The term “in tune” means to create harmony between instruments in a musical setting. Similarly, the InTune project proposes to create a network of harmonious, innovative academic-practice partnerships that have been carefully crafted to provide primary care and leadership services “in tune” with the needs of a rural/underserved (R/US) population. InTune will also foster unique immersive traineeship opportunities for selected nurses enrolled in the Family Nurse Practitioner (FNP) at The University of Texas at Tyler (UT TYLER).
The term “in tune” means to create harmony between instruments in a musical setting. Similarly, the InTune project proposes to create a network of harmonious, innovative academic-practice partnerships that have been carefully crafted to provide primary care and leadership services “in tune” with the needs of a rural/underserved (R/US) population. InTune will also foster unique immersive traineeship opportunities for selected nurses enrolled in the Family Nurse Practitioner (FNP) at The University of Texas at Tyler (UT TYLER). The InTune network of clinical partnerships supports the provision of primary care services to a vulnerable population that currently has limited access to consistent primary care services in a medical home, often seeking medical care in local emergency departments. InTune proposes to create synergy between existing primary care medical homes, developing on-call, telehealth, and community health coach (CHC) services to optimize communication, providing awareness, encouragement, and guidance through a more easily-navigated healthcare model. The InTune model proposes an academic-practice partnership network infrastructure that delivers immersive longitudinal primary care clinical training experiences with R/US populations and facilitates graduates’ employment in those settings. The UT TYLER FNP Program serves a diverse student body from rural Northeast Texas; graduates often return to their own R/US communities to provide primary care.
a) to increase the number of R/US clinical sites and qualified preceptors by providing immersive traineeships for FNP students by 8-10% each year;
b) to increase the number of FNP students placed in immersive clinical traineeships in R/US clinical sites by 8-10%;
c) to increase the number of primary care FNP graduates from UT Tyler FNP Program by 10-15% through financial support of their education;
a) to increase the number of R/US clinical sites and qualified preceptors by providing immersive traineeships for FNP students by 8-10% each year;
b) to increase the number of FNP students placed in immersive clinical traineeships in R/US clinical sites by 8-10%;
c) to increase the number of primary care FNP graduates from UT Tyler FNP Program by 10-15% through financial support of their education;
d) to prepare a competent, diverse, practice-ready workforce of team-based primary care practitioners for distribution to R/US areas by maintaining a 95% pass rate on FNP certification exams;
e) increase the percentage of ANEW- funded FNP graduates who gain employment in R/US areas, public health settings in state or local health departments, medically underserved areas (MUAs), medically underserved populations (MUPs), or Health Professional Shortage Areas (HPSAs) to at least 65%.
Who: diverse FNP students (especially from rural/underserved areas), and academic-practice infrastructure (faculty, preceptors, clinics in rural/underserved areas);
What: recruiting and graduating more skilled, practice-ready, team-based FNPs to become employed in rural/underserved (R/US) areas;
When: traineeship applications NOW OPEN FOR FALL 2018;
Who: diverse FNP students (especially from rural/underserved areas), and academic-practice infrastructure (faculty, preceptors, clinics in rural/underserved areas);
What: recruiting and graduating more skilled, practice-ready, team-based FNPs to become employed in rural/underserved (R/US) areas;
When: traineeship applications NOW OPEN FOR FALL 2018;
Where: Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs);
Why: to increase the numbers of diverse FNP students recruited to/graduating from UT Tyler, and to increase their employment in R/US areas; to improve access to quality healthcare of MUA/MUP/HPSA populations; and, to develop primary care training sites for immersive longitudinal clinical training in R/US areas/populations for enrollees in the UT Tyler FNP programs.
Definitions:
a. MUA: Medically underserved area
b. MUP: Medically underserved populations
c. HPSA: Health Provider Service Area
d. FNP: Family Nurse Practitioner
e. R/US: Rural/Underserved
The overarching goals of the InTune Project include increasing R/US clinical sites, increasing the numbers of FNP students in ANEW traineeships, increasing the number of FNP graduates, maintaining or increasing board certification pass rates, and increasing the percentage of graduates gaining employment in R/US areas. Academic-practice partnerships provide important services to vulnerable populations and provide students with the opportunity to gain valuable insight into the many complexities of clinical practice. Clinical Coordinators (CCs), are faculty who will serve as the liaison between each student, clinic, and the academic environment, and between academic and clinical venues.
We are currently partnering with several clinics in Tyler and the surrounding areas to provide two fully licensed FNPs to provide care. In turn, these community partners will provide space and clientele for said FNPs as well as UT Tyler FNP students who will precept with them as part of their clinical hour requirements. UT Tyler faculty FNPs will provide oversight at each clinical site on an as-needed basis and to help coordinate data collection for HRSA performance reporting requirements. Currently, we have an FNP employed full-time with the Bethesda Clinic and a second full-time FNP employed by FCOC in Tyler, Athens, and Jacksonville.
a. Bethesda Clinic in Tyler, which boasts more than 25 major community donors, who provide professional medical services, medical supplies,
We are currently partnering with several clinics in Tyler and the surrounding areas to provide two fully licensed FNPs to provide care. In turn, these community partners will provide space and clientele for said FNPs as well as UT Tyler FNP students who will precept with them as part of their clinical hour requirements. UT Tyler faculty FNPs will provide oversight at each clinical site on an as-needed basis and to help coordinate data collection for HRSA performance reporting requirements. Currently, we have an FNP employed full-time with the Bethesda Clinic and a second full-time FNP employed by FCOC in Tyler, Athens, and Jacksonville.
a. Bethesda Clinic in Tyler, which boasts more than 25 major community donors, who provide professional medical services, medical supplies, and other program-related services and in-kind donations. Bethesda serves low income adults, uninsured or underinsured adults in Tyler and surrounding areas.
b. Family Circle of Care (FCOC) in Tyler, Athens and Jacksonville, Texas serves a rural, diverse, underserved population with a high percentage of female Hispanic clients.
c. The UT Tyler FNP Program contracts with over 700 clinical facilities, 51% of which serve R/US vulnerable populations. Other examples of community partners include, Special Health Resources of Texas (SHRT) Clinic in Tyler, Texas, serves a diverse population of uninsured and homeless from the Greater East Texas area, and has joined Hi-Way 80 Rescue Mission Clinic increase the utilization of the partnership with UT Tyler’s FNP Program. The NE Texas Public Health District serves a vital function for the citizens of Smith County and NE Texas to prevent illness, promote health, and protect the community and partners with hospitals and primary care entities to fulfill these goals.
c. The UT Tyler FNP Program contracts with over 700 clinical facilities, 51% of which serve R/US vulnerable populations. Other examples of community partners include, Special Health Resources of Texas (SHRT) Clinic in Tyler, Texas, serves a diverse population of uninsured and homeless from the Greater East Texas area, and has joined Hi-Way 80 Rescue Mission Clinic increase the utilization of the partnership with UT Tyler’s FNP Program. The NE Texas Public Health District serves a vital function for the citizens of Smith County and NE Texas to prevent illness, promote health, and protect the community and partners with hospitals and primary care entities to fulfill these goals. Trinity Christus Mother Frances and UT Health Tyler Hospitals have experienced an influx of individuals in Emergency Departments seeking primary care and, unwittingly, placing a burden on community resources. These entities and others have partnered with UT Tyler School of Nursing to participate in the InTune Project to facilitate establishment of medical homes for diverse populations in MUPs in the R/US areas of NE Texas. Because most of the sites associated with this partnership serve extended regional areas, the MUPs, MUAs, and HPSAs will be more easily reached.
The InTune Project will help solidify an existing network of health resources (hospitals, clinics, healthcare professionals, and ancillary service providers) known as CommUnity Cares in a practice partnership with UT Tyler Braithwaite School of Nursing to achieve mutual goals. The philosophy of the CommUnity Cares medical home network is to ‘meet patients where they are’ by establishinga relationship between the patient, clinic, provider,
The InTune Project will help solidify an existing network of health resources (hospitals, clinics, healthcare professionals, and ancillary service providers) known as CommUnity Cares in a practice partnership with UT Tyler Braithwaite School of Nursing to achieve mutual goals. The philosophy of the CommUnity Cares medical home network is to ‘meet patients where they are’ by establishing a relationship between the patient, clinic, provider, and Community Health Coach (CHC), dedicated to helping patients “own” their healthcare decisions and facilitating vulnerable patients’ navigation to the appropriate health care resource. This will be accomplished by removing the Emergency Room as a ‘one stop shop’ for patients who are unable to pay for health care and, instead, assigning them a medical home. Each patient will be assigned a CHC, a medical home identifier, and a card that refers them to the resources of the medical home, along with an 800 number to the communication hub call center. The call center connects patients to the CHC navigator, or the CHC navigator on-call after hours, or to their assigned medical home during office hours. The CHCs will be trained to use an algorithm to direct the patient to the appropriate community partner, health care provider, and/or other patient resource. (This portion of the grant has not been implemented yet, since the CommUnity Cares is still under implementation.)
Dedicated faculty, known as Clinical Coordinators (CCs), will manage student/preceptor/site interactions on an ongoing basis. Four CCs, all of whom are doctoral-prepared DNPs and fully credentialed and practicing FNPs, will be assigned to one or more of the R/US practice partner sites. Collaborative goals, and shared knowledge are the values of the academic-practice partnership model.
Dedicated faculty, known as Clinical Coordinators (CCs), will manage student/preceptor/site interactions on an ongoing basis. Four CCs, all of whom are doctoral-prepared DNPs and fully credentialed and practicing FNPs, will be assigned to one or more of the R/US practice partner sites. Collaborative goals, and shared knowledge are the values of the academic-practice partnership model.
A robust, experienced preceptor network is the foundation of quality nurse practitioner programs. We are privileged to have over 1300 preceptors who have contractual agreements, and who are currently preceptors for UT Tyler FNP students. To recruit a diverse population of preceptors, the InTune PD will evaluate the status of the diversity of existing preceptors and initiate efforts to recruit ethnically diverse preceptors, as well as veterans and males. In collaboration with the Executive Director of the SON, the PD will work to evaluate and expand the diversity among the faculty at UT Tyler.
Recruitment of R/US clinical sites is aggressive and ongoing. Collaboration with agencies like the Area Health Education Consortium (AHEC) increases clinical placement of students. Texas AHEC East works to improve the health of individuals and communities it serves through a wide array of programs that support health workforce development,
Recruitment of R/US clinical sites is aggressive and ongoing. Collaboration with agencies like the Area Health Education Consortium (AHEC) increases clinical placement of students. Texas AHEC East works to improve the health of individuals and communities it serves through a wide array of programs that support health workforce development, cultivate health literacy and spur health care practice transformation. With a priority for underserved populations, AHEC East partners with area communities to find people to fill health care jobs and to maximize local healthcare resources. This agency introduces students to health careers, promotes classroom activities, provides scholastic resource help, and advises students on scholarship availability at all levels of their education. The University of Texas at Tyler School of Nursing partners with AHEC East to better serve students, preceptors, communities, and clinical sites. This can have a positive impact on FNP graduates seeking jobs.
For more information, please view the AHEC East video describing this partnership with UT Tyler, or go the AHEC East website.
Tracking outputs from the logic model, including the access for students, preceptors, health coaches, & patients, enhanced student, and preceptor education with the implementation of Rapid Cycle QI with PDSA Model contributes to the evaluation plan. The PDSA model will be used to complete QI processes. Utilizing all team members will increase project buy-in and generation of new ideas.
Click here for Evaluation Methodology
Following the PDSA model, the PD with the assistance of Senior Risk, LLC consultants will create a comprehensive Rapid Cycle Quality Improvement plan to assure optimum preceptor management and partnership success. Survey questions to elicit feedback from all stakeholders (students, preceptors, clinical sites, and faculty) will provide continuous monitoring of program metrics. Data will be collected and collated by clerical personnel and research assistants from the InTune website, and then reviewed and analyzed by the PD and consultants. Surveys, forms, competency-based education materials and accompanying exams will be revised to improve processes within the partnerships. Results will be monitored
Following the PDSA model, the PD with the assistance of Senior Risk, LLC consultants will create a comprehensive Rapid Cycle Quality Improvement plan to assure optimum preceptor management and partnership success. Survey questions to elicit feedback from all stakeholders (students, preceptors, clinical sites, and faculty) will provide continuous monitoring of program metrics. Data will be collected and collated by clerical personnel and research assistants from the InTune website, and then reviewed and analyzed by the PD and consultants. Surveys, forms, competency-based education materials and accompanying exams will be revised to improve processes within the partnerships. Results will be monitored quarterly and shared with all partners to allow for development of an action plan to address any deficiencies. An evaluation report will be developed by the PD, in conjunction with consultants at least annually, describing the results, challenges, and recommendations quarter over quarter. Interim reports may be compiled throughout the year on a semester basis to inform curriculum, processes, or clinical instruction. Any deficiencies will be viewed as an opportunity to formulate an action plan to monitor and ensure improvement.
When making application for InTune funds, each student signs an agreement to provide the SON Graduate program with required information and data regarding professional employment activity following graduation. Department clerks contact graduates on a routine basis to maintain current data. Student employment is tracked following graduation as part of the program evaluation process through alumni surveys. One of the major cultural hurdles in Texas is being fluent in medical Spanish, since 33% of patients speak Spanish. The UT Tyler Braithwaite School of Nursing collaborates with the Spanish department at the University to provide 9 semester hours of medical Spanish. A university collaboration in Costa Rica is in place for an additional 3 hours of medical Spanish immersion. UT Tyler has initiated a collaboration with the NE Texas AHEC to help with identification of FNP trainee placement sites and employment of graduates in R/US communities is underway.
Incomplete data might be a challenge, so the PD/consultants will create the survey questions/forms. Data will be collected and collated by clerical personnel, reviewed/analyzed by the PD/consultants. Surveys and forms will be revised to increase response rate by clarifying questions that were perceived as unclear on the survey. This will be an ongoing process for QI, as described by the PDSA model. An evaluation report describing the evaluation activities, results, challenges, and recommendations will be developed annually by the PD/consultants. Interim reports may be compiled throughout the year on a semester basis. The PD, consultant, and the PC will work together to ensure all pertinent data is collected/analyzed/reported in a timely manner.
Incomplete data might be a challenge, so the PD/consultants will create the survey questions/forms. Data will be collected and collated by clerical personnel, reviewed/analyzed by the PD/consultants. Surveys and forms will be revised to increase response rate by clarifying questions that were perceived as unclear on the survey. This will be an ongoing process for QI, as described by the PDSA model. An evaluation report describing the evaluation activities, results, challenges, and recommendations will be developed annually by the PD/consultants. Interim reports may be compiled throughout the year on a semester basis. The PD, consultant, and the PC will work together to ensure all pertinent data is collected/analyzed/reported in a timely manner. In addition to stakeholder surveys and InTune website data, other data sources will include, SON graduate recruiter, admissions officer, and graduate advisor. Tracking students after graduation and maintaining accurate contact information could be a challenge, so the SON will allow students to retain their school email account indefinitely, frequently updating graduate program databases to ensure all information is current. PC will contact graduates on a routine basis to maintain current data. Student employment is tracked following graduation through alumni surveys; maintaining an optimum response rate could be a challenge, so incentives such as library access, CE opportunities, research collaboration opportunities, local AHEC news, and access to the job board will be offered via the InTune website.
InTune Project organizers are aware of the need to address barriers to diversity of students, preceptors, and faculty. The project will implement strategies that focus on increased recruitment of underrepresented minority and disadvantaged students, such as identification of talented undergraduate minority students interested in obtaining advanced nursing education and developing bonds through mentoring and support; a strong University marketing campaign that offers information about the ANEW Grant Program and the InTune Project for advanced practice nursing education will be disseminated to high schools, junior colleges, BSN programs, rural clinics, hospitals, and other healthcare entities in the UT Tyler catchment area that are known for diversity by our school of nursing marketing director.
Formative evaluation will occur through regular faculty and administrative meetings to discuss the project and progress toward its objectives and sub-objectives and through the Graduate Studies Committee. Formative evaluation will also occur within courses as FNP faculty and Clinical FNP faculty interact with students online, evaluate their performance in the clinical sites, and make changes in didactic and clinical learning experiences to meet emerging and changing needs. Summative evaluation will occur at the end of each semester via student and faculty course evaluations, annually, and at the end of each funding period. Individual FNP faculty will evaluate student progress each semester during clinical section meetings and address any concerns with student performance.
Formative evaluation will occur through regular faculty and administrative meetings to discuss the project and progress toward its objectives and sub-objectives and through the Graduate Studies Committee. Formative evaluation will also occur within courses as FNP faculty and Clinical FNP faculty interact with students online, evaluate their performance in the clinical sites, and make changes in didactic and clinical learning experiences to meet emerging and changing needs. Summative evaluation will occur at the end of each semester via student and faculty course evaluations, annually, and at the end of each funding period. Individual FNP faculty will evaluate student progress each semester during clinical section meetings and address any concerns with student performance. Evaluation of the disbursement process for ANEW Grant Program funds will be accomplished through a survey sent to students at the end of each disbursement period. The PD will provide summary recommendations to the Graduate Studies Committee and Administration at UT Tyler. Required HRSA reports will summarize progress on all program objectives. The PD will ensure that the HRSA evaluations and reports will be submitted in a timely manner, and as required. As indicated in the inputs from the Logic Model, the evaluation plan includes University faculty, students, staff, clinical partners, public health network, key staff, PD, grant administrator, Clinical Coordinators (CCs), Community Health Coaches (CHCs), consultants, PDSA Process, and budget. At the end of each semester, faculty are evaluated routinely as a part of employment at UT Tyler, and students are encouraged to evaluate faculty and courses; faculty will be evaluated by student trainees (and vice versa), and preceptors will evaluate students (vice versa); students will be expected to evaluate each of the clinical partner sites where they participated in clinical hours, and the CC assigned to each site will evaluate them. Each clinical partner and the public health network will have an opportunity to provide input and evaluation at meetings with the PD (and applicable consultants, as needed) that will be held at least quarterly. CHCs will be evaluated by the PD, applicable community partners, and CCs, once after the first quarter of employment, and yearly thereafter. Formal evaluations of the indicated groups will be conducted as needed, following the PDSA process. The budget will be reviewed quarterly and evaluated annually for quality, correctness, and efficiency. HRSA reports will be submitted as required by the ANEW funding opportunity guidelines. A quarterly review of processes will be conducted by the PD and consultants, and shared with stakeholders to formulate an action plan.
Measurements will also include, student eligibility for InTune traineeship funds, number of students acquiring R/US traineeship positions, communication and collaborative elements between community and academic partners, how the peer support element utilizing CHCs has affected the health literacy, attendance at healthcare appointments and the effect on the number of emergency room visits by participants. Extended data collection will examine the numbers of FNP graduates employed in R/US areas, the effects of the telehealth component, and how all the variables mentioned will trend over time. The InTune project is set to provide pilot data over a one-year period; however, following the rapid-cycle PDSA model of improvement, data will be gathered and examined at least quarterly (and much of it weekly or even daily) to determine if/when improvements can be made. A quality improvement consultant will work closely with the PD and network sites to formulate a data collection and analysis plan to provide timely feedback on quality metrics and completion of subsequent action plans.
InTune traineeship recipients who graduate will be followed for one year to report information about their actual practice settings. This will be accomplished by obtaining student agreements to participate in all follow-up surveys, allowing graduates to retain their University email accounts indefinitely to maintain contact with them, and by sending surveys at the one-year mark asking for pertinent employment and demographic data. The number and characteristics of preceptors, students, and graduates from and/or serving in R/US areas will be tracked. The characteristics of faculty development programs, curriculum development, CE activities, and preceptor activities will also be tracked via the InTune network website.
DNP, APRN
Bethesda Clinic
(FCOC) Tyler and Athens
The University of Texas at Tyler and the U.S. Health Resources and Services Administration have partnered to advance nurse education and healthcare, meeting patients where they are in East Texas. With a $1.399 million HRSA grant, The University of Texas at Tyler will create the INTUNE Network, consisting of academic-practice partnerships with local and regional clinics that provides immersive clinical traineeships in diverse and rural populations for primary care nurse practitioner students.
This grant, named INTUNE, is part of the Advanced Nursing Education Workforce awards by the federal government for 2017-2019.
The term ‘in tune’ means to create harmony between instruments in a musical setting. Similarly, the INTUNE project will create partnerships that have been carefully crafted to provide primary care and leadership services ‘in tune’ with the needs of a rural/underserved population.
The University of Texas at Tyler’s INTUNE Network plans to create synergy between existing primary care medical homes, developing on-call, telehealth and community health coach services to optimize communication, providing awareness, encouragement and guidance through a more easily-navigated healthcare model.
Some of the funding will also help increase the numbers of clinical traineeships for FNP students among rural and underserved populations, thereby increasing the numbers and employment of workforce ready FNP graduates. The University of Texas at Tyler FNP program currently contracts with more than 700 clinical placement sites of which at least 60 percent focus on service to rural and/or underserved vulnerable populations.
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