ETSU COLLEGE OF NURSINGNURSE-MANAGED CLINICS

January 2015

Community-Based Clinics

Hancock County Elementary School CHC

Johnson City Community Health Center

Mountain City Extended Hours Health Center

Johnson City Day Center

Hancock County Middle High CHC

Johnson City Partners for Health

School-Based Clinics

Jonesboro Elementary School

Northeast State Community College

University School

Daniel Boone HS

David Crockett High School

ETSU Student/University Health

ETSU College of Nursing

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."

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

ETSU College of NursingNurse-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

In the beginning…

ETSU College of Nursing

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

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 co-application 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)

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

0

5,000

10,000

15,000

20,000

25,000

7,404 7,454 6,809

9,325 9,94811,577

15,637

18,139

23,648

Became Johnson City Community Health Center 10/11/12

Day Center Visits

2008 2009 2010 2011 2012 20130

2000

4000

6000

8000

10000

12000

59866803 6440

6894 7021

10094

Hancock County School-Based Health Centers Encounters

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

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

6,235

7,329

6,448

5,608

4,551 4,7835,101 5,267

4,084

FY 05-FY 08 inclusive of nursing and NP visits

Mountain City Extended Hours Health Center Encounters

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

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

7,196

6,177

5,369 5,3025,820

4,6245,093

6,085 6,324

Washington County School-Based Health Centers Encounters

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

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

3,0472,816 2,755

2,566

3,1483,409

3,816 3,7353,469

Student Health Clinic Visits

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

0

1000

2000

3000

4000

5000

6000

7000

8000

55815285

61496866

5665 5605

4242

5281

6758H1N1 Scare

EMR Implemen-tation

Total Encounters per Clinic 2005-2014

HC JCCHC MCEHHC SUHS WCSBHC0

20,000

40,000

60,000

80,000

100,000

120,000

45,325

109,941

45,666 44,674

32,516

291,562Total Clinic Encounters FY2005-2014

Community health center funding

15 years of continued support from Health Services and Resource Administration,

Bureau of Primary Health Care

Community Health Center Funding

52%

26%

12% 6%3% 1%

Federal GrantsRevenuesUniversityStateCity/CountyDonations

CHC Poverty Status

10.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

97.47%

79.57%

CHC Insurance Status

54.25%

29.12%

3.17%13.47%

Uninsured Medicaid Medicare Third Party

PAP Smears

2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

CHC State National

Change in national guidelines not con-sistent with HRSA measurement defi-nition

Hypertension ControlB/P <140/90

2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CHC State National

Diabetic ManagementHemoglobin A1C <9 mg/dl

2011 2012 201354%

56%

58%

60%

62%

64%

66%

68%

70%

72%

74%

CHC State National

Immunization 2 yr Olds

2008 2009 2010 2011 2012 20130.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

CHC National State

Influenza added as required to UDS but not CDC

*2012 measurement indicator changed

Prenatal Care First Trimester

2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

CHC State National

RN Case manager left

31

Quality of Care: Low & Very Low Birth Weight Babies

2008 2009 2010 2011 2012 20130.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

CHCState CHCNat'l CHC

*

* Very Low Birth Weight-Measure Changed 2009 to include very low and low combined

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 GrantsGrant 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

mission-health 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