Paula Hill-Collins

St. Mary’s Health Wagon, USA

Abstract Title: Mobile Telehealth in Appalachia: A Nurse Practitioner–Led Integrated Care Mode

Biography: Paula Hill-Collins, DNP, FNP-BC, PPCNP, FAANP, serves as Vice President and Clinical Director of St. Mary’s Health Wagon, the oldest mobile free clinic in the United States. A nationally respected nurse practitioner leader, she pioneered the ICCC model, bringing Starlink-powered telehealth and remote diagnostics to underserved Appalachian communities. She has been interviewed by national press and is widely recognized for her innovative rural health work. Dr. Hill-Collins has presented internationally, including speaking engagements at the World Health Organization and the United Nations, and continues to champion health equity, women’s health, and advanced practice nursing across Central Appalachia.

Research Interest: Background: Rural Central Appalachia faces some of the most persistent health inequities in the United States—one of the few high-income nations without universal health coverage. This lack of universal access further compounds barriers created by geographic isolation, clinician shortages, and poverty. The Health Wagon—the oldest mobile free clinic in the nation—implemented the Integrative Comprehensive Care Collective (ICCC), a nurse-led model strengthened through Starlink satellite connectivity and Tyto remote diagnostic devices to overcome both digital and geographic barriers. Purpose: To evaluate whether a digitally enabled, nurse-led mobile care system improves access, chronic disease management, and patient engagement in remote regions lacking broadband infrastructure and financial access to specialty and primary care. Methods: A mixed-methods evaluation (2020–2024) analyzed outcomes for patients receiving Starlink-supported telehealth and Tyto-facilitated remote assessments across mobile clinics and home-based monitoring programs. Data sources included electronic health records (n=3,100), remote exam uploads, specialty teleconsultation logs, provider documentation, and structured patient interviews conducted across multisite rural settings. Outcomes assessed included changes in chronic disease indicators, time-to-specialty access, patient engagement, and continuity of NP-led care. Findings: Starlink connectivity enabled real-time cardiology, pulmonology, dermatology, endocrinology, and behavioral telehealth services in mountain communities previously unreachable by traditional broadband. Tyto devices allowed nurse practitioners to conduct high-resolution cardiac, pulmonary, otoscopic, and dermatologic assessments during mobile visits and home monitoring. Patients enrolled in Starlink- and Tyto-supported care demonstrated a 28% improvement in HbA1c control, expedited specialty access, earlier detection of uncontrolled chronic disease, improved follow-up adherence, and strengthened continuity of care. Patients also reported reduced transportation barriers and greater trust in telehealth. Conclusions: The ICCC model represents a plausible and scalable clinical innovation for rural health equity. By integrating mobile care, satellite internet, and remote diagnostic technology, this NP-led model provides a pathway toward universal-like access in a region without universal coverage and demonstrates the transformative potential of nurse-led digital health systems in underserved Appalachian communities. Keywords Rural telehealth; Nurse-led care; Satellite connectivity; Chronic disease management; Appalachian health equity