1960s. There are 250 NMHCs across the United States serving 1.5 million medically underserved people, nearly half of whom are uninsured (NNCC, 2005). As the name implies, they are run by nurses—although many employ physicians, social workers, health educators, and outreach workers as members of a collaborative health team. Services generally include comprehensive primary care, family planning, prenatal services, mental/behavioral health care, and health promotion and disease prevention.
The majority of NMHCs are affiliated with a nursing school and about half with a community-based nonprofit organization (King and Hansen-Turton, 2010). NMHCs report that their clients make 15 percent fewer emergency department visits than the general population, have 35–40 percent fewer nonmaternity hospital days, and spend 25 percent less on prescriptions (NNCC, 2005). The ACA authorizes an additional $50 million in 2010 and “such sums as may be necessary for each of the fiscal years 2011 through 2014”33 to NMHCs that offer primary care to low-income and medically underserved patients, although as of this writing, this funding specifically for NMHCs has not been allocated. The case study presented in Box 3-4 shows how an NMHC worked with community leaders to reduce health disparities in an underserved poor neighborhood in Philadelphia.
There is perhaps no greater opportunity to transform practice than through technology. Information technology has long been used to support billing and payments but has become increasingly important in the provision of care as an aid to documentation and decision making. Diagnostic and monitoring machines have proven invaluable in the treatment of cancer, heart disease, and many other ailments. Examples cited by the IOM in Crossing the Quality Chasm: A New Health System for the 21st Century include “growing evidence that automated order entry systems can reduce errors in drug prescribing and dosing” and “improvements in timeliness through the use of Internet-based communication (i.e., e-visits, telemedicine) and immediate access to automated clinical information, diagnostic tests, and treatment results” (IOM, 2001). Since that report was published, the expanded use of online communication has resulted in so-called telehealth services that are not limited to diagnosis or treatment but also include health promotion, follow-up, and coordination of care. Delivery of telehealth services has, however, like that of APRN services, been complicated by variability in state regulations, particularly whenever online communications cross state lines.