The University of Alabama at Birmingham (UAB) School of Nursing has received a three-year, $1.4-million grant from the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) to develop and implement an innovative interprofessional collaborative health-care practice model that improves quality of care and outcomes for underserved patients with diabetes and other chronic conditions.
The HRSA grant will allow a UAB team that includes nurses, nutritionists, social workers and more, to work together. Along with supplemental funding provided by UAB Hospital, the grant will also allow the PATH (Providing Access to Healthcare) Clinic to increase the volume of patients it can see from 150 to 750 a week.
The grant's principal investigator is Cynthia Selleck, D.S.N., R.N., associate dean for clinical affairs and partnerships in the UAB School of Nursing.
"The increase in chronic illnesses and growing need for accessible, cost-effective health-care services, have the health-care industry in the United States moving toward providers from many disciplines working together with the common goal of building a safer, more patient-centered care delivery system," Selleck said. "We know that teams provide better care when they work together, yet too frequently that doesn't happen."
The UAB team comprises faculty, as well as clinical and non-clinical providers from social work, nutrition, optometry, medicine, informatics and health information management, in addition to nursing. The goal is for the members of the team — many of whom will teach the next generation of health-care providers — to learn how to work together. Doing so will allow them to provide the best possible care, as well as teach their students how to effectively serve patients as health care evolves.
"This is a new experience for all of the providers," Selleck said. "We all, through this project, are learning to function as a collaborative health-care team."
The model Selleck's team created utilizes an interprofessional coach to teach the characteristics of a strong team and help members learn how to best work together. Each clinic day, team members meet first thing to talk about the patients they will see, and they decide who on the team will take the lead with each patient.
"If the patient is a diabetic with poor eating habits, the nutritionist may take the lead," Selleck said. "If the patient is homeless, social work may lead the care team to help the patient get the services he or she needs to find a shelter or even a permanent home."
At the end of each day, the team meets to discuss the day and fill out blind surveys about how the group functioned. The coach will observe the teams and use these surveys to provide feedback about the model.
The team is implementing this new practice model at the PATH Clinic, an ongoing partnership between the School of Nursing and Birmingham's M-POWER Ministries. M-POWER provides the only free clinic in Jefferson County, Alabama. It is situated in a medically underserved community designated as a health professional shortage area for primary care, dental health and mental health.
The School of Nursing established the nurse-managed PATH Clinic in May 201 within M-POWER's existing free clinic facility as a primary care and chronic disease management clinic. It has operated for four hours each Wednesday to provide primary care services and see patients with conditions such as diabetes or hypertension — patients who needed closer disease management than M-POWER's three acute-care evening clinics could provide.
"We are thrilled with the partnership with UAB School of Nursing that helped establish the PATH Clinic, along with the clinic's start-up funding from the Community Foundation of Greater Birmingham," said Ryan Hankins, executive director of M-POWER Ministries. "With this new grant, we can work with UAB to significantly expand the number of patients receiving long-term medical care — patients who would otherwise have nowhere else to turn."
Selleck said UAB Hospital joined the effort to provide an avenue for uninsured diabetic patients to receive follow-up care. A large number of patients are admitted through the hospital's emergency room each year because they do not have control of their diabetes. Once they are discharged, they are told to follow up with their primary care provider, but many patients do not have such a provider due to lack of insurance or other reasons. The hospital will now send those patients to the PATH Clinic for follow-up care.
The funding the hospital provides enables the clinic to have an endocrinologist on site to assist patients in keeping their diabetes under control and potentially eliminate future trips to the emergency room.
"Diabetes is an enormous problem in Alabama, with Alabama and Mississippi leading the nation in diabetes prevalence," said Will Ferniany, Ph.D., CEO of the UAB Health System. "We see this every day at UAB Hospital, where 34 percent of non-maternity patients suffer from, and 46 percent of patient days are associated with, poor blood sugar control. When you factor in that a good number of these patients lack insurance, and they often have no access to medical care or diabetic medications and supplies outside of the hospital, providing a source of ongoing care with access to needed medications and testing supplies is a win-win situation. It improves the quality of life for these patients and potentially reduces avoidable use of inpatient and emergency room resources. A recent analysis shows that many of these patients get sick again and return to the hospital. One such patient returned to UAB 35 times in the last 12 months."
This also will be a learning experience for some students from UAB. Students from each of the disciplines represented on the team will be integrated into the model once it is up and running for a few months.
"As trainees, these students are our next generation of providers, and we want them to learn how to practice as part of high-functioning interprofessional teams," Selleck said.
This innovative approach developed at UAB can be reproduced anywhere in the country.
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