OB High-Risk RN at a Federally Qualified Health Center: An Essential Team Member in "Value-Based" Primary Care

Through an academic-practice partnership aligned with the HRSA 18-012, RN in primary care training program, Communicare Health Centers, a federally qualified health center, and the University of the Incarnate Word, successfully implemented an RN-OB high-risk initiative focused on RN practicing independently and collaboratively to improve health outcomes.

Purpose: To design an RN-enhanced practice role at a federally qualified health center (fqhc) focused on high-risk obstetric “value-based” outcomes, specifically gestational diabetes, hypertensive disease, risk of preterm delivery, and chronic conditions during the interpregnancy interval.

Aims: To develop effective clinical processes focused on RN practicing to the extent of Texas Board of Nursing licensure for the delivery of safe, high-quality, evidence-based high-risk obstetric care.

Objectives
1) Discuss the processes used to establish an RN-enhanced role practice at a federally qualified health center (FQHC).
2) Describe the work processes for establishing the RN-enhanced role among the population of high-risk obstetric patients.
3)    Discuss the “value-based” outcomes achieved.

Background: Communicare Health Centers, San Antonio, Texas, FQHC, is the defined academic-practice partner for the University of the Incarnate Word School of Nursing’s HRSA 18-012, RN in primary care training program. The women’s health medical director designed and implemented an OB high-risk initiative aimed at the need for reframing clinic processes to focus on high-quality care and value-based outcomes.

Methods: With the approval of the academic-practice partnership, the RN role was defined and implemented in the women’s health clinics. The RNs work independently and collaboratively with the patients and families using protocols focused on “value-based” care. A referral process within the electronic health record allows the clinic staff and clinicians to notify the RN of potential clients. The RN uses multiple care management techniques to engage the clients in achieving improved health outcomes, i.e., blood pressure monitoring, glucose monitoring, referral to health and wellness coaches and dietitians, and local community resources.

Results: A summary of the results will be presented including the internal “value-based” electronic dashboard, project lesson learned, and practice innovation techniques.

Conclusions: Implementing a high-risk OB program with an FQHC focused on population health framework aligned with roles and responsibilities of RN practicing to the extent of licensure produces reduced healthcare costs and improved health outcomes.

References
1)    American Academy of Ambulatory Care Nursing (AAACN). 2017. American Academy of Ambulatory Care Nursing Position Paper: The role of the registered nurse in ambulatory care. Nursing Economics. 35.1.