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