Advanced Practice Nurse-led Interprofessional Collaborative Practice: Outcomes and Model Evaluation 10 th ICN NP/APN Conference Presentation Rotterdam, The Netherlands August 27, 2018 Bonnie Pilon, PhD, RN-BC, FAAN
Disclosure presenter
Acknowledgements The work described in this presentation was supported by funding from the US Department of Health and Human Services. UD7HP25064 (2012-2015) UD7HP30932 (2017-2019)
Our Clinic Team
Patient Demographics 2017 Patient Demographics 2017 N=936 Age Male Female Total Percentage 0-18 44 40 84 9% 19-64 373 429 802 86% >64 29 21 50 5% Race Ethnicity Total 936 100% White 162 179 341 36% Black or African American 140 136 276 29% Hispanic 0% White Hispanic or Latino 91 118 209 22% Black Hispanic or Latino 3 7 10 1% Other Race Hispanic or Latino 0 0 0 0% American Indian or Alaska Native 1 2 3 0% Asian 46 41 87 9% Pacific Islander 3 3 0% Refuse to Report 3 4 7 1% Total 446 490 936 100% Other Public Housing Homeless last 12 months Income below 200% Poverty Uninsured 242 394 636 68% 279 77 356 38% 364 310 674 72% 257 282 539 58%
Patient Visits: 2012-2017 The Clinic at Mercury Courts Patient Visits 3500 3000 2500 2000 1500 1000 500 0 2012 2013 2014 2015 2016 2017 Insured Uninsured Total Medical Visits
Key Quality Metrics: 2012-2017 Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Behavioral Health Measures # Behavioral Health Referral 0 0 29 30 32 55 Chronic Disease Management Measures DM with A1c (HP2020 Goal 71.1%) 15% (27) 57% (53) 87% (98) 87% (101) 85% (121) 84% (119) DM with Control Hga1c < 7% (HP2020 Goal 53.1%) 2% (27) 28% (53) 47% (98) 52% (101) 58% (121) 56% (119) Controlled HTN (HP2020 Goal 61.2%) 18% (102) 32% (209) 42% (267) 47% (304) 58% (324) 59% (287) Self-Management Goal (DM, HTN, CVD) 0% (131) 27% (293) 67% (392) 76% (431) 82% (502) 81% (487) Tobacco Use Screening 10% (280) 90% (642) 99% (896) 99% (915) 99% (938) 100% (936) Tobacco Use Disorder 79% (280) 68% (642) 61% (896) 48% (915) 47% (938) 45% (936)
Key Quality Metrics, continued Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Pharmacy Consultation Measures Appropriate Asthma (Persistent Asthma) N/A 46% (22) 78% (32) 77% (51) 76% (48) 79% (46) Appropriate ASA (CAD) N/A 58% (11) 92% (17) 94% (22) 90% (27) 93% (25) Appropriate Statin (Hyperlipidemia) N/A 50% (32) 87% (51) 88% (68) 84% (72) 82% (81) Clinical Pharmacy Consultation Rate (All Patients) N/A 52% (642) 89% (896) 91% (915) 84% (938) 91% (936) Cancer Screening and Prevention Measure Mammogram (Female, age >49) 0% (21) 15% (69) 31% (87) 58% (109) 63% (134) 62% (170) Colorectal (age <49) 3% (101) 7% (182) 23% (247) 37% (310) 36% (348) 35% (352) Cervical (Female, age 21-65) 12% (87) 57% (315) 64% (413) 70% (392) 74% (408) 78% (453)
Social Service Quality Metrics: 2012-2017 Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Social Service Patient Pharmacy Assistance/Cover RX New Measure for 2017 62 Housing Service Referrals N/A 21 38 47 44 50 Emergency Food Box Distributed N/A 102 157 187 198 240 Insurance New Measure for 2017 60 Assistance with Food Stamps New Measure for 2017 15 Assistance with Benefits New Measure for 2017 5 Other 'Emergent Needs New Measure for 2017 55 Operational Measures 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Total Unique Patients 280 642 896 915 938 936 Total Patient Encounters 432 2186 2672 3064 3245 2462 Percentage Uninsured 78% 67% 61% 58% 56% 58%
Introduction of Behavioral Health Services: 2018 Active Caseload Statistics Number (#) of active patients on caseload Percent (%) of active patients with 1+ contacts this month Percent (%) of active patients with PHQ < 5 or -50% (response/remission rate) Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18 21 24 35 48 50 48 95% 92% 80% 90% 80% 90% 5% 29% 23% 42% 28% 31% Relapse Prevention Inactive Total Percent (%) of active patients not improved and without psych consult Percent (%) of active patients in relapse prevention status Number (#) of patients discharged to date Total number (#) of patients enrolled to date (Active + Inactive) 24% 4% 6% 0% 0% 4% 0% 8% 14% 19% 16% 17% 3 4 7 8 14 23 24 28 42 56 64 71
BHI Registry Trends Current Patients Cumulative 24 28 21 24 42 35 56 64 71 48 50 48 Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18
Current Patient Volume: Jan 2018--present BHI Program Totals BHI Enrolled Total BHI Current Patient 71 48 BHI "Relapse Prevention" BHI "Graduated" BHI "Lost to Follow-up" 8 15 8
Suicidality Screening: Jan 2018--present Time frame: Jan-Jun 2018 Count Percentage Behavioral Health and Suicide Screening Process Measures Total Unique Patients seen at the CMC 448 Total Unique with BHI Screened last 6 months (N=448) 431 96.21% Total Clinic Visits 1120 Total # of Visit with BHI screening done (N=1120) 1089 97.23% Suicidality Measures Total # of Patients Screened Positive for Suicidality (N=448) 52 11.61% Total # of Positive Screens (N=1120) Note: patients can screen 64 5.71% positive multiple times Safety Assessment Performed by BHI 64 Clinic Intervention and Safety Plan Initiated (N=64) 50 78.13% 6 9.38% Crisis referral required based on Safety Assessment (N=64) 8 12.50% No intervention required based on Safety Assessment (N=64)
Team Development Measure Scores Over Time Time point Average TDM score Team Stage Winter 2013 58.25 Stage 4 Summer 2013 58.50 Stage 4 Winter 2014 62.00 Stage 4 Summer 2014 58.86 Stage 4 Winter 2015 60.16 Stage 4 Winter 2017 91.1 Fully Developed Winter 2018 105.8 Fully Developed
Student Rotations: 2012-2017 Extended Clinical Rotation Type Students Family Nurse Practitioners 42 Psychiatric/Mental Health Nurse Practitioners 3 Acute Care Nurse Practitioners 1 BSN Nursing students 1 Physician Assistants 18 Pharmacy students 75 Pharmacy Residents 6 Master of Social Work Students 12 Counseling (PhD students) 5 Medical Students 11 Internal Medicine Residents 1 Law students 1 Divinity students 4 MBA students 4 Medical Assistant students 3 Total 189
Student Metrics: Snapshot 22 current students surveyed pre/post in 2015-2016 Readiness for Interprofessional Learning (RIPLS) tool used Students rotations < 20 full days on site Statistically significant increase in scores after their rotations
Graduated Student Feedback 53 graduated students surveyed No statistical differences among the professions Score range on RIPLS was 28-39 Lower scores indicate more positive attitudes toward interprofessional learning (tool range 21-105) Graduates open ended comments also indicated high satisfaction with IPCP model of care
Questions? Thank you! Contact: bonnie.pilon@vanderbilt.edu