Nurse-managed Clinics for Faculty Practice

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The University of Maryland School of Nursing
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Meeting the Needs of Uninsured and
UnderinsuredThe State of Maryland Governors
Wellmobile

• Collaboration for Public Health
• APHA Annual Meeting 2001
• Marla T. Oros, MS, RN
• Associate Dean for Clinical and External Affairs

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Mission of the Governors Wellmobile

• To provide primary health services to the
  underinsured and uninsured populations throughout
  the State of Maryland.
• To work with local health departments, community
  organizations, and hospitals to improve the
  health status of patients who utilize the
  Wellmobile.
• To provide health education and promotion to
  diverse populations.

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School Of Nursing Focus

• Changing health care delivery system shift
  towards community based primary care and managed
  care.
• Focus on health promotion and disease prevention
  and management.
• Curriculum redesign to meet the current health
  care trends.
• Opportunity for faculty practice and research.

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History of the Governors Wellmobile

• Delegate Marilyn Goldwater
• Began in 1994 as a private/public partnership
  with funding from the State of Maryland, Merck,
  Kaiser Permanente, Prudential, MAMSI, Giant Food
  and others.
• Managed by the University of Maryland
• Serves as one of the principle training sites for
  the School of Nursing.

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Current Status

• Currently operating two Wellmobiles
• Central Maryland
• Eastern Shore
• New regions opening in the Fall
• Western MD
• New region, possibly Southern
• Equipped with exam rooms, labs, and health
  education area.
• Funded through Federal, State, local, and private
  funding.

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Current Statistics

• In 2000, 639 patient visits at 11 sites
  throughout the state.
• Primary Diagnosis Hypertension and Well Child
  Checks
• In 2001 to date, 886 patient visits at 15 sites
  throughout the state.
• Primary Diagnoses Hypertension and Health
  Assessments

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Services of the Governors Wellmobile

• Physical Examinations
• Immunizations
• Well-child Care
• Vision and Hearing Screenings
• Early Detection for Cancer
• Health Education
• Lab testing and Diagnosis
• Community Assessment

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Program Model Governors Wellmobile

• Mobile treatment unit to deliver primary and
  preventive health services to underserved
  communities.
• Staffed by
• Full time faculty FNP
• Full time nurse care coordinator
• Full time driver/office assistant
• Travel to local community sites to deliver
  services.

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Strategic Partnership Program Model

• Mission compatibility in care to the underserved
  FQHC preferable partner.
• Mutual desire to serve hard-to-reach sites.
• Utilize Wellmobile as an extension of partner
  provider system to reach strategic locations and
  populations.
• Wellmobile becomes modified satellite primary
  care center of partner system.
• Partner system provides back up medical,
  specialty and ancillary support services.

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Partnership Roles

• Wellmobile
• Provide and fund all on-site primary health care
  services.
• Manage, operate and staff Wellmobile services.
• Identify patients eligible for MCHIP or other
  insurance programs and enroll as appropriate with
  partner provider system.
• Complete encounter forms and other
  registration/data collection information as
  mutually identified between SON and partner.

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Partnership Roles

• Health Systems
• Develop physician collaborative agreement with
  Wellmobile FNP.
• Accept referrals for follow-up medical and
  specialty services.
• Accept new patients inappropriate for Wellmobile
  services.
• Assist in providing referrals for patients
  needing additional diagnostic and laboratory
  services.
• 24 hour medical back-up.

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Partnership Opportunities

• Provide greater comprehensiveness and continuity
  of care for uninsured patients served by
  Wellmobile in designated communities.
• Increase enrollment of MCHIP and other new
  insured patients to local health systems.
• Expand primary care services through Wellmobile
  to additional sites that currently can not
  support a full time medical practice.
• Collaborate on development of fourth Wellmobile
  for Southern Maryland.

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Future Plans

• Expand services to a total of five mobile clinics
  throughout the state of Maryland.
• Development of partnerships throughout the state
  to collaborate, coordinate, and expand services.
• Enhance current data collection system necessary
  for patient tracking and outcomes management.