The Upper Cumberland Primary Care Project is a 20 year old joint state/federal venture that operates 15 Community/Migrant Health Centers in 14 central Tennessee rural counties. The Project is fully integrated into the county health departments and shares facilities and resources with the Tennessee Department of Health. Comprehensive care through the life span is delivered by physician/mid-level teams who are able to offer a wide range of preventive, as well as, therapeutic primary care services, including: ambulatory adult and child primary care, family planning, specialized GYN and children' s clinics, home health, prenatal and HIV co-management, routine and restorative dental services, and extensive case management assistance.
Primary care centers were established in the Upper Cumberland region of Tennessee in the mid-1960s as part of the national "War on Poverty". Originally, clinics were staffed by National Health Service Corps providers under the auspices of "Project Concern", an independent not-for-profit organization based in California. The operation of the clinics was transferred to Tennessee Department of Health in the early 1970s when the first Appalachian Regional Commission (ARC) grant was awarded to the Department. The grant funded primary medical and dental operations in a five county area (Cumberland, Fentress, Overton, Pickett, and Putnam). In 1976, the first Rural Health Initiative (RHI) grant was awarded under Title 330 of the Public Health Services Act. This allowed services to be extended to Clay and Macon counties, with three more counties added the following year. As ARC allocations ended for the various sites, funding from the RHI program increased to offset the losses. All 14 county health departments of the Upper Cumberland region were recipients of RHI funding by 1981.
Throughout its history the Upper Cumberland Primary Care Project has allocated resources according to identified service gaps in each unique community. During 1985, specialty care districts were developed and strategically placed to serve as referral sources for the existing sites. Four physicians (2 OB/GYNs, 1 IM, and 1 FP) were recruited and practice sites established, making such care available for the first time in some pockets of the region. The following year, the RHI grant reached its maximum federal funding level of $1,244,955. Several years ago, the federal share of the Project' s funding decreased to $720,181.
Co-location of the primary care centers with public health facilities has been enormously advantageous as it has enabled the combined strengths of both public health and traditional primary care practice methodologies to produce a payoff that is greater than the sum of its parts. The result has facilitated the development of a health care delivery system at the lowest possible cost and has simplified patient case management and care coordination.
There are 15 facilities located in: Woodbury, TN (Cannon County), Celina, TN (Clay County), Crossville and Crab Orchard, TN (Cumberland County), Smithville, TN (DeKalb County), Jamestown, TN (Fentress County), Gainesboro, TN (Jackson County,) Lafayette, TN (Macon County), Livingston, TN (Overton County), Byrdstown, TN (Pickett County), Cookeville, TN (Putnam County), Carthage, TN (Smith County), Spencer, TN (Van Buren County), McMinnville, TN (Warren County), and Sparta, TN (White County).
County populations range in size from 4,500 to 75,000 and constitute just under 20% of the state' s population. Per capita personal income for the region ($14,665--with a range of $10,718 to $16,921) lags behind the state average but is projected to grow at a rate that is .1% ahead of projections for the state. All of the counties within the Upper Cumberland region are considered Medically Underserved Areas. Additionally, eight of the counties are designated Health Professional Shortage Areas; however, due to relatively high poverty levels, most of these specifications have been awarded based on federal population-in-poverty requirements (as opposed to the unconditional geographic requirements which rely predominately on physician to population ratios). The regional hub, Cookeville, is located along interstate I-40, approximately 80 miles east of Nashville. The region' s terrain is primarily mountainous and is marked by the Cumberland Plateau. There are 14 hospitals in the region with 9 active OB units and 1,013 staffed beds. Two counties, Pickett and Van Buren do not have hospitals within their county borders.
There are 222 full and part-time employees (including Regional Office staff in Cookeville) assigned to the Upper Cumberland region. Only 12% receive their salaries from the RHI budget, but all staff members are involved in the delivery or support of primary care services.
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