Rush Nurse Practitioner Students Essential to the Success of a New Patient Care Delivery Model

Sunday, February 12, 2012

Last month, seven primary care physician groups at Rush University Medical Center were the first academic medical center practices in Illinois to receive National Committee for Quality Assurance (NCQA) level 3 recognition as Patient Centered Medical Homes (PPC-PCMH). These practices represent an entire range of specialties including pediatrics, family, adult health, gerontology, endocrinology and internal medicine, and serve more than 43,000 patients. An essential guideline of the medical home model involves providing care coordination to patients. The care coordinator is responsible for patient care, population outreach, quality improvement and documentation.

Through the proposal of a strategic alliance with Medical Center leadership, Melanie Dreher, PhD, RN, FAAN, dean of the College of Nursing and Raj Behal, MD, MPH, associate chief medical officer, envisioned a high quality and cost-effective way to transition these seven physician practices to a PCMH. They proposed that Rush advanced practice nursing (APRN) students function as the care coordinators. Marcia Murphy, DNP, ANP-CS, faculty liaison from the advanced practice nursing (APN) program explains, “The medical homes needed high quality health care professionals that could be trained in the care coordination role to meet standards set by the NCQA. Our APN students needed clinical education to complete their program. This was a win/win situation—the students build their skills and the practices gain key positions.”

In June 2010, after only six months of planning, Kathy Swartwout, PhD, APN, FNP-BC, medical home steering committee member and first faculty liaison from the college, began placing APRN students from primary care specialty programs into the participating practices. Swartwout and other College of Nursing faculty including Murphy, Joanne Miller and Jan Odiaga, along with key members of the PCMH team, met with these students every three weeks to assess their progress. “This was a pilot program,” said Swartwout, “so the student role changed and evolved over the course of their experience. The students were able to meet their clinical management objectives, while acquiring the knowledge and skill required for care coordination, interprofessional teambuilding, electronic health tools and population outreach. This provided them invaluable experience to practice in an era of health care reform.”

Nursing student, Leah Maier, reflects on her clinical education at Associates in Internal Medicine, “Being a part of the first medical home pilot as a student gave me the opportunity to play a key role in transformative, holistic health care. While learning how to manage care for patients with chronic diseases, I also was a primary player in long-term education and follow-up, and had an overall impact in decreasing hospital re-admissions. As a nursing student, my one-on-one time with the medical home patients was just what they needed for the extra motivation to take control over the chronic diseases they have struggled with for years.”

Lauren Ellis, family nurse practitioner student and orthopedic RN, was also placed at Associates in Internal Medicine. “The medical home approach really centers on comprehensive care,” said Ellis. “In conjunction with the other health team members, I have done a lot of follow up with patients beyond their office appointments. Some of the medical home activities include linking patients with financial or social support resources. Dealing with chronic illness can be overwhelming and many of the patients appreciate that we call to check up on how they are doing with things like blood glucose control, medication management or breathing.”

Ellis further explains, “Beyond preventing decline, medical home is about health promotion, which is especially important for this population. Patients in medical homes usually have multiple co-morbidities, which are often hard to control and too much to cover in a twenty minute visit. Nurse practitioner students involved in medical home provide more resources, mainly time, and work with the physicians to ensure that not only are the patients receiving the best possible care for their conditions, but also are getting all the routine screening and health promotion care with their convenience in mind.”

The National Quality Forum, which advises the President, designated care coordination as one of six “national priorities” for national action. “Care coordination is the lynchpin to improving quality in health care reform,” said Murphy. “Our students with this experience now have an opportunity to propose and implement projects aimed at improving access, quality and costs within the new national framework.”

Allison Vasilj, family nurse practitioner student, had just this opportunity during her time as the care coordinator at Rush University Family Physicians at Lincoln Park (RUFPLP). “The dynamics of the office created a wonderful learning environment where my organizational strengths could be fully utilized,” said Vasilj. “Ultimately, this environment translated into a better place for patients as well. Part of the role of the PCMH was to identify patients who would benefit from the program and then I was approached, as the care coordinator, about those patients. I discussed possible interventions, how those strategies might benefit tailored health care management, and how best to implement the interventions with the different providers. The office manager and I used our time together to brainstorm on the medical home program and how to best direct it at RUFPLP. An efficiently run office, such as this one, streamlined the delivery and quality of health care by all providers.”

As health care reform continues to evolve, the collaborative relationships established throughout Rush during the medical home pilot program are key to providing high quality, affordable health care for the future. “Our experience with the PCMH initiative at Rush will serve as an example of successful integration of APRN students in a new patient care delivery model,” said Swartwout. “We envision our Rush APRN students as future leaders, ready to contribute to the new health care reality.”