been treated for both acute and chronic illnesses within the scope of practice of Advanced Practice Nurses. The Project serves as a practice site for nursing and medical faculty, and as a clinical rotation for nursing and medical students. Mobile nurse-managed centers enable the deeper penetration of this much needed service in underserved communities. This Project is one visionary approach to the Institute of Medicine’s call for the improvement of quality of care through the restructuring of clinical education, with nursing in leadership roles. Outcomes are tracked using a structured process. One of the main Project outcomes is cost effectiveness, because it utilizes faculty-supervised nursing and medical students and an interdisciplinary mobile health team staff. This project is in partnership with Project’s Community Advisory Board, consisting of representatives from the community-based organizations. Challenges include efforts to expand the same reimbursement mechanisms now afforded to fixed site clinics to mobile nurse-managed centers by third-party payors.

MIGRANT HEALTH SERVICE, INC. NURSE-MANAGED HEALTH CENTERS

Migrant Health Services, Inc. (MHSI) is a HRSA-funded voucher program whose primary goal is improving the health status of Hispanic migrant and seasonal agricultural workers (Guasasco et al., 2002; Lausch et al., 2003). In Minnesota and North Dakota, MHSI has established four seasonal satellite nurse-managed health centers (NMHCs), two mobile units, as well as four year-round NMHCs to meet the health and educational needs of farmworkers. Services include assessment, health promotion, disease prevention and self-management, health risk assessment, counseling, and health education (Guasasco et al., 2002). Patient outcomes have dramatically improved, such as a significant decrease in patients’ hemoglobin AlCs. Another innovation was the development of Cluster Clinics, a series of 9–11 mini-clinics, physically arranged so patients can circulate a single site for two or three hours to receive medical care, diabetes education, and counseling. An interdisciplinary diabetes team provides health care, education, and counseling according to the American Diabetes Association Clinical Practice Recommendations. The education and counseling address such issues as nutrition, diet, exercise, tobacco use, foot care, and access to recommended services and referrals (Heuer et al., 2004). Challenges include continuity and the availability of funding for this invisible, bilingual, mobile population.

CENTURA HEALTH AT HOME

Centura Health At Home (CHAH) is the largest home care organization in Colorado and is part of the Centura Health system, a not-for-profit, faith-based health care system. CHAH instituted an interactive Telehealth Program in 2004 for congestive heart failure patients with high recidivism. Telehealth nurses monitor patients each day in real time and can perform a video visit enabling one-on-



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