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Increasing Access to 1 Running head: INCREASING ACCESS TO HEALTHCARE: DEVELOPMENT OF A

Increasing Access to Healthcare: Development of a Free Clinic Business Proposal Angela McGregor

A Capstone Leadership Project Submitted in partial fulfillment for the

Doctor of Nursing Practice Degree in Nursing

In the Graduate College of The University of Iowa July 4, 2011

Project Chair: Brenda Hoskins, DNP, ARNP, GNP-BC, FAANP

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Table of Contents

Abstract

3

Executive Summary

4

Literature Review

5

Methodology

Action plan

7

Risk analysis

10

Implementation/Timeline

13

Budget

16

Marketing

18

Evaluation

19

Healthy People 2020

24

Conclusion

24

References

26

Appendix

Appendix A-D

28

Appendix E-H

34

Business Proposal

38

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Abstract Hancock County has a high rate of uninsured patients. The purpose of this project is to evaluate the need for a free clinic in Hancock County. This project describes the challenges of developing the free clinic business proposal. Additionally, this project identifies how a free clinic supports the future needs of healthcare addressed in Healthy People 2020.

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Increasing Access to Healthcare: Development of a Free Clinic Business Proposal Executive Summary

Hancock County has a significant number of residents without health insurance. Working in a small rural clinic, one is able to see the number of patients who are uninsured. Without insurance patients are not able to keep up with recommended preventative health care or screening (Freeman et al., 2008). The purpose of this project was to determine the need for a free clinic, and to develop a free clinic business proposal. Preventative healthcare is the mainstay to long term health. Developing a relationship with a primary care provider ultimately increases utilization of preventative care services. Uninsured patients are more likely to utilize the emergency department (ED) for acute illnesses instead of establishing care with a primary care provider (Pitts, Carrier, Rich, & Kellermann, 2010). Currently there are three hospitals within an hour drive from Hancock County Memorial Hospital (HCMH). Only one of these hospitals, Mercy Medical Center, has a free clinic. The free clinic at Mercy Medical Center only offers acute visits. The model proposed for the free clinic will be a wellness clinic for preventative care and chronic care management. The proposed location for the free clinic is the existing specialty clinic of the hospital. The clinic has examination rooms that are already set up with the appropriate exam tables and supplies. Currently this space is only being used on a part time basis, during the daytime. The medical staff at HCMH will provide examinations and treatments of patients with chronic conditions such as; hypertension, hyperlipidemia, diabetes, COPD, asthma, and CHF. The medical staff will provide preventative care and screening to uninsured patients. The clinic will be open one night per week for two hours each clinic. One provider will work with the assistance of a nurse, receptionist, and administration. This paper analyzes the need for such a clinic and the development of a business plan for implementation and operations.

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In Hancock County 13% of the population is uninsured, with a 6% unemployment rate. Without insurance patients are not able to keep up with recommended preventative health care or screening (Freeman et al., 2008). The purpose of this project was to determine the need for a free clinic in Hancock County, and to develop a free clinic business proposal. A literature review was performed using CINAHL and PUBMED; 326 articles were identified with 9 selected, and 8 used to meet the criteria. The literature was searched according to three themes; the relationship between the lack of insurance and health outcomes, the prevalence of uninsured using the ED for primary care, and the effectiveness of free clinics.

Literature Review Relationship between Lack of Insurance and Health Outcomes

The first objective was to determine how being uninsured affects individual health outcomes. The literature review suggests that uninsured patients were more likely to experience a major decline in health, and were less likely to utilize preventative services (Freeman, Kadiyala, Bell, & Martin, 2008). According to Freeman et al., (2008), health insurance increases health utilization of preventative health services, and improves health. Patients without insurance who seek care for chronic conditions do not feel that the care they receive is as good as a person who has insurance. A study performed in a national Latino population found that patients who had access to health insurance perceived their quality of care as better than patients who did not have access to care (Perez, Ang, & Vega, 2009). This study found that insured patients have a usual source of healthcare, and those who were uninsured did not, and therefore did not seek care as often as the insured patient (Perez et al., 2009). Patients with higher incomes who are uninsured receive more preventative healthcare than the poor who are uninsured, but there are still gaps in preventative care (Freeman, Kadiyala, Bell, & Martin, 2008; Perez, Ang, & Vega, 2009; Ross,

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