December 15, 2000

Vine Hill Clinic part of national model design

Featured Image

Patient Deborah Hutchings, right, shares a laugh with Allison DeHart, FNP, during an examination at the Vine Hill Clinic. (photo by Dana Johnson)

Vine Hill Clinic part of national model design

Vine Hill Clinic occupies the second floor of the Vine Hill Community Center. The facility sits at the corner of the newly renovated Vine Hill Homes – almost as a watchdog over the area.

The clinic is operated by the Vanderbilt University School of Nursing and was once housed on the third floor of the Vine Hill Towers. Located in an under served and isolated area with a large population of elderly and disabled, the clinic opened in 1990 with a grant from the Kellogg Foundation.

This summer the clinic moved into the 22,000-square-foot community center. The change has been a good one for both the clinical staff as well as clients.

The health clinic sits among a redevelopment project that was paid for through a Hope IV grant program designed to assist cities in revitalizing old public housing projects and generate economic growth. The $18-million project brought 76 duplexes and 18 single-family homes to the site.

“We have expanded as our needs have grown,” said Terri Crutcher, MSN, RN and clinical director for faculty practice. “We are always looking at our patient population and its needs. We are responsible for 5,000 covered lives, which means we are the primary care source for these people. We also have an additional 1,000 Medicare patients that we could potentially care for.

“We offer a full-range clinic offering primary care services which also includes women’s health and mental health services.”

The 3,400-square-foot facility has eight exam rooms and three mental health consultation rooms. There are two full-time and two part-time nurse practitioners and nine office staff.

With a log of 60 to 70 patient visits daily and over 8,000 visits annually, the clinic’s top priority is ensuring that clients are well taken care of.

“This population has traditionally not had access to health care and there are a lot of self-care concerns,” said Allison DeHart, FNP. “We do a good job of getting patients to buy into their own health care and become interested in it – but that is happening because we are interested. We show we care. It conveys to patients a sense of respect.

“Just because they are TennCare patients doesn’t mean that they have to have a clinic that is not up to par. That message of respect is important. That definitely plays into their willingness to seek out care.”

The clinic recently agreed to take part in an Institute for Healthcare Improvement project called Idealized Design of Clinical Office Practices (IDCOP). The goal of the project is to produce better clinical outcomes, lower costs, gain higher satisfaction among patients and improve efficiency. This national initiative includes 34 clinical sites and one locale in Sweden.

What makes this project special at VUSN is the fact that Vine Hill is the only practice site that is run exclusively by advance practice nurses.

The information gathered from this collaborative effort will be used among those institutions involved in the project as well as become instrumental as a model for other practice sites nationwide.

“Our goal is to improve care delivered to the Vine Hill population,” said Dr. Paul Miles, associate professor of Pediatrics and executive director and chief quality officer for the Center for Clinical Improvement at Vanderbilt University Medical Center.

“This project will help us redesign our process of care. It is an opportunity to learn throughout Vanderbilt,” he said.

Vine Hill’s involvement is a coup for Vanderbilt – this type of project has traditionally focused on physician office practices.

“Being involved in a national project shows that nurse practitioners provide superb care. The philosophy behind IDCOP is customized care – a team approach. Good care requires multidisciplinary teams. This is not just about physician/patient interaction.

“In some clinics in order to expand what they do, they must expand the physician practice and include nurse practitioners. This project will promote the use of multidisciplinary teams with nurse practitioners very much a part of the picture,” he added.

Crutcher said what makes Vine Hill successful is the relationship it has with Vanderbilt physicians and specialists.

“We have a great relationship with our physician preceptors and physician specialists to whom we refer,” she said. “We keep an open line of communication with all the doctors seeing our patients. We give good care with solid back up from the Vanderbilt physicians.”

Joyce Thomas, RN, improvement consultant for the Center for Clinical Improvement said the project’s goal is to improve the care delivery in ambulatory outpatient settings.

“We are hoping to reduce the Emergency Department usage and reduce hospital admission,” she said. “If we can manage wellness on an outpatient basis, then the patients are healthier and it is more cost effective – this would be an indication that the disease management is under better control and the overall state of wellness is better.

“If our nurse practitioner site can make this work and serve as a model on how to successfully manage patient care, especially with their limitations of space and resources, then it should work successfully in our physician practice sites also.”

Vine Hill is currently working on incorporating an open access policy when scheduling patient appointments. This would allow patients to receive an appointment on the day requested. It is also one of the missions of the IDCOP model – patients having unlimited access to the care and information they need and when they need it. This practice model is also characterized as “doing today’s work today.”

Despite the IDCOP model and goals, Crutcher said Vine Hill Clinic is successful for one reason: “Every clinic has lots of good things about it and has a committed staff,” she said. “But around here, we all know why we get up in the morning to come to work.

“We really do a good job here, good things are happening and we care about what we are doing – and it shows.”