Background & Goal
In many of this nation’s underserved communities, the absence of clinics, pharmacies, physicians and other healthcare services directly translates to poor healthcare outcomes. For the under- and uninsured, the out-of-pocket expenditures associated with transportation to clinic locations, and co-payments for the delivery of primary care services, are cost prohibitive. It has been well documented that the best patient care outcomes of the future will directly correlate with the utilization of an interprofessional team of healthcare providers that leverage clinical, operational, and data-based solutions, to deliver the highest quality person-centered care.
The National University Nurse-Managed Clinic (NUNMC) Project sought to shift the paradigm for the provision of healthcare services by taking the interprofessional healthcare team directly to the community to deliver primary care services onsite at designated locations throughout underserved neighborhoods in south Los Angeles County, at no cost to the patients served. This novel approach is in direct contrast to the existing healthcare system, which expects patients to travel to the healthcare facility and to have the finances to pay for the services rendered. The NUNMC Project’s Interprofessional Collaborative Practice team has been providing comprehensive primary care services and monitoring trending healthcare outcomes since 2016. The NUNMC Project is the fourth in a series of multimillion dollar corporate and federally-funded nurse-led clinics designed by Dr. Gloria McNeal over the course of nearly three decades. She has operationalized this model in selected underserved communities of Philadelphia County in PA, Essex County in NJ, and Los Angeles County in CA. In 1994, the American Academy of Nursing initially recognized this work, naming Dr McNeal a recipient of the coveted Media Award. In 2009, this model of care was presented in testimony before the Institute of Medicine (IOM; currently named the National Academy of Medicine), that was subsequently included in the IOM landmark publication on the Future of Nursing: Leading Change, Advancing Health, for which Dr. McNeal served as an invited co-contributor.
The NUNMC project launched its virtual, nurse-led initiative, which augments the provision of direct care services with the utilization of telehealth care technologies, to expand the reach of the healthcare team beyond traditional clinic walls. Patients and their families are examined and treated in the familiar surroundings of their place of worship, residential drug rehab center, or Salvation Army locations. Patients are registered onsite for services within the nurse-led clinic without walls, which is embedded within a trusted community-based organization or faith-based institution. Patients are screened for third party reimbursement eligibility by a licensed clinical social worker, and evaluated for care by advanced practice nurses.
The NUNMC Project cost effectively utilizes faculty-supervised nursing and other health professions students, in collaboration with a full-time healthcare team in the provision of care. This Project uniquely created public-private partnerships, in the goal to improve access to care for at-risk populations. Working with this broad array of community-based organizations and faith-based institutions, the partnerships formed by this collaborative initiative are designed to ensure that the individual healthcare needs of the patient are met, maintaining a culturally and linguistically responsive approach to care. Further, the Project’s unique use of biometric remote monitoring systems is designed to significantly improve access to care among the residents of the targeted neighborhoods. By closely monitoring patient clinical findings on a daily basis, predictive modeling can be used to identify patient care needs. This approach to care facilitates the implementation of treatment modification early in the illness trajectory. More significantly, the use of remote monitoring applications reduces overall healthcare costs by eliminating the need for costly emergency room and urgent care visits to treat conditions.
Evidence of Success
To critically measure outcomes, the clinical team initiated a four-year longitudinal, convenience study of the Project findings. The study found that:
- Cost savings in emergency room visits were significant with an 11:1 dollar ratio yielding a savings of nearly $2 million;
- Loss to follow up was significantly reduced with a 69.9% follow up return rate at the 95% CI;
- Patient Ethnic Demographics: 49.2% were Black, 28.5% were White/Hispanic, and 4% were Asian; a small percentage of patients reported being more than one race (1.3%), and 0.2% were Pacific Islanders; and
- While a majority of the patients (58%) had Medicaid insurance, 38.6% were uninsured.
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