Date of Graduation

5-2019

Document Type

Capstone

Keywords

Home based primary care; High-needs high-risk; Microsystem analysis; Referral process; Compliance

Degree Name

Doctor of Nursing Practice (DNP)

Degree Level

Graduate

Advisor/Mentor

Casida, Jessie

Abstract

Home Based Primary Care (HBPC) services in the Central Arkansas Veterans Healthcare System (CAVHS) are underutilized among high-needs, high-risk (HNHR) patients based on baseline assessment of provider capacity. It is important to evaluate this problem as these patients have the highest need for frequent care yet face the most difficult challenges in accessing care. The purpose of this project was to analyze the factors that contribute to the under-utilization of HBPC services in the CAVHS and make recommendations for improvement. An assessment of the CAVHS HBPC service was completed using the Dartmouth Institute Microsystem Academy Outpatient Specialty Care Workbook. Microsystem analysis of the HBPC service found many areas of deficiency that could be improved. The HBPC referral process was not in consistent compliance with HBPC policy, as guidelines were not being met, were not being met correctly, or did not exist. Providers were not meeting the 30-day admission criteria 10% of the time. There were no specific timeframe guidelines for the social worker assessment to be completed in the admission policy. There are inconsistent time frames for completion across both formal and informal referrals. HBPC was not in compliance with its caseload standard policy. The HBPC consult template included incorrect information and unclear directions. In addition, a lack of referrals from others in key positions to identify HBPC patients was discovered. Recommendations include improving compliance with guidelines, creating guidelines where needed, educating providers, improving collaboration, and correcting the referral template.

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