| Learning Objective #1: Discuss the strategies used to design a system of care that is sensitive to the needs of an indigent population, is cost effective, and results in high-quality outcomes | |||
| Learning Objective #2: Describe the outcomes of a clinic designed to deliver care for indigent patients diagnosed with chronic lung disease |
The local prevalence of asthma, COPD, and poverty all exceed the state and national norms. These diseases of disparity are associated with high rates of ER visits and hospitalizations. Recognizing the challenge of providing care across the continuum, a clinic designed to be sensitive to the needs of a diverse population of indigent patients diagnosed with chronic lung disease is operated by a healthcare system. Through trial and error, this model clinic has evolved to be highly successful and cost-effective.
From the outset, a strong commitment was made to document outcomes of care. Under the direction of the patient care research specialist, an ANP, care was provided by a FNP. After brief apparent success, the project faltered. The patient population dwindled and, through attrition, new patient care research specialist and FNP hired. Together, the VP for Patient Care Services and newly hired research specialist and FNP reviewed the clinic’s system of care and outcomes. Based on the review, the clinic was reorganized to better meet patients’ needs. It has since been highly successful.
Over the past two years, care has been highly individualized. Patients are retained, new referrals are common, and patient outcomes positive. Outside funding has enhanced ability to support varied patient initiatives. The many improved outcomes include decreased number and costs of ER visits and admissions, improved pulmonary function, and self-care indicators. Treatment regimens are evidence-based.
The challenges associated with implementing a model disease-managed clinic and strategies used to reorganize and improve the clinic’s function will be shared. Outcomes will be identified. The implications include increased knowledge of the successful implementation of an evidence-based clinic for medically indigents, with demonstrated cost-effectiveness and positive clinical outcomes. The discussion will support the need for care to be evidence-based, culturally sensitive, and outcomes directed.
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