Provider variability in delivery of preventive services has been observed to adversely affect minority populations. To address this, we implemented a strategic partnership between preventive medicine and nursing. Through the partnership, preventive services were incorporated into the single standard of nursing practice at a VA hospital serving 21,594 people. Medical leadership had agreed to the guidelines of the U.S. Preventive Services Task Force. After a planning survey, it was determined that all required Task Force recommendations were within the competence of registered nurses. Preventive medicine physicians provided back-up and also staffed referral clinics. Under the single standard model, it was no longer necessary to have a separate physician's order each time an immunizaiton, screening test or behavior change referral was indicated. Reveiw of 557 randomly selected medical records at baseline and 386 records during year one by an external quality review organization showed dramatic improvements (e.g., increases in recording height (76% to 99%), nutritional counseling (35% to 78%), asking about tobacco use (45% to 78%), sending tobacco users for treatment (8% to 83%), pneumonia immunization (24% to 63%), and influenza immunization (30% to 74%). Subsequent reviews showed that improvements have held for three years. Moreover, personnel costs for prevention declined. These results suggest the potential for nurse-physician partnerships to remove barriers to prevention in ways which are sustainable, which do not disrupt care, and which require only re-allocation of existing resources. Testing of the model in a Medicaid setting has now begun.
Learning Objectives: Attendees will be able to describe a new model for equality in preventive services delivery based on a nurse-physician partnership and a single standard of care
Keywords: Veterans, Vulnerable Populations
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Alvin C. York Veterans Affairs Medical Center
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Part of my Meharry salary is supported by a contract with the Alvin C. York Veterans Affairs Medical Center.