Expanding a Nurse-Managed Primary Care Clinic in Appalachia: A Community-Academic Partnership

Background: The Health Wagon, a free 5013c clinic, was awarded a HRSA Affordable Care Act in 2010 to form an academic partnership with the University of Virginia and other community agencies in Southwest Virginia (SWVA) Appalachia. The 4 counties targeted by the grant have almost 43% of residents below 200% of the federal poverty level, with 25% reporting no health insurance. Age-adjusted mortality rates in some of the counties are as much as 70% higher than the rate for the state of Virginia. Description: The primary goals of the grant are 1) to expand access to comprehensive health care with a public health focus on prevention, 2) to expand the number of clinical training opportunities for nurses, 3) to improve access to care and become a patient-centered family home for those without insurance or ability to pay, and 4) to improve clinical services and data collection ability by implementing an electronic medical record (EMR). Lessons Learned: Up-front training of all involved in the grant at start up is critical. Back up plans for scheduling nurses in training are important to accomodate unexpected, unavoidable events while ensuring training opportunities. Implementating an EMR into the daily operations of a busy free clinic takes more time and is more complex that EMR salespeople share! Recommendations: We report on progress to date related to each goal and share lessons learned related to public health practice and project implementation. Those planning such partnerships would benefit from contacting others who are working within a similar culture.