Enhancing Nurse-Managed Health Clinic for Improved Access and Training

Expanding a Nurse-Managed Health Clinic to Improve Access to Care and Facilitate Training of the Nurse Practitioner Work Force Donna Marvicsin PhD, PNP-BC, CDE Clinical Associate Professor University of Michigan SON Ann Arbor

Background 2010 University of Michigan SON had 2 Nurse Managed Health Centers in Ann Arbor HRSA grant received to consolidate the 2 clinics into one clinic Objectives: Increase access and capacity to care for underserved populations Increase structured clinical training opportunities for primary care and nurse midwife students

Grant $1.5 million over 3 years ($500,000/year) PI, Co-Investigator, Program Evaluator (5-20%) 2 FNP s and 2 MA Psych NP RN Patient Advocate IT In addition, start up supplies for clinic

Factors Impacting Implementation Between 2000 and 2009, Michigan ranked last in the nation in growth in population and employment Michigan became poorer relative to other states as its per capita personal income national ranking fell to 41st in 2009 NMHC could not build a sustainable payer mix and in 2011 decision was made to close the clinics

Innovation: Faculty Practice U of M SON has a long standing relationship with CHASS, FQHC in southwest Detroit CHASS serves as a clinical site for FNP students May 2012 CHASS opened a new clinic to increase capacity with 4 medical pods Only had sufficient providers for 3 pods SON NP s became providers for 4thpod, nurse managed care imbedded within CHASS

Community Health and Social Services CHASS The Community Health and Social Services (CHASS) Center, Inc. is a community based, not-for-profit organization formed to develop, promote, and provide comprehensive, accessible and affordable quality primary health care and support services to all residents of the community, with emphasis on the underserved African American and Latino populations in Detroit.

2012 - 2014 CHASS had 6 MD s, one full time FNP and 2 part time FNP s Faculty successfully integrated into CHASS with students Objectives of the grant were met Main challenge was need for interpreters due to lack of fluency of faculty and students Meanwhile ..

Sustainability 2012 CHASS began process to achieve recognition as a PCMH Emphasis on MD led care teams Model of separate pod for nurse managed care did not meet CHASS objectives FNP s dispersed to other care teams at end of the grant Experience has been that it is difficult to find community partners willing to have faculty practice part time in the clinic

Possible Future Outcomes Currently CHASS has 3 MD s, 4 FNP s and one CNM Reality of difficulty finding MD s for underserved populations ongoing concern Impact on Clinical Education: as more APRN s enter the workforce, more clinical opportunities may develop