Jean Nagelkerk

The Safety Net: Academic Nurse-Managed Centers’ Role

This article reports on a study conducted in 2001 that examined the role of four schools of nursing (SONs) in Michigan and their challenges in serving the safety net population through primary care nurse-managed centers (NMCs). The NMCs are described and compared to community health centers (CHCs) in terms of patient mix, funding sources, and contributions SONs make as a substitute resource for federal funding to the NMCs. NMCs are frequently invisible providers in the health system, yet they serve high-need populations. Similarities and differences between NMCs and CHCs are discussed as well as the unique challenges faced by NMCs and their SONs as the result of policies that sometimes limit NMCs ability to serve safety net populations.

Toward a national nurse-managed health center data set: Findings and lessons learned over 3 years

Although primary care nurse-managed health centers (NMHCs) have gained increasing recognition, there are limited standardized clinical and financial data on these centers. The purpose of this paper is to present the process, benefits, and challenges in collecting standardized national data based on a consensus process from NMHCs over 3 consecutive years. The Institute for Nursing Centers (INC) NMHC Survey focuses on demographic, clinical, and financial data. A detailed codebook accompanied the INC NMHC Survey. A total of 42 NMHCs responded in at least 1 of the 3 years. Despite the challenges in collecting some of the data, especially for the first survey year, data quality improved remarkably when the INC NMHC Survey was repeated. Financial data seemed to be more easily reported than demographic or clinical data. NMHCs increase access to care, often for vulnerable populations, yet to date there are limited standardized clinical and financial data on these centers. The INC NHMC Survey and data described in this paper begins to address that gap.

Financially viable nurse-managed centers.

Nurse managed centers play an important role in the health service delivery system; often serving those in greatest need, while struggling to remain financially viable. This article discusses the role of a Financial Advisory Committee (FAC) and the process of financial peer review in academic nurse-managed centers to improve financial outcomes. Advanced practice nurses may find the identified strategies for financial sustainability useful in their own practices.

Patient safety culture transformation in a children’s hospital: an interprofessional approach

Abstract In 2008, a children’s hospital based in the Midwest of the USA launched a hospital-wide safety transformation initiative to improve the safety and quality of care resulting in a decrease in the number of critical safety incidents. In order to build on the early successes of the Hospital’s safety program and further improve safety metrics, investigators developed a set of multi-pronged, interprofessional interventions designed to improve overall safety outcomes. The interprofessional interventions focused on didactic training, simulation exercises and safety rounding components. Study results indicate that the didactic portion of the study intervention was the most effective component in terms of safety behavior knowledge gained and satisfaction. The student groups had statistically significant higher post-didactic (86.2 versus 77.7, p < 0.001) and post-simulation (85 versus 81.8, p < 0.05) knowledge scores than did the staff groups. After gaining knowledge in basic safety training didactic instruction, students and staff maintained the knowledge gain throughout the study, but no significant knowledge gains were observed after simulation experiences and rounding with safety coaches. An overall increase in hospital metrics (all safety events) of the study year, compared retrospectively to the previous year, was observed. Investigators attribute the increase in the metric indicators to greater attention to reporting safety events.

Improving outcomes in adults with diabetes through an interprofessional collaborative practice program

ABSTRACT In 2014, the Midwest Interprofessional Practice, Education and Research Center partnered with a Federally Qualified Health Center (FQHC) to implement an interprofessional collaborative practice (IPCP) education program to improve the health of adult patients with diabetes and to improve practice efficiency. This partnership included integrating an interprofessional team of students with the practice team. Twenty-five students and 20 staff engaged in the IPCP program, which included completion of educational modules on IPCP and implementation of daily huddles, focus patient visits, phone calls, team-based case presentations, medication reconciliation, and student-led group diabetes education classes. This study used a sequential mixed methods design. Tools used for collecting data from staff and students included demographic forms, the Interdisciplinary Education Perception Scale (IEPS), the Entry-level Interprofessional Questionnaire, the Collaborative Practice Assessment Tool, and pre/post module knowledge tests completed at baseline and at one-year post implementation. Patient clinical indicators included HgbA1c, glucose, lipid panel laboratory assessments, body mass index, blood pressure, and documentation of annual dental, foot, and eye examinations. Practice efficiency was measured by the average number of patients seen per provider per hour. Both students and staff showed significant knowledge gains in IPCP on Team Dynamics and Tips for Behavioural Changes knowledge tests (p < .05). Patients who had an HgbA1c of ≥ 7% significantly decreased their HgbA1c (p < .05) and glucose (p < .01). However, BMI and annual dental and eye examinations did not improve. Providers demonstrated an increase in the number of patients seen per hour. This IPCP intervention showed improvement in practice efficiencies and select patient outcomes in a family practice clinic.

Board 387 - Research Abstract Outcomes of Veterans with TBI: Standard of Care Versus Enhanced Care. (Submission #1098)

Introduction/Background This abstract describes the use of simulations to enhance interprofessional education for students and health professionals interested to provide military relevant treatment to veterans with traumatic brain injuries (TBI) and mental health concerns using an interprofessional team approach care model. The audience will: 1) assess the use of simulations to enhance interprofessional education and practice for treatment to veterans with TBI and 2) evaluate the importance of post-event debriefing to enhance learning and team communication. Three simulations were developed by Grand Valley State University to enhance the education of the Mary Free Bed Rehabilitation Hospital interprofessional outpatient TBI team on how to treat veterans with TBI. Module simulations included Pathophysiology/Symptomatology, Behavioral/Mental Health and Case Management/Community Reintegration. Methods Phase I: A civilian TBI rehabilitation interprofessional team provided standard care treatment to veterans with TBI. Phase II: University faculty, with input from military health professionals, delivered three educational modules. Module 1: Pathophysiology/Symptomatology; Module 2: Behavioral/Mental Health; and Module 3: Community Reintegration/Case Management. Knowledge gain and satisfaction was measured using pre and post-tests and program evaluations. The GVSU Simulation Center facilitated simulations using veteran standard patients to deliver module content and meet learning objectives. Three module developers collaborated to create a patient case focusing on a U.S. combat veteran searching for TBI/PTSD treatment. Participants: Fourteen MFBRH health professionals participated: medical physician (1), neuropsychologist (1), physical therapists (3), occupational therapists (2), speech language pathologists (2), social worker (1), rehabilitation driving instructor (1), project coordinators (2) and a secretary (1). Pedagogy: Simulation sessions were scheduled for two to three hours each. Standard patients with combat experience were recruited from local National Guard units. Using the case modified for the module, participants were encouraged to interact with the standard patients to implement learned skills from classroom and online content. At the Conclusion of each simulation, the instructor debriefed the health professional cohort including the standard patients. Discussion included facets of the case from professional and personal experiences. The standard patient veterans provided feedback based on team interactions while proving military culture insight. Program evaluation measures were administered at Conclusion of each simulation and continuing education credits were provided. Phase III: After receiving military relevant education the same rehabilitation team provided enhanced care to veterans. All veterans received seven validated psychological assessments at baseline, treatment discharge and three months post-discharge. Phase I and III outcomes were compared to show any differences between the standard of care and the enhanced care. Results Per the evaluations, exercises were perceived elementary and advanced based on education and professional roles. Simulations could have been more realistic. Greatest value was in the debriefing sessions including team, instructor and veteran standard patients. Fifteen health professionals demonstrated improved pre and post-knowledge tests on the three modules (p < 0.001): Module 1 (53.7%-81.7%); Module 2 (47.3%-71.0%); and Module 3 (60.7%-72.0%). Regardless of health professional team role/education, there was improved knowledge change on all modules: terminal degrees (2), 63.3-79.3%; bachelors/masters degrees (10), 53.5-75.2%, p<0.01; Non-Clinical Administrative (3), 48.9-71.1%. For veterans, there were no significant differences between the Standard Care (4) and Enhanced Care (4) groups; likely due to low enrollment and different psychological chronicity between groups at baseline. As a group (8), participants showed trends toward improvement across psychological assessments (baseline vs. follow up). Clinically significant changes showed overall cognition, decreased demoralization. Conclusion Simulations for treating veterans with TBI were positive for facilitating team communication. The standard patient coordinator suggested more robust training for veteran standard patients. GVSU used evaluations to create simulation video vignettes for an online course. Education to civilian health providers showed increased knowledge gain and veterans with TBI showed trends toward improved clinical outcomes. References 1. Belanger HG, Uomoto JM, & Vanderploeg RD: The Veterans Health Administration System of Care for Mild Traumatic Brain Injury: Costs, Benefits, and Controversies. Journal of Head Trauma Rehabilitation 2009; 24(1):4-13. 2. Burnam AM, Meredith LS, Helmus TC, Burns RM, Cox RA, D’Amico E, et al: Systems of Care: Challenges and Opportunities to Improve Access to High-Quality Care, Chapter 7Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist RecoveryTanielian, T., & Jaycox, L., EdsRAND Center for Military Health Policy ResearchRAND: Santa Monica, CA.2008. 3. Collins RC, & Kennedy MC: Serving Families Who Have Served: Providing Family Therapy and Support in Interdisciplinary Polytrauma RehabilitationJournal of Clinical Psychology 2008; 64(8): 993-1003. 4. Darkins A, Cruise C, Armstrong M, Peters J, & Finn M: Enhancing Access of Combat-Wounded Veterans to Specialist Rehabilitation Services: The VA Polytrauma Telehealth NetworkArchives of Physical Medicine Rehabilitation 2008; 89:182-187. 5. Defense and Veterans Brain Injury CenterDoD Worldwide Numbers for TBIIn Defense and Veterans Brain Injury Centerhttp://www.dvbic.org/dod-worldwide-numbers-tbiAccessed July 31, 2013. 6. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, & Koffman RL: Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to CareNew England Journal of Medicine 2008; 351:13-22. 7. Institute of Medicine(2009)Gulf War and Health, Volume 7: Long-term consequences of Traumatic Brain InjuryWashington, D.C.: The National Academies Press. 8. Kreutzer JS, Marwitz JH, Godwin EE, & Arango-Lasprilla JC: Practical Approaches to Effective Family Intervention After Brain InjuryJournal of Head Trauma Rehabilitation 2010; 25(2):113-120. 9. NAE (National Academy of Engineering), & Institute of MedicineSystems Engineering to Improve Traumatic Brain Injury Care in the Military Health System: Workshop summaryWashington, DC.: The National Academies Press 2010. 10. Sarajuuri JM, Kaipio ML, Koksinen SK, et al: Outcome of a Comprehensive Neurorehabilitation Program for Patients with Traumatic Brain InjuryArchives Physical Medicine & Rehabilitation 2005; 86:2296-2302. 11. Sayer NA, Chiros CE, Sigford B, et al: Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the global war on terrorArchives of Physical Medicine & Rehabilitation 2008; 89:163-170. 12. Schneider SL, Haack L, Owens J, Herrington DP, & Zelek A: An Interdisciplinary Treatment Approach for Soldiers With TBI/PTSD: Issues and Outcomes. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 2009; 19(2):36-46. 13. Solomon Z: The impact of Posttraumatic Stress Disorder in military situationsJournal of Clinical Psychiatry 2001; 62(17):11-15. 14. The Management of Concussion/mTBI Working GroupVA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain InjuryDepartment of Veterans Affairs & Department of Defense: Washington, DC2009. 15. VanderPloeg RD, Schwab K, Walker WC, et al: Rehabilitation of traumatic brain injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches Archives of Physical Medicine & Rehabilitation 2008; 89:2227-37. Disclosures None.