ETSU COLLEGE OF NURSING NURSE-MANAGED CLINICS August 2012.
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Transcript of ETSU COLLEGE OF NURSING NURSE-MANAGED CLINICS August 2012.
ETSU COLLEGE OF NURSINGNURSE-MANAGED CLINICS
August 2012
ETSU College of Nursing
Mission
” To optimize health and reduce health disparities through the provision of innovative and high quality care and services in partnership with our patients, communities, and regional health and services agencies."
ETSU College of Nursing
ETSU College of NursingNurse-Managed Clinics
– Johnson City Downtown Clinic (Designated Community Health Center)• Johnson City Day Center• Johnson City Downtown Clinic/Johnson City Public Housing Authority
Clinic (JCDC/JCHA Clinic)– Hancock County School-Based Clinics-Sneedville, TN (Designated Community
Health Center)• Elementary• Middle/High Combined School
– Mountain City Extended Hours Health Center, Mountain City, TN (Designated Rural Health Center)
– Washington County School-Based Clinics• Jonesborough Elementary• David Crockett High School• Daniel Boone High School
– ETSU Student/University Health
In the beginning…
ETSU College of Nursing
History• Initial mission– Service for the homeless-basement of Salvation
Army (Johnson City)-1990– Service for those who lost health care providers
and hospital (Mountain City)-1990• Expansion-Underserved– Washington County School Contract-1992– Service as a collaborative in Hancock County-1992– ETSU Student Health -2000– Johnson City Public Housing January 2011
Johnson City Downtown Clinic Encounters
FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/120
2000
4000
6000
8000
10000
12000
14000
16000
18000
7404 7454 6809
9325 994811577
15637
Day Center Visits (20 hours a week)
2008 2009 2010 20110
1000
2000
3000
4000
5000
6000
7000
8000
59866803
6440 6894
Hancock County School-Based Health Centers Encounters
FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/120
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
6,235
7,329
6,448
5,608
4,551 4,7835,101
FY 05-FY 08 inclusive of nursing and NP visits
Mountain City Extended Hours Health Center Encounters
FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/120
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
7,196
6,177
5,369 5,3025,820
4,6245,093
Washington County School-Based Health Centers Encounters
FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/120
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
3,0472,816 2,755
2,566
3,1483,409
3,816
Total Encounters per Clinic 2005-2012
HC JCDC MCEHHC SUHS WCSBHC0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
40,058
68,154
39,58135,151
21,577
230,674Total Clinic Encounters FY2005-2012
Community health center funding
15 years of continued support from Health Services and Resource Administration,
Bureau of Primary Health Care
Community Health Center Funding
52%
26%
12% 6%3% 1%
Federal GrantsRevenuesUniversityStateCity/CountyDonations
CHC Poverty Status
Series10.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
97.84%
79.20%
CHC Insurance Status
54.25%
29.12%
3.17%13.47%
Uninsured Medicaid Medicare Third Party
Community Health Center Sliding Scale Fee Discounts (Uncompensated Care)
2008 2009 2010 2011$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$374,908
$529,346 $543,878
$798,354
PAP Smears
2008 2009 2010 20110%
10%
20%
30%
40%
50%
60%
70%
80%
90%
CHC State National
Hypertension ControlB/P <140/90
2008 2009 2010 20110%
10%
20%
30%
40%
50%
60%
70%
80%
CHC State National
Diabetic ManagementHemoglobin A1C <9 mg/dl
2008 2009 2010 201162%
64%
66%
68%
70%
72%
74%
76%
78%
80%
82%
CHC State National
Immunization 2 yr Olds
2008 2009 2010 20110.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
CHC National State
Prenatal Care
2008 2009 2010 20110
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
CHC State National
24
Quality of Care: Low Birth Weight Babies
2008 2009 2010 20110.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
CHCState CHCNat'l CHC
*
* Very Low Birth Weight-Measure Changed 2009 to include very low and low combined
FY 2010-2012 Accomplishments• Expanded Hours JCDC• JCDC/JCHA Clinic opened• Full implementation integrated electronic medical records and practice management
system• Sue Reed, FNP recognized by Tennessee Primary Care Association as Practitioner of the
Year• Finished FY in the black across all clinics• Dr. Vanhook continues to be ongoing member of the HRSA Office Rural Health Policy
Issues Group• SEARCH funding for primary care students @ JCDC• TPCA Community Health Workers funding for JCDC and implementation of the ABCD
program (A1C, Blood Pressure, Cholesterol, Diet)• Quality indicators from the United Data System report that continue to be better than
the state and the nation across most measures (low birth weight babies, A1C, B/P control, immunizations, and cost of care)
• Additional FT NP at HCSBHC• Interprofessional collaboration in practice, research, and grant applications• 2 publications by NPs
FY 2010-2012 Grants• Nurse-Managed Health Center Grant $1.4 million forward funding-assisted to
expand hours for the delivery of primary care and student clinical hours. In year one, 116 students (MSN, BSN, medicine, pharmacy, Social Work, & psychology) participated in the delivery of care during 4,072 clinic visits
• Capital Improvement Project for JCDC $6.89 million• Successful Community Health Centers Competition grant $1,225,018/year for 5
years funded ($6,125,090)• HRSA Patient Centered Medical Home $35,000• HRSA Quality Cervical Cancer Screening $60,000Grant Applications:• 2010 SAMHSA Grant Application for community treatment team for homeless
$500,000 (not funded)• 2011 HRSA New Access Point $600,000 for MCEHHC (not funded)• 2011 TDOH Diabetes grant (Dr. Charlie Stuart) $250,000 (funded)• 2012 Nurse Education, Practice, Retention, & Quality $1.47 million (not funded)
Goals 2012-2013• Level 3 Patient-Centered Medical Home • Increase NP productivity across all clinics• Develop new programs to generate revenue to support the
mission• Develop infrastructure for comparative effectiveness research• Quality outcome core measures at or better than state
metrics• Publications from each clinic type• Interprofessional research• Integrate technology in patient care and interprofessional
education