Bridging the gap: Collaboration brings lifesaving care to communities across Kentucky.

The first patient admitted to the University of Kentucky Albert B. Chandler Hospital on April 24, 1962 (known as University Hospital at the time) was a young girl from Pikeville who was born with patent ductus arteriosus, a congenital heart defect.

While cardiovascular medicine has evolved significantly in the 60 years since, the need for services — particularly in rural Kentucky — has only grown.  

The latest data from the U.S. Census Bureau estimates that 40.6 percent of Kentucky’s population resides in rural areas, yet fewer than 10 percent of physicians practice outside of urban settings. Coupled with the higher rate of cardiovascular mortality found in rural communities, there is a clear need to enhance access to care. 

From Paducah to Middlesboro and Ashland to Owensboro, the Gill Heart & Vascular Institute Affiliate Network, with its 27 hospitals, is tackling the issue. It’s a collaboration that enables more patients to receive care in their own communities while their local hospitals improve or expand cardiovascular services with support from the network. It also provides vital access to more comprehensive care when needed. 

“Working collaboratively, we are really able to have an impact across the state,” said Dr. Vincent Sorrell, chief of the Division of Cardiovascular Medicine. “We are able to support the smaller hospitals with services they may not have the resources to bring in on their own, provide guidance while they develop new clinical services and streamline referrals when more complex care is necessary.” 

Network Connections Continue to Grow  

As an early member of the network, Georgetown Community Hospital and its patients have experienced the advantages of being connected to a larger collective of cardiovascular healthcare providers.  

“Our patients appreciate and find comfort in knowing that they have the benefit of care from a leading academic medical center when and if needed,” said a member of one affiliate hospital. “Our physicians and staff gain access to leading-edge care and best practices from an education standpoint.” 

Rural Kentuckians, who often must travel to see a primary care physician, face even greater challenges in accessing specialists.

“Kentucky has the unenviable status of having one of the nation’s highest rates of heart disease,” said Dr. Navin Rajagopalan, director of the Gill Heart & Vascular Institute Affiliate Network. “Heart care has improved in the 10 years since the affiliate network began, and it’s imperative that we continue to develop new programs that connect us with people throughout the state.” 

As connections have continued to grow and the network has evolved, it has moved from a pull to a push organization, said Rebecca Craft, director of Cardiovascular Outreach Operations and manager of the affiliate network. “In the past, affiliates primarily reached out to us when they needed assistance. Now, we proactively bring new services, education and opportunities directly to them, helping support their cardiovascular programs.”  

Nurse liaison program streamlines care between facilities 

In 2024, the network introduced its nurse liaison program, designed to provide a seamless, concierge-level referral experience for affiliate hospitals and their patients.

“It’s truly personalized service,” Craft said. “Hospitals can email, fax or call our liaison, who then coordinates outpatient appointments across cardiology, vascular surgery, cardiothoracic surgery and cardiac imaging. She personally reaches out to patients to ensure they have everything they need for a smooth and positive experience when they arrive.” 

More than 300 referrals were received between June and December. The nurse liaison also tracks metrics, such as patient touchpoints (pre- and post-appointment calls with patients, record requests and other communication), and logged 1,170 touchpoints in the same time period. 

Quality metrics making their mark  

A focus on quality metrics is also beginning to show results, Craft said. For example: 

•Door In – Door Out Time (the time for a STEMI patient to arrive at a hospital and be transferred to the next point of care) – has dropped an average of 11 minutes since the first reporting period. 

•Door-to-ECG Time – (for all patients experiencing chest pain) – has improved, now exceeding the 75 percent goal of completing ECGs in 10 minutes or less.  

•Heart Failure Readmissions – rates have decreased 1 percent, bringing the network below its goal of 20 percent and helping ensure better patient outcomes while reducing the burden on healthcare resources. 

•Cardiac Rehab Referrals – have exceeded the network’s initial goal of 75 percent of patients following a cardiac event such as a heart attack or a procedure. Referrals for post-PCI patients increased by 6.3 percent and referrals for AMI patients rose by 28.1 percent. The goal has now been raised to 92 percent, which aligns with the 50th percentile benchmark set by national standards. 

Educational offerings expand  

The evolution of cardiovascular care guidelines and protocols and advancements in technology and treatment are among the key reasons that education remains a priority. The network’s annual affiliate conference, with 239 attendees and 52 exhibitors in 2024, included sessions on standardization practices, updates in cardiometabolic disease and aortic disease, research, building a cardiac device clinic and advanced heart failure. 

This year, the network will launch imPULSE 4.0, an online continuing education series focused on chest pain competency. The interactive program features modules on foundational cardiac principles, rhythm recognition, 12-lead ECG interpretation and best practices for patients experiencing chest pain.

“Providing this level of specialized education ensures that all affiliates have access to the resources they need to enhance patient care,” Craft said. “By making this education available, we’re strengthening cardiovascular care statewide, ensuring patients benefit from high-quality, evidence-based treatment.” 

By sharing resources, expertise and best practices, hospitals are overcoming barriers that typically divide them, creating a more cohesive and effective approach to patient care across the state. 

Reaching beyond the network  

In its ongoing commitment to improving care, the Gill Heart & Vascular Institute is continuously exploring innovative solutions to enhance and accelerate care for its partners statewide. One example is its Surgical Triage and Recovery Program (STAR), which has been playing a fundamental part in improving access since its launch in 2023.  

“Historically, providers in the community had to call around to see who had openings for the transfer of a high-risk patient who needed a time-sensitive intervention,” said Dr. Vedant Gupta, acting director of the Cardiovascular Service Line. “They could spend hours on the phone with different hospitals and still patients were often put on a waitlist. Now, our doctor in the transfer center takes the call and can begin the transfer process immediately.” 

Patients appropriate for referrals to the STAR Program include those who need urgent cardiac procedural interventions. This includes left heart catheterization for acute coronary syndrome or high-risk abnormal stress test as well as urgent pacemaker placement for symptomatic heart block. 

Patients come directly to the unit, bypassing the ER. The program has enabled patients to get to an intervention within 12 hours on average and out of the hospital within 24 hours, Dr. Gupta said.

Gill Imaging Initiative fills a void  

To support and enhance cardiovascular imaging programs statewide, the Gill Imaging Initiative offers virtual image interpretation across the spectrum of imaging modalities, including cardiac CTA, cardiac MRI, SPECT, PET and echocardiography at numerous sites, with more locations in the pipeline. 

The program works well because while many community hospitals have the necessary equipment to perform imaging studies, they lack cardiologists at their local hospitals and have the image interpreted by specialists at Gill.

For some of the hospitals, Gill Heart & Vascular cardiologists and radiologists regularly read images. For others, the service is a backup when the local cardiologist is unavailable, thereby avoiding disruption of cardiac care in the community. 

Outreach extends to more than 50 sites  

The Gill Heart & Vascular Institute continues to expand access to high quality cardiovascular care across Kentucky. At several sites, the Institute extends its expertise through outreach clinics, bringing cardiovascular specialists directly to communities where advanced care is otherwise unavailable.

With the Gill Affiliate Network, the Gill Imaging Initiative and outreach clinics, the Institute’s reach now extends to more than 50 sites statewide. Looking ahead in 2025, Gill is on track to expand to more than 60 locations, further strengthening cardiac care access in communities that need it most. 

“By working collaboratively, and not competitively, we are making significant strides,” Dr. Rajagopalan said. “I can’t wait to see what we are working on in five or 10 years. We’ll be doing things in the network that we haven’t even imagined yet. With every new program, we move closer to providing more effective and personalized cardiovascular care.”