Hawaii Rural Health Interdiciplinary Training Demonstration Project

The focus of this project is to develop interdisciplinary, collaborative and culturally appropriate family medicine residency, nursing and allied health professions training in rural Hawaii. The project and training are paired with the goal of reducing health disparities and improving access to culturally appropriate care for native Hawaiians and underserved populations. Hawaii is a state that is geographically isolated and has an uneven distribution of physicians and health care providers. Most health care providers are clustered around tertiary care hospitals in Honolulu. Likewise, medical education and health professional training sites are largely limited to O'ahu with the exception of associate-level nursing programs in the community college system. Thirty percent of the population are scattered on the remaining isolated and rural neighbor islands. Native Hawaiians represent 20% of the population, and carry a disproportionate burden of disease. For example, native Hawaiians have rates of type II diabetes that are four times higher than the US standard population, and mortality rates from diabetes eight times that of non-Hawaiians. Failure to address these disparities will lead to significant health care costs for state and federal governments in the future. This project relies on the development of a partnership between the Hilo Medical Center, community, and the University of Hawaii Department of Family Medicine and Community Health. Together they plan to develop an ACGME-accredited three year Rural Family Medicine training program that emphasizes native Hawaiian health. This program will catalyze a broader interdisciplinary training collaborative to develop culturally-appropriate and accessible care, as well as community-appropriate strategies for training nursing, social work, nutrition, and other allied health professionals. The focus will be on improving hospital-community collaboration and team care for native Hawaiians and underserved persons with chronic illness in order to reduce health disparities.