The scope and impact of mobile health clinics in the United States: a literature review

Stephanie W Y Yu, Caterina Hill, Mariesa L Ricks, Jennifer Bennet, Nancy E Oriol, Stephanie W Y Yu, Caterina Hill, Mariesa L Ricks, Jennifer Bennet, Nancy E Oriol

Abstract

As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.

Keywords: Chronic disease management; Community-clinical linkage; Cost-effectiveness; Health disparities; Mobile health clinics; Population health; Preventative care; Social determinants of health.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

All authors are current or former staff or volunteers at mobile health clinics.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. U.S. Department of Health and Human Services. Disparities. In: Health People 2020. U.S. Department of Health and Human Services. 2014. . Accessed 26 Mar 2017.
    1. Campos M, Olmstead-Rose L. Mobile Health Clinics: Increasing Access to Care in Central and Eastern Contra Costa County. Final report from La Piana Consulting: In; 2012.
    1. Clinic database. Mobile Health Map, Boston MA. 2016. . Accessed 16 May 2016.
    1. Aung K, Hill C, Bennet J, Song Z, Oriol N. The Emerging Business Models and Value Proposition of Mobile Health Clinics. . 2015; . Accessed 26 Mar 2017.
    1. Rodriguez KL, Appelt CJ, Young AJ, Fox AR. African American veterans' experiences with mobile geriatric care. J Health Care Poor Underserved. 2007;18(1):44–53. doi: 10.1353/hpu.2007.0016.
    1. Edgerley LP, El-Sayed YY, Druzin ML, Kiernan M, Daniels KI. Use of a community mobile health van to increase early access to prenatal care. Matern Child Health J. 2007;11(3):235–239. doi: 10.1007/s10995-006-0174-z.
    1. Guruge S, Hunter J, Barker K, McNally MJ, Magalhães L. Immigrant women's experiences of receiving care in a mobile health clinic. J Adv Nurs. 2010;66(2):350–359. doi: 10.1111/j.1365-2648.2009.05182.x.
    1. Iredale R, Hilgart J, Hayward J. Patient perceptions of a mobile cancer support unit in South Wales. Eur J Cancer Care (Engl) 2011;20(4):555–560. doi: 10.1111/j.1365-2354.2011.01247.x.
    1. Kisilevzky N, Elkis H. Provision of a mobile uterine artery embolization service to medically underserved areas in Brazil. J Vasc Interv Radiol. 2011;22(4):490–496. doi: 10.1016/j.jvir.2010.12.012.
    1. Hill CF, Powers BW, Jain SH, Bennet J, Vavasis A, Oriol NE. [*joint first authors]. Mobile health clinics in the era of reform. Am J Manag Care. 2014;20(3):261–264.
    1. Alvi RA, Justason L, Liotta C, Martinez-Helfman S, Dennis K, Croker SP, Leiby BE, Levin AV. The Eagles Eye Mobile: assessing its ability to deliver eye care in a high-risk community. J Pediatr Ophthalmol Strabismus. 2015;52(2):98–105. doi: 10.3928/01913913-20150216-02.
    1. Morano JP, Zelenev A, Walton MR, Bruce D, Altice FL. Latent tuberculosis infection screening in foreign-born populations: A successful mobile clinic outreach model. Am J Public Health. 2014;104(8):1508–1515. doi: 10.2105/AJPH.2014.301897.
    1. Morano JP, Zelenev A, Lombard A, Marcus R, Gibson Bam Altice FL. Strategies for Hepatitis C Testing and Linkage to Care for Vulnerable Populations: Point-of-Care and Standard HCV Testing in a Mobile Medical Clinic. J Community Health. 2014;39(5):922–934. doi: 10.1007/s10900-014-9932-9.
    1. Hill C, Zurakowski D, Bennet J, Walker-White R, Osman JL, Quarles A. Oriol. N. Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities. Am J Public Health. 2012;102(3):406–410. doi: 10.2105/AJPH.2011.300472.
    1. Mayernik D, Resick LK, Skomo ML, Mandock K. Parish nurse-initiated interdisciplinary mobile health care delivery project. J Obstet Gynecol Neonatal Nurs. 2010;39:227–234. doi: 10.1111/j.1552-6909.2010.01112.x.
    1. Diaz-Perez Mde J, Farley T, Cabanis CM. A program to improve access to health care among Mexican immigrants in rural Colorado. J Rural Health. 2004;20(3):258–264. doi: 10.1111/j.1748-0361.2004.tb00037.x.
    1. Nuttbrock L, McQuistion H, Rosenblum A, Magura S. Broadening perspectives on mobile medical outreach to homeless people. J Health Care Poor Underserved. 2003;14(1):5–16. doi: 10.1353/hpu.2010.0831.
    1. Viera AJ, Thorpe JM, Garrett JM. Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data. BMC Health Serv Res. 2006;6:15. doi: 10.1186/1472-6963-6-15.
    1. Mandal A. Disparities in Access to Health Care. In: News Medical: Health News and Information. . 2014. . Accessed 26 Mar 2017.
    1. Bouchelle Z, Rawlins Y, Hill C, Bennet J, Perez L, Oriol N. Respect, Relationship-Building, and Preventative Health: Service Delivery on a Mobile Health Clinic. [Unpublished manuscript]. 2015.
    1. Kullgren JT, McLaughlin CG, Mitra N, Armstrong K. Nonfinancial barriers and access to care for U.S. adults. Health Serv Res. 2012;47(1 pt 2):462–485. doi: 10.1111/j.1475-6773.2011.01308.x.
    1. Agency for Healthcare Research and Quality. National healthcare disparities report. U.S. Department of Health and Human Services. 2010. . Accessed 26 Mar 2017.
    1. Jupka KA, Weaver NL, Sanders-Thompson VL, Caito NM, Kreuter MW. African American adults’ experiences with the health care system: in their own words. J Health Dispar Res Pract. 2008;2(3):17–32.
    1. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academics Press; 2003.
    1. Clark CR, Soukup J, Govindarajulu U, Riden HE, Tovar DA, Johnson PA. Lack of access due to costs remains a problem for some in Massachusetts despite the state’s health reforms. Health Aff (Millwood). 2011;30(2):247–255. doi: 10.1377/hlthaff.2010.0319.
    1. Viswanathan M, Kraschnewski JL, Nishikawa B, Morgan LC, Honeycutt AA, Thieda P, Lohr KN, Jonas DE. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48(9):792–808. doi: 10.1097/MLR.0b013e3181e35b51.
    1. Scisney-Matlock M, Bosworth HB, Giger JN, Strickland OL, Harrison RV, Coverson D, Shah NR, Dennison CR, Dunbar-Jacob JM, Jones L, Ogedegbe G, Batts-Turner ML, Jamerson KA. Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans. Postgrad Med. 2009;121(3):147–159. doi: 10.3810/pgm.2009.05.2015.
    1. Bloch MJ, Betancourt J, Green A. Overcoming racial and ethnic disparities in blood pressure control: a patient-centered approach to cross-cultural communication. J Clin Hypertens (Greenwich) 2008;10(8):589–591. doi: 10.1111/j.1751-7176.2008.08046.x.
    1. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems: a systematic review. Am J Prev Med. 2003;24(3 suppl):68–79. doi: 10.1016/S0749-3797(02)00657-8.
    1. Song Z, Hill C, Bennet J, Vavasis A, Oriol NE. Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use. Health Aff (Millwood). 2013;32(1):36–44. doi: 10.1377/hlthaff.2011.1392.
    1. Fayanju OM, Kraenzle S, Drake BF, Oka M, Goodman MS. Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program. Am J Surg. 2014;208(3):425–434. doi: 10.1016/j.amjsurg.2014.03.005.
    1. Maxwell J, Cortes DE, Schneider KL, Graves A, Rosman B. Massachusetts’ health care reform increased access to care for Hispanics, but disparities remain. Health Aff (Millwood). 2011;30(8):1451–1460. doi: 10.1377/hlthaff.2011.0347.
    1. Long SK, Masi PB. Access and affordability: an update on health reform in Massachusetts, fall 2008. Health Aff (Millwood) 2009;28(4):w578–w587. doi: 10.1377/hlthaff.28.4.w578.
    1. Devoe JE, Baez A, Angier H, Krois L, Edlund C, Carney PA. Insurance + access not equal to health care: typology of barriers to health care access for low-income families. Ann Fam Med. 2007;5(6):511–518. doi: 10.1370/afm.748.
    1. Callahan TL, Caughey AB. Why a Van?: Identification of critical factors determining the necessity of a mobile unit in the success of The Family Van Program. Policy Analysis Exercise submitted in partial fulfillment of the requirements for the Masters in Public Policy from the Harvard Kennedy School of Government. 1995;
    1. Hamilton EL, Wallis MG, Barlow J, Cullen L, Wright C. Women's views of a breast screening service. Health Care Women Int. 2003;24(1):40–48. doi: 10.1080/07399330390170015.
    1. Diao W, Patel J, Snitzer M, Pond M, Rabinowitz MP, Ceron G, Bagley K, Dennis K, Weiner R, Martinez-Helfman S, Maria KS, Burke B, Aultman WB, Levin AV. The Effectiveness of a Mobile Clinic in Improving Follow-up Eye Care for At-Risk Children. J Pediatr Ophthalmol Strabismus. 2016;53(6):344–348. doi: 10.3928/01913913-20160629-04.
    1. Evans K, Lerch S, Boyce TW, Myers OB, Kocher E, Cook LS, Sood A. An Innovative Approach to Enhancing Access to Medical Screening for Miners using a Mobile Clinic with Telemedicine Capability. J Health Care Poor Underserved. 2016;27(4A):62–72. doi: 10.1353/hpu.2016.0182.
    1. Dasgupta S, Kramer MR, Rosenberg ES, Sanchez TH, Reed L, Sullivan PS. The Effect of Commuting Patterns on HIV Care Attendance Among Men Who Have Sex With Men (MSM) in Atlanta. Georgia JMIR Public Health Surveill. 2015;1(2):e10. doi: 10.2196/publichealth.4525.
    1. Kennedy S, Grewal M, Roberts EM, Steinauer J, Dehlendorf C. A qualitative study of pregnancy intention and the use of contraception among homeless women with children. J Health Care Poor Underserved. 2014;25(2):757–770. doi: 10.1353/hpu.2014.0079.
    1. Harris DE, Hamel L, Aboueissa AM, Johnson D. A cardiovascular disease risk factor screening program designed to reach rural residents of Maine. USA Rural Remote Health. 2011;11(3):1–15.
    1. Carmack HJ. “What happens on the van, stays on the van”: the (re)structuring of privacy and disclosure scripts on an Appalachian mobile health clinic. Qual Health Res. 2010;20(10):1393–1405. doi: 10.1177/1049732310372618.
    1. Kahn RH, Moseley KE, Thilges JN, Johnson G, Farley TA. Community-based screening and treatment for STDs: results from a mobile clinic initiative. Sex Transm Dis. 2003;30(8):654–658. doi: 10.1097/01.OLQ.0000083892.66236.7A.
    1. Carmack HJ, Bouchelle Z, Rawlins Y, Bennet J, Hill C, Oriol NE. Mobilizing a narrative of generosity: patient experiences on an urban mobile health clinic. Commun Q. 2017; 10.1080/01463373.2017.1279677.
    1. Chen YR, Chang-Halpenny C, Kumarasamy NA, Venegas A, Braddock CH. Perspectives of mobile versus fixed mammography in Santa Clara County California: A focus-group study. Cureus. 2016;8(2):e494.
    1. Keller A. United Way estimates cost of helping children $100M. WNEM News (Meredith Corporation). 2016. . Accessed 26 Mar 2017.
    1. Hanna-Attisha M, LaChance J, Sadler RC, Schnepp AC. Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. Am J Public Health. 2016;106(2):283–290. doi: 10.2105/AJPH.2015.303003.
    1. Johnson J. Medical mobile unit will help aid Flint children exposed to lead in water. MLive Media Group. 2016; . Accessed 26 Mar 2017
    1. Allen R. Mobile doctor's office arrives in Flint from NYC. Detroit Free Press. 2016; . Accessed 26 Mar 2017
    1. Prevention N. Health Promotion, and Public Health Council. Department of Health and Human Resources: National Prevention Strategy. U.S; 2011.
    1. U.S. Department of Health and Human Services. HHS Action Plan to Reduce Racial and Ethnic Health Disparities. U.S. Department of Health and Human Services. 2011. . Accessed 26 Mar 2017.
    1. Health Disparities Council. A Framework for Eliminating Health Disparities in the Commonwealth of Massachusetts. U.S. Department of Health and Human Services. 2011. . Accessed 26 Mar 2017.
    1. Post PA. Mobile Health Care for Homeless People: Using vehicles to extend care. National Health Care for the Homeless Council. 2007; . Accessed 26 Mar 2017
    1. Liebman J, Pat LM, Altice F. Effectiveness of a mobile medical van in providing screening services for STDs and HIV. Public Health Nurs. 2002;19(5):345–353. doi: 10.1046/j.1525-1446.2002.19504.x.
    1. Robinowitz N, Smith ME, Serio-Chapman C, Chaulk P, Johnson KE. Wounds on Wheels: Implementing a Specialized Wound Clinic within an Established Syringe Exchange Program in Baltimore. Maryland Am J Public Health. 2014;104(11):2057–2059. doi: 10.2105/AJPH.2014.302111.
    1. Drake BF, Abadin SS, Lyons S, Chang SH, Steward LT, Kraenzle S, Goodman MS. Mammograms on-the-go—predictors of repeat visits to mobile mammography vans in St Louis, Missouri, USA: a case–control study. BMJ Open. 2015;5(3):e006960. doi: 10.1136/bmjopen-2014-006960.
    1. Atkins E, Madhavan S, LeMasters T, Vyas A, Gainor SJ, Remick S. Are obese women more likely to participate in a mobile mammography program? J Community Health. 2013;38(2):338–348. doi: 10.1007/s10900-012-9619-z.
    1. Ellen JM, Bonu S, Arruda JS, Ward MA, Vogel R. Comparison of clients of a mobile health van and a traditional STD clinic. J Acquir Immune Defic Syndr. 2003;32(4):388–393. doi: 10.1097/00126334-200304010-00007.
    1. Garbers S, Friedman A, Martinez O, Scheinmann R, Bermudez D, Silva M, Silverman J, Chiasson MA. Adapting the Get Yourself Tested Campaign to Reach Black and Latino Sexual-Minority Youth. Health Promot Pract. 2016;17(5):739–750. doi: 10.1177/1524839916647329.
    1. Jani JS, Tice C, Wiseman R. Assessing an Interdisciplinary Health Care Model: The Governor's Wellmobile Program. Soc Work Health Care. 2012;51(5):441–456. doi: 10.1080/00981389.2012.660566.
    1. O'Connell E, Zhang G, Leguen F, Prince J. Impact of a mobile van on prenatal care utilization and birth outcomes in Miami-Dade County. Matern Child Health J. 2010;14(4):528–534. doi: 10.1007/s10995-009-0496-8.
    1. Tso LS, Best J, Beanland R, Doherty M, Lackey M, Ma Q, Hall BJ, Yang B, Tucker JD. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS. 2016;30(10):1639–1653. doi: 10.1097/QAD.0000000000001101.
    1. Division for Heart Disease and Stroke Prevention. High Blood Pressure and Cholesterol Out of Control. In: CDC Vital Signs. National Center for Chronic Disease Prevention and Health Promotion, CDC. 2011. . Accessed 26 Mar 2017.
    1. Connolly NEB, Concha JB, English J. Mobile Health Is Worth It! Economic Benefit and Impact on Health of a Population-Based Mobile Screening Program in New Mexico. Telemed J E Health. 2014;20(1):18–23. doi: 10.1089/tmj.2013.0080.
    1. LTP Medical Mobile Inc., The Health Hut. [Unpublished data]. 2015.
    1. Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report. In: Morbidity and Mortality Weekly Report. U.S. Department of Health and Human Services. 2013. . Accessed 26 Mar 2017.
    1. Irwin A, Scali E. Actions on the social determinants of health: Learning from previous experiences. Discussion Paper Series on Social Determinants of Health. Commission on Social Determinants of Health, World Health Organization: In; 2010.
    1. Taylor LA, Coyle CE, Ndumele C, Rogan E, Canavan M, Curry L, Bradley EH. Leveraging the social determinants of health: What works? Blue Cross Blue Shield of Massachusetts Foundation. 2015.
    1. Boston University School of Medicine Outreach Van Project: Project History. (2016). Accessed 26 Mar 2017.
    1. Barr P. Hospitals rev up use of mobile care. Hosp Health Netw. 2014;88(5):20.
    1. Auerbach J. The 3 Buckets of Prevention. J Public Health Manag Pract. 2016;22(3):215–218. doi: 10.1097/PHH.0000000000000381.
    1. Ojamaa LS, Calista J. Achieving Health Equity through Community-Clinical Linkages. In: January 2014 Summit, Massachusetts Partnership for Health Promotion and Chronic Disease Prevention, U.S. Department of Health and Human Services. 2014. . Accessed 26 Mar 2017.
    1. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010;26:1–31.
    1. Division of Health Care Finance and Policy, Commonwealth of Massachusetts. Massachusetts Health Care Cost Trends: Efficiency of Emergency Department Utilization in Massachusetts. Division of Health Care Finance and Policy, Commonwealth of Massachusetts. 2012. . Accessed 26 Mar 2017.
    1. Health Policy Commission, Commonwealth of Massachusetts. 2015 Cost Trends Report. Health Policy Commission, Commonwealth of Massachusetts 2016. . Accessed 26 Mar 2017.
    1. Berstein SL. Frequent emergency department visitors: the end of inappropriateness. Ann Emerg Med. 2006;48(1):18–20. doi: 10.1016/j.annemergmed.2006.03.033.
    1. Young GP, Wagner MB, Kellerman AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments. JAMA. 1996;276(6):460–465. doi: 10.1001/jama.1996.03540060036032.
    1. Billings J, Parikh N, Mijanovich T. Emergency department use in New York City: a substitute for primary care? Issue Brief (Commonw Fund) 2000;433:1–5.
    1. Howard MS, Davis BA, Anderson C, Cherry D, Koller P, Shelton D. Patients’ perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs. 2005;31(5):429–435. doi: 10.1016/j.jen.2005.06.023.
    1. Cunningham PJ. What Accounts for Differences in the Use of Hospital Emergency Departments Across U.S. communities? Health Aff (Millwood) 2006;25(5):w324–w336. doi: 10.1377/hlthaff.25.w324.
    1. Morphew T, Scott L, Li M, Galant SP, Wong W, Garcia Lloret MI, Jones F, Bollinger ME, Jones CA. Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program. Popul Health Manag. 2013;16(4):261–269. doi: 10.1089/pop.2012.0060.
    1. Farber JI, Korc-Grodzicki B, Du Q, Leipzig RM, Siu AL. Operational and quality outcomes of a mobile acute care for the elderly service. J Hosp Med. 2011;6(6):358–363. doi: 10.1002/jhm.878.
    1. Hines AL, Barrett ML, Jiang HJ, Steiner CA. Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011. In: Statistical Brief #172. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 2014. . Accessed 26 Mar 2017.
    1. Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol. 2010;105(4):274–281. doi: 10.1016/j.anai.2010.07.012.
    1. Tolley G, Kenkel D, Fabian R. Valuing Health for Policy: An Economic Approach. Chicago, IL: University of Chicago Press; 1994.
    1. Schmitt B. Highmark unveils mobile clinic. Tribune Review. 2016; . Accessed 26 Mar 2017
    1. Rosenbaum S, Margulies R. Tax-exempt hospitals and the Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Rep. 2011;126(2):283–286. doi: 10.1177/003335491112600220.
    1. Peek ME, Han J. Mobile mammography: assessment of self-referral in reaching medically underserved women. J Natl Med Assoc. 2007;99(4):398–403.
    1. DeBruhl ND, Bassett LW, Jessop NW, Mason AM. Mobile mammography: results of a national survey. Radiology. 1996;201(2):433–437. doi: 10.1148/radiology.201.2.8888236.

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