ETSU COLLEGE OF NURSING
NURSE-MANAGED CLINICS
January 2015
Community-Based Clinics
Hancock County
Elementary School
CHC
Johnson City Day
Center
Johnson City
Community Health
Center
Hancock County
Middle High CHC
Mountain City Extended
Hours Health Center
Johnson City Partners
for Health
School-Based Clinics
David Crockett High School
Daniel Boone HS
Jonesboro Elementary
School
Northeast State
Community College
University School
ETSU
Student/University
Health
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
Vision
• “Our vision is two-fold: To deliver world-class
quality health care that is accessible,
affordable, and outcome driven and to
provide students with the best
interprofessional clinical experience that is
nationally renowned.”
VALUES STATEMENTS
•
East Tennessee State University pursues its mission through a student-centered
community of learning reflecting high standards and promoting a balance of liberal
arts and professional preparation, continuous improvement, and based upon core
values. The College of Nursing faculty and staff will support and exhibit the
university’s core values as follows:
•
PEOPLE come first, are treated with dignity and respect, and are encouraged to
achieve their full potential;
•
RELATIONSHIPS are built on honesty, integrity and trust;
•
DIVERSITY of people and thought is respected;
•
EXCELLENCE is achieved through teamwork, leadership, creativity, and a strong
work ethic;
•
EFFICIENCY is achieved through wise use of human and financial resources; and
•
COMMITMENT to intellectual achievement is embraced.
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
• Expansion of services to 6 schools in 2014
–
–
–
–
–
Service as a collaborative in Hancock County-1992
ETSU Student Health -2000
Johnson City Public Housing January 2011
University School 2014
Northeast State Community College 2014
ETSU College of Nursing
CO-APPLICANT AGREEMENT
• The Governing Board (herein known as the
"Board”) of the ETSU College of Nursing
Community Health Centers and the College of
Nursing (CON) at East Tennessee State University
(ETSU) herewith agree to provide for
comprehensive primary care services to be
delivered through the ETSU College of Nursing
Community Health Centers and do make coapplication that the associated clinics be
operated as Federally Qualified Health Centers
under the provisions of the Public Health Services
Act Section 330.
HRSA Key requirements
• There are 19 key requirements, with #
18 - Board Composition: The health
center governing board is composed
of individuals, a majority of whom are
being served by the center and, who
as a group, represent the individuals
being served by the center.
Johnson County Community Health Center
(Includes Johnson City Partners for Health
Clinic)
25,000
23,648
20,000
Became Johnson
City Community
Health Center
10/11/12
18,139
15,637
15,000
11,577
10,000
9,325
7,404
7,454
9,948
6,809
5,000
0
FY
05/06
FY
06/07
FY
07/08
FY
08/09
FY
09/10
FY
10/11
FY
11/12
FY
12/13
FY
13/14
Day Center Visits
12000
10,094
10000
8000
6803
6000
5986
6440
6894
7021
4000
2000
0
2008
2009
2010
2011
2012
2013
Hancock County School-Based Health
Centers Encounters
8,000
7,329
7,000
6,000
6,235
6,448
5,608
5,000
4,551
4,783
5,101
5267
4084
4,000
3,000
2,000
1,000
0
FY
FY
FY
FY
05/06 06/07 07/08 08/09
FY 05-FY 08 inclusive of nursing and
NP visits
FY
09/10
FY
10/11
FY
11/12
FY
12/13
FY
13/14
Mountain City Extended Hours Health
Center Encounters
8,000
7,000
7,196
6,177
6,000
5,369
5,000
6085
5,820
5,302
4,624
6324
5,093
4,000
3,000
2,000
1,000
0
FY
05/06
FY
06/07
FY
07/08
FY
08/09
FY
09/10
FY
10/11
FY
11/12
FY
12/13
FY
13/14
Washington County School-Based Health
Centers Encounters
4,500
4,000
3,816
3,500
3,000
3,047
3,148
2,816
2,500
2,755
3,735
3,409
3469
2,566
2,000
1,500
1,000
500
0
FY
05/06
FY
06/07
FY
07/08
FY
08/09
FY
09/10
FY
10/11
FY
11/12
FY
12/13
FY
13/14
Student Health Clinic Visits
8000
H1N1 Scare
7000
6000
5000
4000
6866
6758
6149
5581
5285
5665
5605
5281
4242
EMR
Implementation
3000
2000
1000
0
FY 05/06FY 06/07FY 07/08FY 08/09FY 09/10FY 10/11FY 11/12FY 12/13FY 13/14
Total Encounters per Clinic 2005-2014
120,000
109,941
100,000
80,000
60,000
45,666
45,325
44,674
40,000
32,516
20,000
0
HC
JCCHC
MCEHHC
SUHS
WCSBHC
Total Clinic Encounters FY2005-2014
291,562
Community health center
funding
15 years of continued support from
Health Services and Resource
Administration, Bureau of Primary
Health Care
Community Health Center Funding
3% 1%
6%
12%
Federal Grants
52%
26%
Revenues
University
State
City/County
Donations
CHC Poverty Status
120.00%
100.00%
97.47%
79.57%
80.00%
60.00%
40.00%
20.00%
0.00%
1
CHC Insurance Status
3.17%
13.47%
54.25%
29.12%
Uninsured
Medicaid
Medicare
Third Party
PAP Smears
90%
80%
70%
60%
50%
40%
30%
20%
Change in national
guidelines not
consistent with
HRSA measurement
definition
10%
0%
2008
2009
2010
CHC
State
2011
National
2012
2013
Hypertension Control
B/P <140/90
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010
CHC
State
2011
National
2012
2013
Diabetic Management
Hemoglobin A1C <9 mg/dl
74%
72%
70%
68%
66%
64%
62%
60%
58%
56%
54%
2011
2012
CHC
State
2013
National
Immunization 2 yr Olds
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Influenza added
as required to
UDS but not CDC
2008
2009
CHC
*2012 measurement
indicator changed
2010
National
2011
State
2012
2013
Prenatal Care First Trimester
80%
70%
60%
50%
40%
RN Case manager
left
30%
20%
10%
0%
2008
2009
2010
CHC
State
2011
National
2012
2013
Quality of Care: Low & Very Low Birth Weight
Babies
10.00%
9.00%
8.00%
7.00%
*
6.00%
CHC
5.00%
State CHC
4.00%
Nat'l CHC
3.00%
2.00%
1.00%
0.00%
2008
2009
2010
2011
2012
* Very Low Birth Weight-Measure Changed 2009
to include very low and low combined
2013
31
FY 2013-2014 Accomplishments
• Finished FY in the black across all clinics
• Dr. Lisa Ousley published dermatology handbook
• 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, B/P control, immunizations, and cost of care)
• Transitioned of Dispensary of Hope to JCCHC-ETSU Charity Pharmacy
• 9 Interprofessional collaboration in practice, research, and grant
applications. 1 Approved but not funded. 1 not funded and 2 pending
• 2 poster presentations-Dr. Vanhook; 90 minute podium presentation-Dr.
Ousley
• Practice network grew by 2 clinic sites
• 11 Practice research/capstone projects completed or in progress at our
clinics
• Clinical coordinator for students established for each site
FY 2013-14 Grants
Grant Applications:
• 1/24/2014 HRSA-13-188 NEPQR, $1,499,856 (Nurse Education, Practice, Quality, &
Retention-approved but not funded)
• 2/05/2014 HRSA H80CS00840 $1,226,018 (Community Health Center) Funded
• 6/22/2014 HRSA 14-148 Expanded Medical Capacity $203,305 (NP, LCSW, RN)
Funded
• 4/30/2014 HRSA-14-073 Facilities Improvement Grant $250,000 (Mammography
equipment/patient portal) Funded
• 4/10/2014 HRSA-14-110 Behavioral Health Integration Grant $250,000/yr. for 2 yrs.
Not funded
• 9/22/2014 Walgreens/American Cancer Society Colorectal Cancer Screening Grant
$50,000 11/2014 for 1 year Funded
• 10/06/2014 HRSA-15-016 New Access Point-School-Based Health (submitted)
• 11/14/2014 HRSA-15-039 Rural Healthcare Services Outreach (submitted)
• 11/24/2014 National Nursing Centers Consortium Medical-Legal Partnership
Foundation grant $50,000 18 months Funded
Goals 2014-2015
• Level 3 Patient-Centered Medical Home
• Increase NP productivity across all clinics
• Develop new programs to generate revenue to support the missionhealth care for female inmates,
• 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
• Excellence in patient outcomes and student success!
Contacts for Each Site
• Johnson City Community Health Center/Day
Center & Public Housing Clinic
– Gina Flack 423-929-6956 flackg@etsu.edu
• Mountain City Extended Hours Health Center
– Shelia Cooke 423-727-1160 cooke@etsu.edu
• Hancock County School-Based Health Centers
– Nancy Seal 423-733-2819 sealn@etsu.edu
• Student/University Health & Washington Co.
School-Based Health Centers
– Pam Williams 423-439-4038 WilliaPA@etsu.edu