Clincal Nurse Leader in the Community

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Clincal Nurse Leader in the Community

• Pamela N. Clarke
• Fay W. Whitney School of Nursing
• University of Wyoming

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National Need for Clinical Leadership

• DNP or MS/CHN
• 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)

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Clinical Nurse Leader in the Community

• Masters prepared provider
• Family focused
• Fits model of care proposed in the state and AACN
  CNL competencies
• AACN competencies critical to the model
• Generalist vs Advanced Practice
• Educator
• Integration of care
• Advocate
• Population competencies

4
Unique Rural Environment

• Access and transportation issues in frontier
  state
• High-end specialty care out of state
• Negotiation of complex care systems across state
  lines
• Care coordination is critical
• PHNs
• Working in under-funded health departments

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New Service Model

• Public-Private partnership
• Builds on PharmAssist Program (direct service to
  individual for medication regimen)
• Clinical prevention key element
• Timing coincided with national Clinical Nurse
  Leader movement
• Need for data to support entrepreneurial venture
  Efficient and effective

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HealthAssist Business Model

• Non-profit business developed with assistance
  from Business and Law Schools
• Long-term plan includes for profit venture
• Initial funding from the state 5 state agencies
  
• Pilot project targeted toward high users of
  medications services

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Family Success PilotChanging Delivery Systems
Program-centric
Family-centric
to
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Home Visit as the Core

• Conceptual shift patient-centered vs
  family-centered
• Home-based services
• Prevention and health promotion for all families
• Family empowerment
• Family advocacy and negotiation skills
• Development of family health plan
• Information and decision-making

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Pilot Study to Demonstrate Effectiveness

• 200 Medicaid cases (using gt10 medications 2 or
  more state services) under age 65 in two counties
• Homogeneity on funding source
• Randomly assigned to intervention and comparison
  groups
• Consent with potential for delayed treatment

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Timeline for Project

• 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)
• Staff training (difference between CNS and CNL
  family empowerment training for nurse and
  pharmacist) (December, 2005)
• Some nurses and most of the pharmacists dont
  get it

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Predicted Outcomes

• Evaluation Measures
• Pharmacy Outcomes Reduced rate of Adverse
  Drug Effects Improved family/caregiver
  knowledge of prescribed medications Reduced
  pharmacy cost Reduced number of drugs
• 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

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Outcomes

• Evaluation Measures (Continued)
• CDC Health Related Quality of Life
• Summary index of unhealthy days
• Activities Limitation Module
• Healthy Days Symptoms Module
• Human Capital Development Achievement of
  family plan goals
• Cross Agency Coordination Discovery and
  recommendation for managing high cost families

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CNL vs CHN

• Same or different?
• 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
• Economic indicators/ Bottom line cost savings
• Implications for education

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END