Transcript HealthAssist

Clincal Nurse Leader in the
Community
Pamela N. Clarke
Fay W. Whitney School of Nursing
University of Wyoming
National Need for Clinical Leadership
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DNP or MS/CHN
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Few CHN programs
Jobs have disappeared
Public needs health counseling to achieve
cost efficient care
Nursing is natural fit [vs physicians, trained
counselors or social workers]
Families need guidance negotiating the
system and information (integration of care)
Clinical Nurse Leader in the
Community
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Masters prepared provider
Family focused
Fits model of care proposed in the state and AACN
CNL competencies
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AACN competencies critical to the model
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Generalist vs Advanced Practice
Educator
Integration of care
Advocate
Population competencies
Unique Rural Environment
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Access and transportation issues in frontier
state
High-end specialty care out of state
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Negotiation of complex care systems across state
lines
Care coordination is critical
PHNs
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Working in under-funded health departments
New Service Model
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Public-Private partnership
Builds on PharmAssist Program (direct
service to individual for medication regimen)
Clinical prevention [key element]
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Timing coincided with national Clinical Nurse
Leader movement
Need for data to support entrepreneurial
venture: Efficient and effective
HealthAssist Business Model
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Non-profit business: developed with
assistance from Business and Law Schools
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Long-term plan includes “for profit” venture
Initial funding from the state [5 state
agencies]
Pilot project targeted toward high users of
medications & services
Family Success Pilot
Changing Delivery Systems
Program-centric
to
Family-centric
Other
Community Programs
State Agencies
Programs
DFS
WDH
Executive
Leadership
Team
WHIN
IDB
Risk
Analysis
WHIN Project Coordinator
Family
Person
DOC
DWS
Health Services
Powerful
Families
Health Assist
DOE
Home Visit as the Core
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Conceptual shift: patient-centered vs familycentered
Home-based services
Prevention and health promotion for all families
Family empowerment
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Family advocacy and negotiation skills
Development of family health plan
Information and decision-making
Pilot Study to Demonstrate
Effectiveness
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200 Medicaid cases (using >10 medications
& 2 or more state services) under age 65 in
two counties
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Homogeneity on funding source
Randomly assigned to intervention and
comparison groups
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Consent with potential for delayed treatment
Timeline for Project
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Acceptance of model (2003-2005) 2 years
IRB Approval (5 state agencies) Fall, 2005
Business plan (May, 2005) Ongoing communication
within university system
Created a Board of Directors and EIN number
(November, 2005)
Hiring staff: (Fall, 2005)
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Staff training (difference between CNS and CNL; family
empowerment training for nurse and pharmacist)
(December, 2005)
Some nurses and most of the pharmacists “don’t get it”
Predicted Outcomes
Evaluation Measures
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Pharmacy Outcomes:
• Reduced rate of Adverse Drug Effects
• Improved family/caregiver knowledge of prescribed medications
• Reduced pharmacy cost
• Reduced number of drugs
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Medical Care Outcomes:
• Less fragmentation of providers, reduced number of providers
• Reduced rate and cost of emergency room, technical, and
institutional care
• Coordinated medical and pharmacy treatment among medical
providers
Case-finding: family member needs
Outcomes
Evaluation Measures (Continued)
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CDC Health Related Quality of Life
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Summary index of unhealthy days
•
Activities Limitation Module
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Healthy Days Symptoms Module
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Human Capital Development:
• Achievement of family plan goals
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Cross Agency Coordination:
• Discovery and recommendation for managing high cost families
CNL vs CHN
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Same or different?
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CHN/PHN responsible for core public health
functions
CNL: generalist leader in practice
New Service Model is an opportunity to
demonstrate effectiveness of generalist
practice
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Economic indicators/ Bottom line= cost savings
Implications for education
END