$1.5 million grant to provide care for underserved Detroiters
As part of an expanded partnership between the University’s School of Nursing and the Detroit non-profit Community Health and Social Services, the U.S. Department of Health and Human Services has allocated a $1.5 million grant to help improve care for underserved populations.
CHASS, a Detroit-based community organization, provides primary health care and support services. The program aims to apply chronic disease management to address diabetes, cardiovascular disease, asthma and mental health issues.
This grant is the second $1.5 million gift awarded to the Nursing School and CHASS. The first grant, awarded in 2010, was intended to be three-year provision to fund nurse practitioners who would help increase access to primary health care in underserved areas.
This year’s grant will allow Registered Nurse Chronic Care Coordinators to lead teams of doctors, pharmacists, support staff and social workers in the provision of health care in impoverished communities.
Donna Marvicsin, Nursing School clinical associate professor, was the recipient of the initial grant and will serve as project director of the new program as well.
“This first grant resulted with a wonderful partnership with CHASS that then — because we had this community relationship, we had the trust — it allowed us then to be in the position to get the second grant,” she said.
The grant’s first goal is to facilitate training for CHASS employees with University professionals. Though Marvicsin said no University hospital nurses will participate in the program, undergraduate Nursing students will have the opportunity to gain clinical experience at CHASS.
Marvicsin said the Nursing School will act as a consultant for CHASS, to ensure the new training is properly completed and efficient communication occurs between patients and their primary caregivers.
“In a primary care clinic, it’s just so busy, it’s hard to start new programs and make sure they’re sustained,” she said.
Marvicsin said communication training is vital for an interdisciplinary team.
“What they find with teams is usually interprofessional workers have different ways of communication and different culture within health care providers,” she said. “We’re going to make sure that everyone is trained with cross interprofessional cultures and communication for successful teamwork.”
The program includes training in communication skills, decision making, care coordination and problem solving.
The second part of the program includes work with IT professionals. The aim is to ensure all patients’ health care information is documented properly in electronic health records.
The grant also aspires to help patients whose chronic conditions require frequent visits to health care professionals, in cases where health care professionals require the details of their patients’ cases before they even enter the clinic.
“These are patients who are established, they have diabetes, they have hypertension, they have high cholesterol. So they’re known to the clinic and they’re followed closely,” she said.
Marvicsin said patients with these conditions rely on their records, as do the nurses and doctors who treat them. Information gaps in the charts of patients with chronic diseases often result in malpractice.
The program hopes to meet a health care need that communities across the country face.
“There’s a primary care provider shortage nationally in rural underserved areas, and nurse practitioners — nationally, through the Institute of Medicine — have been recognized as strong potential source to bring primary care to underserved areas, which includes city and rural areas,” she said.
Marvicsin said the communities people live in, on top of genetic factors, can impact the onset of chronic conditions.
“Chronic conditions are multifactorial, but risk factors include being in a resource-poor environment,” she said.
Nursing Dean Kathleen Potempa said while it is not necessarily unusual for nurses to lead team teams in patient care, it is not as frequent as having a medical official in charge.
“What this grant does is it (allows) the nurse to bring the team together, focused on coordination of care for community patients who often can get lost in the care process,” Potempa said.
Nurses are particularly trained to listen to patient history and handle changes in care, making them uniquely qualified to be authoritative on a patient’s case.
“We understand better than other professions what the main issues are in terms of care coordination across settings,” Potempa said. “Because nurses take a very holistic comprehensive view of patient care — in other words, pharmacists look at drugs, social workers look at different types of services, physicians look at diagnosis and treatment plan, nurses look at everything.”
Potempa said the program would allow the University to change the model of care and promote this approach as a model for others.
“That’s the purpose of these grants, the feds don’t give this money to anybody, they give it to people they think can actually turn this money into a national model of care,” she said. “But it also allows us to train the next generation of nursing students so that they can go forth and spread it to other agencies and other situations.”