Mobile health clinics in a rural setting: a cost analysis and time motion study of La Clinica in Oregon

Abstract

BACKGROUND: Mobile Health Clinics (MHCs) are an alternate form of healthcare delivery that may ameliorate current rural-urban health disparities in chronic diseases and have downstream impacts on the health system by reducing costs. Evaluations of providers' time allocation on MHCs are scarce, hindering knowledge transfer related to MHC implementation strategies. METHODS: Retrospective economic cost was assessed using business ledgers and expert assessments in 2023 US Dollar (USD) from 2022 to 2023. Time motion observational study assessed nurse practitioner (NP) and community health worker (CHW) time allocation and compared them between patients residing in isolated rural areas and patients experiencing houselessness (PEH) sub-populations. Procedure codes were assessed retrospectively for each patient encounter (n = 1,981) over one year (April 2022 to April 2023). RESULTS: Intervention start-up and operational costs totaled 275,000USD and 308,000USD, respectively, with the largest allocations to the modified recreational vehicle (RV) unit and labor. NP attributed 32% of time on direct care, 38% on indirect care, and 21% on MHC tasks. CHW spent 47% of time on MHC tasks, 22% on medical care tasks, and 22% on social needs tasks. Of all procedures, 31.3% were vaccinations, 27.0% were Covid-19 related, 12.8% were outside referrals, and 11.8% were point of care testing. CONCLUSION: Patient sub-populations require varying provider time in different tasks and variable economic resources for interventions.