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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 [email protected]
• Mountain City Extended Hours Health Center– Shelia Cooke 423-727-1160 [email protected]
• Hancock County School-Based Health Centers– Nancy Seal 423-733-2819 [email protected]
• Student/University Health & Washington Co. School-Based Health Centers – Pam Williams 423-439-4038 [email protected]