Wanda Lancaster, F.N.P., checks Bonnie Thornton's blood pressure during a checkup in her apartment at Trevecca Towers. The Vanderbilt University School of Nursing is testing a new house call program, VandyCalls, where nurse practitioners visit patients at their homes in Trevecca Towers.
photo by Dana Johnson
VUSN’s VandyCalls program brings care to Trevecca residents
The Vanderbilt University School of Nursing recently launched its “VandyCalls” pilot program at Trevecca Towers in Nashville.
The innovative house call program was developed by the school's Faculty Practice management team, led by Bonnie Pilon, D.S.N., senior associate dean for Practice. The group saw a need to bring services to people with physical, economic or logistical obstacles to getting important health care needs met.
The idea for VandyCalls has been evolving for three years, since two of the school's Health Systems Management graduate students developed a business plan for delivering reimburseable and private-pay care options for home assessments and traditional home health care, Pilon said.
“The idea of nurse practitioners doing 'house calls' seemed to be another value-added service that we might provide within a package of services initially developed through the graduate student assignment. About 18 months ago, we met a company trying to start a Nurse Practitioner house calls program in South Florida. I left those discussions thinking 'our ideas of three years ago must be on target if the private market is moving in that direction; we should move forward with a pilot.' Dean (Colleen) Conway-Welch and the University Community Health Services board were supportive, so we began to plan our program,” Pilon said.
Details started coming together late this summer when VUSN partnered with Trevecca Towers to conduct a three-month test of the program as part of a larger Medical Center initiative at Trevecca under the Senior Care Services program, led by Vickie Harris.
The clinic is located in the three-building complex that houses 650 senior and disabled residents. The average age of the residents is 84. Residents can call to schedule a future appointment or call for same-day visits. Either way Family Nurse Practitioner Wanda Lancaster, armed with her contemporary version of a traditional doctor's bag, will come to the patient's home ready to diagnose problems, prescribe medication, draw blood, treat acute illnesses and chronic diseases, give shots or handle other medical needs.
“It's a very effective approach that integrates a high-level of care that is as convenient as possible for the patient,” said Lancaster.
Caroline Portis-Jenkins, clinical director for Employer Health and VandyCalls, is one of the graduate students who first analyzed the feasibility of the program, along with Laura Beth Brown, M.S.N., who directs Vanderbilt Home Health. Portis-Jenkins points out that VandyCalls is very different from traditional home health care.
“Our program is based on having a full-time family nurse practitioner, like Wanda, who can deliver the type of health care typically associated with a traditional visit to a medical provider's office. That's a different approach than home health care, which usually involves R.N.-managed care, acting under physician orders, as well as home therapies such as physical therapy and infusion therapy. Home care can be thought of as extending hospital-level professional nursing care into the home. Our program extends the medical provider's office into the home for diagnosis and treatment appropriate to the home environment.”
Lancaster has stayed busy since the program launched just a month ago. She's spent time getting to know the residents and explaining her role as a health care resource. She already sees up to nine patients a day and the phone keeps ringing with requests from new patients.
One day, for example, Lancaster did a follow-up visit with Bonnie Thornton, who a few weeks ago was battling severe pneumonia-like symptoms. Two weeks ago, the normally active 82-year-old was bedridden, without energy to get medical help. Lancaster came on the scene, diagnosing the problem and immediately starting treatment. Now, the smile on Thorton's face reflects her improved health.
“I was so sick, I don't know what I would have done if it wasn't for Wanda,” said Thornton. “Now I'm telling all my friends not to wait, just call Wanda and she'll check you out.”
With VandyCalls, Thorton received on-the-spot treatment and had a better chance of recovery. Without VandyCallls, she might have been sent to the Emergency Room, which could have caused her unnecessary discomfort, stress and more expensive health care.
The VandyCalls pilot phase will last through the end of December. Then Pilon and her staff will evaluate the program. One area they already know they need to refine is the issue of communicating feedback from the home visits to the patient's primary care provider.
“We want to be very responsible and determine the best way to work with the entire trajectory of the patient's care. The primary care physcian needs to know what happened during the VandyCalls visit in order to best coordinate the patient's overall care. We are just one part of a continuum of care,” said Pilon.
Long-term goals for VandyCalls include branching out into other targeted areas of Davidson and Williamson counties and getting involved in private-pay community case management.