16.8, 

Magoffin 28.3, Martin 26.3, Morgan 22.8 and 

Rowan 25.5

b. All discharges, 2011 (rate per 1,000 persons):

Elliot 88.2, Floyd 199.1, Johnson 225.4, Lewis 85.5, 

Magoffin 207.1, Martin 176.9, Morgan 137.8 and 

Rowan 149.0

Follow-up data is not available (latest year available 

is 2011).
care decrease for 

referred individuals?