An Innovative Academic Clinical Coordination Model Supporting Academic-Practice Partnerships, Competency Development, and Patient Outcomes

Purpose: To describe an innovative academic clinical coordination model that supports developing academic-practice partnerships, promotes BSN student competency development, and improves patient outcomes in underserved populations.

Description: As part of a 4-year HRSA grant integrating primary care competencies into the BSN curriculum, an academic-practice partnership was formed between a northeast Ohio university-based school of nursing (SoN) and a federally qualified health center (FQHC).

Two senior students were placed with the FQHC wellness team as part of their clinical experience. In collaboration with the FQHC preceptor and improvement officer, a quality improvement initiative (QII) was completed identifying FQHC patients who were at risk for diabetes and hypertension (HTN). The students developed evidence-based screening tools to assess the presence of social, mental health (MH), and medical factors that place a person at risk for developing diabetes and HTN.

Sophomore students were placed at the FQHC to complete COVID-19 outreach activities. This need was discovered through continuous grant staff involvement with the FQHC.

Evaluation/outcome: Using the academic clinical coordination model, the following occurred:
• SoN clinical faculty and sophomore students supported:
o    COVID-19 outreach activities including symptom assessment, vaccination scheduling, and self-care/disease prevention strategies.
o    Care coordination and transition management (CCTM) competencies of nursing process, advocacy, and support for self-management, respectively.
•    The QII diabetes and HTN screening tools:
o    flagged the same number of at-risk patients as the automated system.
o    identified that 65% of the patients experience food and financial insecurity.
o    identified MH factors in 90% of patients with diabetes and 80% of patients with HTN.
o    supported development of CCTM competencies of nursing process and population health management.
•    Handoff of the QII to incoming senior students, including student huddles related to next steps.

The academic-practice partnership continues to expand through periodic evaluation and planning meetings. In addition to continuing the diabetes and HTN screening QII, sophomore students will be integrated into the QII; senior students will orient the sophomore students to the QII and support coordination of outreach calls, phone screening, and follow-up appointments. Follow-up appointments will be made with senior students for patient education and counseling on self-management and healthy lifestyle options, FQHC dieticians, and primary care or MH providers as indicated by the screening tool. Additional primary care competencies of support for self-management, teamwork and collaboration, and education and engagement of patient and family will be introduced to the nursing students, while continuing to meet the FQHC’s goals of improved patient screening and self-care prior to disease progression in patients at-risk for diabetes and HTN.

Multiple levels of student learners in an FQHC may not be possible due to limited RN staff. To achieve these outcomes, the innovative model of an onsite academic clinical coordinator will be introduced to support student exposure to the primary care setting, competency development, and patient care. Additional measurements are anticipated to evaluate outcomes related to economic feasibility, competency development, and patient outcomes.

The academic clinical coordination model aligns with the 2017 Macy Report, Partners in Transforming Primary Care, promoting faculty and student primary care competence.