ETSU COLLEGE OF NURSING NURSE-MANAGED CLINICS August 2012

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 Nursing Nurse-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 ETSU College of Nursing

In the beginning…

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 – Johnson City Public Housing January 2011 ETSU College of Nursing

Johnson City Downtown Clinic Encounters

Day Center Visits (20 hours a week)

Hancock County School-Based Health Centers Encounters FY 05-FY 08 inclusive of nursing and NP visits

Mountain City Extended Hours Health Center Encounters

Washington County School-Based Health Centers Encounters

Total Encounters per Clinic

230,674 Total Clinic Encounters FY

Community health center funding 15 years of continued support from Health Services and Resource Administration, Bureau of Primary Health Care

Community Health Center Funding

CHC Poverty Status

CHC Insurance Status

Community Health Center Sliding Scale Fee Discounts (Uncompensated Care)

PAP Smears

Hypertension Control B/P <140/90

Diabetic Management Hemoglobin A1C <9 mg/dl

Immunization 2 yr Olds

Prenatal Care

Quality of Care: Low Birth Weight Babies 24 * Very Low Birth Weight-Measure Changed 2009 to include very low and low combined

FY 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 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 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 $60,000 Grant 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 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