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A Community Comes Together: Caring for the Underserved

The numbers tell the tale. But a meeting with worried moms drove the point home: too many people in Snohomish County can't get basic health care. "We don't have enough health care practitioners, especially primary care providers," explains Dr. Tony Roon, medical director for health care access at Providence Everett Medical Center. "We need to find alternative ways to provide cost-effective care." So Roon and his colleagues launched a community effort to open a low-cost clinic to care for the region's thousands of underserved patients. In January of this year, the Providence Everett Healthcare Clinic opened its doors, offering a smart, practical solution to a community's health care crisis. The UW School of Nursing has participated as a key partner from the beginning.

Eleanor Bond, professor of biobehavioral nursing and health systems, first met with Roon in late 2002 to talk about how the school could be involved. S h e 's since joined the clinic advisory board and leads efforts to develop clinical training opportunities for UW nursing students. She's moved by the community support for the clinic, which included gifts of $1 million in cash and in-kind services to get it up and running. "It's been a remarkable accomplishment for everyone involved. In just two years, an idea has evolved into a working solution to an enormous problem," she says.

Staffed and managed by nurse practitioners, the clinic offers basic health care services to people who can't find a provider. It's not a free clinic, but unlike 95 percent of physician practices in Snohomish County, it accepts Medicare and Medicaid, as well as the uninsured. These patients would otherwise go to an emergency room or go without treatment. Providence Everett Medical Center's emergency department is the busiest in Puget Sound. Nearly 18,000 of the 93,000 patients treated there in 2002 could have been seen at a clinic or doctor's office except for one thing: with no insurance, they would have been turned away.

Nursing faculty and students at UW's Seattle and Bothell campuses work with clinic staff to meet two objectives: provide patient care and educate future nurses. Together, they find creative ways to simultaneously improve access to health care and address the nursing shortage. "A university is a resource for a state, and a community can be a resource for a university," Roon says. "This clinic represents a meeting of those two opportunities."

Bond and Brenda Zierler, associate professor of biobehavioral nursing and health systems, agree. "Our approach has been to ask 'what do you need?' and then develop projects to help meet those needs," explains Zierler, who oversees student scholarship and research at the clinic. "There's a lot of opportunity to be innovative in ways that really make a difference to patients."

For example, graduate nursing students are working on ways to improve quality of care by tracking workflow efficiency in the clinic and developing standards of care for medical assistant students. Others have created screening and self-management tools for diabetes and sexually transmitted diseases. Plans are to create culturally relevant chronic disease prevention and self-management classes, which align with the school's mission of cultural awareness in nursing. Students already work alongside translators and interpreters to better serve Everett's diverse population.

"The care we provide needs to respect different ethnic and cultural needs or it won't work," explains Zierler. Students from the UW School of Nursing-Bothell, who are registered nurses working on a bachelor's degree, bring to the clinic the ability to speak and write in various languages, as many of them speak English as a second language.

They are well-poised to do patient education and community health outreach with the clinic as a base, says Mary Baroni, professor and director of the nursing program at UW Bothell, and a board member at the clinic. "It's really about getting the right match for the right student and place."

According to Roon, student projects fill a big gap in managerial time needed to evaluate systems and programs that affect delivery of care. Over time, Zierler will build a clinical database of projects to evaluate how well the nurse-run clinic model meets patient needs, and whether it's an effective training ground for nursing students.

Two to four students per quarter get clinical experience under the guidance of a nurse practitioner. They get a real-world view of how our health care system works, and doesn't work. " It's a completely different experience from what most students are used to," Zierler says. "They see the problems in the health care system firsthand and how policies, access and use affect delivery of care."

Since January, clinic staff have seen 2,100 patients and, in time, could see as many as 20,000 a year. "It's going well so far," Roon says. "Patients are being better served and the clinic is approaching financial targets with a goal of becoming self-sustaining." It's early to say for sure, but this nurse managed clinic shows promise as an affordable way to make high-quality, basic health care available to anyone who needs it.

Over time, Bond and Zierler look forward to expanding the school's involvement and measuring the clinic's impact. "We'll have a nurse-managed model for service delivery that can be applied in other communities like Everett," Bond says. "I believe that more care will be delivered this way."