UMDNJ School of Nursing Mobile Healthcare Project

Transcription

1 UMDNJ School of Nursing Mobile Healthcare Project UMDNJ-SN Mobile Healthcare Project Project Director Gloria J. McNeal, PhD, ACNS-BC, APN, C, FAAN Associate Dean for Community and Clinical Affairs Medical Director Mark S. Johnson, MD, MPH Pediatric Medical Director Madolene Aliparo, MD Project Manager Olivia Sims, APN, C Project Coordinator Ariel Almacen, PsyD, APN, C

2 Why Mobile Healthcare? NJ State Office of Rural Health for Year 2000 Health Rates Essex County/State NJ DM rate = 37.4/31.8 Asthma Hosp = 411/191 HIV/AIDS = /357.4 CA = 521.4/517.4 Death Rates COPD = 32.1/34.1 Heart Dis = 268.3/269.4 Lung CA = 54.2/54.9 Stroke = 52.5/49.0 MUA/HPSA Mental Health Newark City Primary Care C.T to C.T

3 Why Mobile Healthcare? Health Research & Educational Trust of NJ Cost of Care Across the Nation for the Leading ACS Conditions Asthma = $10 billion Pneumonia = $23 billion CHF = $21 billion Diabetes = $91 billion ACS Admission Rates by County per 1,000 pop. Essex = 22.6/13.6 (highest rate in the State) Top 3 ACS Conditions Essex County ranked Asthma = 1 st in NJ Pneumonia = 2 nd in NJ CHF = 1 st in NJ

4 Why Mobile Health Care? Barriers to Care Insufficient # of doctors caring for the poor Inconvenient clinic locations Lack of transportation Communication difficulties, language barriers Perceived negative attitudes and lack of cultural sensitivity Source: Health Research & Educational Trust of NJ

5 Why Mobile Health Care? Recommendations Create more neighborhood-based health clinics and mobile units Use more NPs and PAs in primary care offices Provide evening and weekend hours Provide staff training on cultural sensitivity Provide patient education on disease control, self management, use of medications diet and signs and symptoms of chronic conditions Create educational materials in languages other than English and Spanish Source: Health Research & Educational Trust of NJ

6 : Thomas Jefferson University Mobile Immunization Unit Funding Source Clinton Administration Summer of Service Initiative $1.1 million to fund 8 schools of nursing Purpose To identify individuals and families at risk for vaccinepreventable disease Staff Nurse Faculty Nursing Students Community Leaders Medical Consultant Collaborations Philadelphia DOH Office of the City Managing Dir Churches Philadelphia Housing Authority Day Care Centers Homeless Shelters Public Schools Recreation Centers Area Rotary Clubs Outcomes 800 children/elders immunized City tracking database updated 30 community partnerships established 20 educational programs designed and delivered

7 MercyCARE Mobile Health Program Don t Wait Vaccinate Mural was Commissioned by Mayor sending a message to the community

8 : MercyCARE Mobile Health Program Funding Source $500,000 Mercy Health Corporation $1 million SmithKline Beecham Corporation Purpose To provide free ambulatory care services to medically underserved residents of Philadelphia and surrounding counties Staff Advanced Practice Nurses Medical Social Worker Community Outreach Coor Medical Consultant Mammography Technician Collaborations Sisters of Mercy Keystone Mercy Health Plan Roman Catholic Churches Philadelphia Housing Authority Day Care Centers Homeless Shelters Public Schools Recreation Centers Outcomes 4000 patient encounters per year PCP assigned to all patients Seamless healthcare delivery system from primary to tertiary care established for all patients Electronic patient information system linked to clinical affiliates of Mercy Health System

9 MercyCARE Mobile Health Program For large community events two vans were positioned onsite

10 : UMDNJ-SN Mobile Healthcare Project Potential Funding Sources Foundations City/State/Federal Grants Pharmaceutical Companies Third-party payors Charity Care Staff Advanced Practice Nurses Nurse Faculty Nursing Students Community Leaders Medical Director CNA/Driver Pediatrician Community Partnerships (partial listing) El Club del Barrio Clinton Hill West Ward Cultural Center Vision of Hope Covenant House The Leaguers UMDNJ Collaborations Foundation School of Medicine Urban and Community Devt UH Ambulatory Services Institute for the Elimination of Health Disparities

11 Improving Access to Care Addressing issues associated with healthcare disparities

12 The New Jersey Children s Health Project A Program of the UMDNJ-SN Mobile Healthcare Project FOR A HEALTHIER COMMUNITY A Neighborhood Health Clinic on Wheels Improving Access

13 A Community-based Model for Healthcare Delivery Eliminates barriers to care Supports the health promotion model Monitors ambulatory care sensitive conditions

14 Mission Statement The mission of the UMDNJ-SN Mobile Healthcare Project is to provide mobile health services that enhance access to health care delivery for persons in need and to ensure a continuum of care.

15 Mission Statement The UMDNJ-SN Mobile Healthcare Project emphasizes primary, secondary health promotion and disease prevention, state-of-theart health screenings, and access to tertiary care.

16 Primary Aim The primary aim of this community-based, nurse-faculty managed initiative is to link resources with caregivers and residents in the local communities served by the Project, and to be culturally and linguistically responsive to the needs of those served.

17 Project Goals To screen, identify and provide health promotion/disease management services for at-risk populations To foster community involvement in the health assessment and referral process To provide culturally and linguistically sensitive health promotion/disease management health education

18 UMDNJ-SN Mobile Healthcare Project Team Composition Project Director Medical Director Pediatric Medical Director Project Manager Project Coordinator Advanced Practice Nurses CNA/Driver APN Faculty Social Worker Students

19 New Jersey Children s Health Project A program of the UMDNJ-SN Mobile Healthcare Project joins a network of 21 programs nationwide delivering mobile healthcare services

20 Mobile Healthcare Project Brochure

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22 Mobile Health Unit Design Examination Room

23 Mobile Health Unit Design Waiting Area Intake Area

24 Telecommunication Technologies Laptop with Modem: /Fax/Transmission of Files Remote Transmission of Electrocardiographic and Medical Record Data

25 Provider Network Referral Systems: Specialty Areas Oncology Cardiology Otolaryngology Dental Ophthalmology Psych/Mental Health Pediatrics Gerontology Neurology Urology Endocrinology Obstetrics / Gynecology

26 Project Timeline Phases of Project Development Year 01 - Planning Year 02 - Implementation Year 03 - Evaluation Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Project Outcome Measures: 1) decrease in mortality/morbidity rates associated with ambulatory care sensitive (ACS) conditions in clients served as measured by clinical data; 2) increase in referrals for follow up care as measured by percent of return visits; 3) increased community involvement as measured by number of MOUs executed; 4) increased patient satisfaction as measured by surveying instruments; and, 5) increased dissemination of health information as measured by number of health packets distributed

27 Yr 01 Phases of Project Development Phase I Planning Identification of Mobile Health Team members Finalization of structured site visit schedule Establish referral mechanisms with tertiary care centers Publicize the Project via the media and community outreach Development of community partnerships

28 Yr 01 Phases of Project Development Phase 2 Implementation Initiate scheduled onsite mobile health visitations Provide primary care services for identified client base Conduct monthly audit of screenings/encounters Make referrals and follow up care as needed Provide patient education

29 Yr 01 Phases of Project Development Phase 3 Evaluation Outcomes of the Project will indicate: A decrease in mortality/morbidity rates associated with ACS conditions in the county served An increase in referrals for follow up care An increase in community involvement An increase in patient satisfaction An increase in the dissemination of health information

30 Project Sustainability FQHC Look-Alike Designation Third Party Reimbursement Charity Care External Funding Mechanisms Federal State Corporation Foundation

31 SN-MH Project Updates The Project has secured $3.4 million in extramural funding The Project has linked with the NYC-based Children s Health Fund, joining a national network of mobile healthcare programs Plans to establish a state-wide initiative are under development 30 MOUs have been signed Student clinical placements for both graduate and undergraduate nursing and medical students have been assigned

32 Table 1 Summary of Mobile Project Clinical Outcomes Number of Days Clinic is Open 4 days w/weekend and after hours on-call Number of Clinic Sites 30 Number of Patient Contacts 3860 Chief Reason for Clinic Visit Physical examinations 31.5% Dental screening and referral 18% Cardiovascular conditions 7.5% Genitourinary conditions 5.5% Respiratory conditions 3.5% Infectious processes 11% Skin conditions 4.5% Psychiatric conditions 3% Musculoskeletal conditions 2.5% Neurological conditions 0.5% Tumor/palpable mass 4% Positive pregnancy test 3.5% Gastrointestinal conditions 4.5% Endocrine 0.5% Number of follow up visits Number of physician referrals 1 3 per month 1 3 per month

33 Funding Request for Next Steps Expand to 4 additional sites Add 1 additional APN to the Project Staff Develop point-of-care testing procedures Implement the electronic health record system Develop a telemedicine initiative to perform retinal scans to evaluate visual acuity, diabetic retinopathy, and hypertensive changes

34 Acknowledgement Project Funding Agencies Healthcare Foundation of New Jersey Children s Health Fund Health Resources and Services Administration

35 Website