The author did not have affiliations with any agency to fulfill this project. This author did
not receive any funding for the development of the ABNC framework for California project. The
author endured mild expenses related to printing the resource guide, occasional travel, time and
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Appendix C: Evidence Table for Nurse Practitioner Impact of Care
Author/Year Design Sample/Setting Topic Studied Key Findings Strength of Evidence (Johns Hopkin’s Appraisal Tool) Stanik-Hutt et al (2013) Systematic Review n=37 published articles, selected from 27,993 total studies during 1990- 2009 United States The impact of Nurse Practitioner’s vs physician on health care quality
Eleven patient outcomes for measures of quality and effectiveness of care were
identified: patient satisfaction with provider, patient self-assessment of perceived health status, functional status, number of unexpected ED visits, hospitalization, duration of ventilation, and hospital level of service, blood pressure, blood glucose, serum lipids and mortality. Among these outcomes it was determined care delivered by NPs was no different than the care delivered by physicians in regards to patient satisfaction, functional status, number of ED visits, hospitalization rates, and self- report of perceived health status. The outcomes for mortality were equal among both providers, and outcomes for blood glucose and blood pressure were also similar. NPs had slightly improved
outcomes on serum lipid measures.
Level I Quality A Jennings, N. et al. (2015) Systematic Review n=14 research articles selected from 1013 studies between 2006-2013 United States The impact of NP services on quality of care, cost, satisfaction, and waiting times in the emergency department.
The evidence demonstrated that quality of care, patient satisfaction and wait times were impacted positively by NP care, however little evidence pointed to any cost benefit that might lead to any reform of emergency room services.
Level I Quality B
Mekwiwatanaw ong, C. et al. (2013) Descriptive Comparativ e Study n=315 provider participants n=300 patient participants Thailand Three primary care models: a) NP-MD with fulltime supervision, b) NP-MD with part- time supervision, and c)NP without supervision, attending to patients with Diabetes
Using standardized guidelines for care of the diabetic patient 3 clinic models were studied for outcome comparison. The NP role in Thailand remains in much question and conversion as here in the United States and data for better understanding of NP care delivery and safety of outcomes was examined. The interventions examined were: screening and diagnosis of diabetes, treatment for glycemic control, follow-up and evaluation of treatment, complications and diabetes education for self-care and lifestyle adjustment. The results
demonstrated the lowest mean for fasting blood glucose in the NP without supervision model as well as the highest score for self-care, lifestyle adjustment, and patient satisfaction. Level II Quality A Oliver, G.M., et al. (2014) Meta- Analysis Review of data from 4 different databases including: Medicare & Medicaid Research Review, JAMA Thirty day hospital readmission (2006-2011), Office of the Inspector General Report (2011), America’s Health Rankings (2012) Readmission rates and health behaviors of Medicare and Medicaid patients compared in states with full practice NP authority to states without full practice NP authority.
In states where NPs are allowed full practice, preventable
hospitalization and readmission rates are decreased.
Level III Quality B
Buerhaus, P. et al. (2015) Qualitative Analysis n=972 clinicians NPs and physicians from 2011-2012 The identification of practice characteristic s of NP’s vs physicians in the United States
A 61.2% response rate was achieved using a mail survey to study practice demographics, compensation, billing practices, NP privileges, and types of clinical activities performed. The data demonstrated that NP’s were more likely to practice in rural areas, delivered a smaller range of services, found that regulations were impeding their capacity to perform, and did not have salary adjustments for quality or
performance. Both sets of providers supported collaboration and team practice and felt that NP’s could offer some relief in expanding primary care access.
Level III Quality B
Appendix G: Demands for Full Time Providers per 10,000 population in Three Models of Care Delivery
Appendix H: Mobile Health Unit Proposal Submission
SONHP Integrated Health Clinic Mobile Van Initiative
Project Proposal
Criteria:
1. Priority will be given to projects that are inter-professional and/or span SONHP departments and programs 2. Projects MUST include student learning experiences
3. Projects must advance the USF and SONHP vision, mission, and values 4. The financial implications of the project must be considered
Project Name: “Expanding primary care/preventative health to HPSA’s (Health Provider shortage Areas) and high risk communities, through mobile clinic outreach using FNP’s” Date: 9/29/2015
Faculty Champions:
Prabjot (Jodie) Sandhu & Dr. Jo Loomis Project Goals:
This project aims to identify/screen communities in need of health interventions such as education, referrals, physical exams, immunizations, screenings and other primary care interventions. This is a population health project. By using the mobile van and a collaborative agreement between Dr. Svenson & FNP’s there will be a standardized protocol set up to evaluate certain communities and pilot health based interventions- 1 day a week.
The FNP’s will be able to maintain autonomous practice to their full extent with this collaborative agreement and develop a holistic philosophy of care to be delivered through USF that is aligned with the mission and values of the Jesuit community.
The project will provide students at USF with the opportunities of service, community outreach and interaction and a holistic perspective to providing health needs.
Students (FNP, Behavior Health, PSY D, and even CNLS’s) can be involved in these outreach projects as clinical preceptorships or with outcome intervention change projects.
Target Population: Local and rural communities, HPSA’s (Health Provider shortage areas)
Will probably begin with Ella Hutch as an established partnership community that has health based needs.
Location: All/Any to be determined by setting up a community assessment tool that can be used broadly, along with web based research through communities
Student Population (number of students; type of students; nature of commitment; expected time and duration of commitment, etc.)
1-2 FNP faculty per shift- with one to two FNP, or other SONHP students as appropriate for intervention
Student Outcomes:
1. FNP students can obtain clinical hours, develop clinical skills, do community practice, develop and lead DNP projects for USF via community outreach.
2. CNL students can apply educational projects.
3. Behavior health students can assist in health administration tasks and complete their internship/project hours.
4. PSY D students can also obtain hours by attending to psych/mental health community needs. Faculty Commitment (planning v. implementation; weekly commitment; projected impact on load, etc.)
Jodie is leading the DNP project and will pilot one day a week and further strategize continued efforts and regularity with faculty load.
Currently all FNP are assigned faculty load for precepting students and can have the flexibility to use those hours on this project in rotation.
Financial Considerations:
The staff /students to pilot this project is already in place.
Risk management at USF will be able to provide a double check on all legal aspects.
Need for specific state licenses and waivers will be researched and costs provided if applicable.
Supplies and equipment that is currently available through LRC and FNP programs will be used.
Additional equipment list can be made after designation of project based on first pilot and actual need > not to exceed $1500.
Grant from the Jesuit fund will be attempted.
Future funding efforts will be made through HPSA- if we can pilot the method and gain access to health service shortage areas on a regular basis.
Project Timeline:
November through February – Pilot project Evaluation Metrics/Timeframe:
1. Establish a community with a health need in which we can provide a regular service using the Mobile Health Van, using the project timeline.
2. Provide the designated service with satisfactory scores from the community (scoring and quality metrics to be determined)
3. Assess the benefits of the service to the community by direct measurement of given intervention, ie screening leading to proper follow up, education leading to increased knowledge, immunizations leading to higher vaccination rates, health exams leading to proper referrals and gaining access to care.
4. Successful integration of various SONHP departments in providing care to the community through USF