1. Patience- Persistence-Patients Kim White, PhD, MSN, PHCNS-BC Linda Omondi, DNP, M.Ed, FNP-BC

2. Disclaimer "I have no financial relationships to discuss and I will not discuss off label use and/or investigational use in my presentation"

3. Nurse-Managed Health Clinic “The term ‘nurse-managed health clinic’ means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency.” (U.S. Department of Health & Human Services, 2010a)

4. Patient Protection and Affordable Care Act Increased number of insured people Young adults up to age 26 able to remain covered under parents No denial due to pre-existing conditions Those not already in a health system need a health care provider Health system overburdened and understaffed Increased focus on Prevention and Health Promotion US Department of Health & Human Services (2010b)

5. Our Community Primary Population – 26,697 96.4% AA/Black Median Income - $19,856 45.4% below poverty 7.7% unemployment 40.2% - food stamps/SNAP 60.1% - Medicaid/Medicaid Managed Care 21.2% - No insurance US Census Bureau (n.d.)

6. Our Community Leading Causes of Death (per 100,00) Health IndicatorState/County Assault/Homocide6.6/12.9 Cerebrovascular Disease39.3/43.6 Chronic Lower Respiratory Disease39.2/55.0 Diabetes Mellitus19.7/40.9 Heart Disease180.6/191.8 Essential Hypertension & Hypertensive Renal Disease7.0/14.8 Illinois Department of Public Health (n.d.)

7. Vision Integrate primary care and public health to provide holistic, culturally competent care across the lifespan that promotes health and well-being Provide opportunities for interdisciplinary care experiences, services, and research for undergraduate and graduate students and university faculty. Promote partnerships between university faculty, students, and members of the community to decrease health disparities and promote health in the surrounding communities.

8. Mission Provide care to diverse clients in the Metro-East Provide comprehensive evidence-based primary care services Work with residents, health care providers, and agencies to identify health needs, develop and implement plans to meet those needs Provide educational experiences to undergraduate and graduate students that promote intellectual, spiritual, ethical, and social growth

9. Characteristics of Our Nurse Managed Health Center Structure Fixed traits Material resources Human resources Fiscal resources Organizational characteristics Care Process Primary prevention Secondary prevention Tertiary prevention Multiple levels of prevention (Holt, J., Zabler, B, & Baisch, M.J., 2014)

10. Characteristics cont. Outcomes Individual/family Community System Academic (Holt, J., Zabler, B, & Baisch, M.J., 2014)

12. Barriers & Challenges Staffing mix Collaborating physician Credentialing Reimbursement Electronic health record Understanding of what we do Marketing Hansen-Turton, Bailey, Torres, & Ritter (2010) Coddington & Sands (2008)

13. Ways To Address Barriers & Challenges Patience Persistence Creativity Increased patient satisfaction McIntosh, Nagelkerk, Vonderheid, Poole, Dontje, & Pohl (2003)

14. Checklist Vision & Mission Approach Revenue source(s) Staffing Credentialing Supplies Marketing Patients

17. References Coddington, J. & Sands, L. (2008). Cost of health care and quality outcomes of patients at nurse-managed clinics. Nursing Economics, 26(2), p.75-83. Hansen-Turton, T., Nagle Bailey, D., Torres, N., & Ritter, A. (2010). Nurse-managed health centers: Key to a healthy future. American Journal of Nursing, 10(9), 23-26. Holt, J., Zabler, B., & Baisch, M.J. (2014). Evidence-based characteristics of nurse-managed health centers for quality and outcomes. Nursing Outlook, 62, 428-439. Illinois Department of Public Health. (n.d.). I-Query. Retrieved from http://iquery.illinois.gov/iquery/ Link, D., Perry, D., & Cesarotti, E. (2014). Meeting new health care challenges with a proven innovation: Nurse-managed health care clinics. Nursing Administration Quarterly, 38(2), 128-132.

18. References cont. McIntosh, E., Nagelkerk, J., Vonderheid, S., Poole, M., Dontje, K., & Pohl, J. (2003). Financially viable nurse-managed centers. The Nurse Practitioner, 28(3), p.40-51. US Census Bureau. (n.d.). 2010-2014 American community survey 5- year estimates. Retrieved from http://factfinder.census.gov/ US Department of Health & Human Services. (2010a). The Affordable Care Act: Section by section. Title V – Health care workforce. Subtitle A – Purpose and definitions, p1310. Retrieved from http://www.hhs.gov/sites/default/files/v-healthcare- workforce.pdf. US Department of Health & Human Services. (2010b). Patient Protection and Affordable Care Act. Retrieved from https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW- 111publ148.pdf.