Model Proposals - Helping Hands Health Center Nurse Practitioner Primary Care Program Proposal

Applying for grant funding can be a very intimidating and burdensome process, particularly for organizations that do not have a professional development staff or the resources to hire a grantwriter. VNA recognizes this reality and strives to evaluate grant proposals based on the merit of the program and its fit with our guidelines rather than the appearance of the request. We offer the following proposal from the Helping Hands Health Center as an example. Prepared by health center volunteers, the request simply and directly responds to VNA application guidelines and in combination with a site visit, received a positive review.

This proposal was approved in full by the VNA Foundation Board at its February 6, 2003 board meeting. We are pleased to offer it as the Proposal of the Quarter for the quarter ending March 31, 2003.

Submitted to the VNA Foundation December 18, 2002
The Board of Directors of Helping Hands Health Center is requesting $65,000 to support the salary and benefits of a full-time nurse practitioner for one year. The goal of Helping Hands is to provide free, comprehensive, patient-centered health services to uninsured, low-income residents of all ages in the Chicago area.

A. Background

Access to health care for the uninsured segment of the population is a growing national problem. The Urban Institute estimates there are about 44 million Americans without adequate insurance. Increasing unemployment due to recession and health benefit cutbacks by employers exacerbate the problem. Although government programs have expanded to help fill this need, Illinois ranks in the lowest quartile of states in providing government benefits to low-income residents without health insurance. According to the Illinois Primary Health Care Association, free and subsidized clinics have been expanding to fill the need, but the growth in numbers of uninsured far outpaces the increase in clinics.

The need is especially great in Chicago where traditional sources of care for the underserved are either no longer free or are closed to the uninsured. Census figures show that at least 15% of the US population is uninsured, and in the city of Chicago 20% are uninsured. Twenty-five percent of those households with incomes under $25,000 per year are uninsured. Ravenswood Hospital, which saw 70,000 uninsured/self-pay patients yearly, has recently closed. The Chicago Board of Health and Illinois Masonic Medical Center have recently put restrictions on uninsured patients. Both are now referring patients to Helping Hands.

Over the past year, health professionals and people representing the religious, political, municipal and business communities have been planning a health center to meet the needs of the medically underserved. As plans progressed, these task force members evolved into a Development Board for the new health center. The majority of health professionals on the Board are nurses, bringing a wealth of background and experience. Most Board members have extensive experience developing and volunteering at free clinics. In addition, members of the Board have past fund-raising experience and existing partnerships that can be used to fund the Health Center. See the appendix for a list of Board members.

Helping Hands began as the idea of committed healthcare providers concerned about the lack of comprehensive healthcare for the uninsured. It was started with a donation of medical equipment and a building on the northwest side of Chicago from Advocate Illinois Masonic Medical Center. A seed grant from the Ravenswood foundation was used to hire a clinic manager, Joy Glazer. Ms. Glazer, with the help of the Board, was able to secure the following in-kind donations: laboratory services from Quest Laboratories; vaccines, X-rays and mammograms from the city of Chicago; supplies, equipment and labor from local businesses; and medication samples from pharmaceutical companies. A 501(c)3 application has been filed and status is pending. The IRS has stated the application will be approved by mid-March at the latest, and possibly much earlier. See the appendix for a list of donors.

Helping Hands has joined the Chicago Cook County District Health Council, which is an organization of health centers in Chicago that serve low-income populations. Most of these are Federally Qualified Health Centers. Helping Hands is working with Dr. Lee Francis, the medical director of Erie Health Center, to explore the possibility of becoming Federally Qualified. In addition to assuring the Health Center a stable source of funding, being federally qualified also demands a high level of quality.

Helping Hands, through its clinic coordinator Joy Glazer, has met with business, municipal, political and religious communities in the area. Logan Square and Albany Park business associations are involved in the clinic. The Albany Park Chamber of Commerce is hosting a fund-raiser for the Health Center. Ms. Glazer has attended CAPS beat meetings to speak about the clinic, and is meeting with local aldermen, state representatives and senators, and our congressmen. Ms. Glazer has also spoken to pastors and congregations of local churches about the clinic.

The Health Center has been open for three weeks and has about 40 patients, with appointments booked a month in advance. The number of patients has been growing steadily. There are sufficient volunteers to staff the Health Center three to five sessions a week. Several urgent cases have been referred elsewhere due to lack of a full-time provider. With the help of community members, outreach is expanding. The Polish American Association is organizing busloads of needy patients to see our Polish-speaking providers. This program is booking scheduling patients ithree months in advance.

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B. Purpose of funding request

The mission of Helping Hands is to improve the health of the medically underserved community by increasing access to healthcare, assessing patient needs, providing appropriate referrals, and extending programs to those underserved due to barriers of culture, citizenship, or language. Helping Hands is located in a low-income neighborhood on the northwest side of Chicago. The surrounding area is approximately 50% Hispanic, 5% percent African-American, 5% Asian, 5% mixed race, and 35% white. A large segment of the population is foreign-born. According to the US Census, in the neighborhoods around Helping Hands, both the poverty rate and the child poverty rate is double that of the national rate. The area has higher than national rates of teen pregnancy, lead poisoning, heart disease, homicide, HIV and AIDS, cirrhosis and liver diseases, diabetes, and tuberculosis (almost 5 times higher). This increased burden of disease is related to poverty, lack of health care being one aspect of the problem. The Board of Helping Hands is committed to provide the health care necessary to eliminate these disparities.

Helping Hands has many volunteers both professional and non-professional willing to provide care for the medically underserved. However, to provide continuity and to remain goal-directed, it is essential to have a basic structure of paid staff. Funds from the VNA Foundation will be used to hire a full-time nurse practitioner. Ann McCormick, a founder and long-time volunteer at Community Health clinic, has been identified for the position. Ms. McCormick is adjunct faculty at the University of Illinois of Chicago College of Nursing, speaks Spanish and works at a school-based health center in Chicago. The nurse practitioner will be a primary provider of patient care, and will be responsible for coordination, planning and evaluation of patient care.

The full-time nurse practitioner would greatly expand the services the Health Center is able to offer. She would provide continuity of care by having daily clinic hours. She would greatly increase clinic availability for both urgent needs and for those patients whose schedules or whose lifestyles preclude them from making appointments. She would expand outreach into the community, by making home visits and meeting with community leaders. She would be able to coordinate the work of volunteers interested in providing workshops and classes. She would also coordinate program evaluations by assessing relevant statistical data and planning future programs to meet community needs.

Others working on this project include the clinic coordinator, medical director and Board members. The work of Board members has been crucial in establishing the Health Center. Board members volunteer at the clinic, donate money and services, and provide links with other agencies and sources of funds. It is expected that Board members will continue to volunteer at the clinic.

At present, Helping Hands has one paid staff person. Joy Glazer, the clinic manager, was one of the founders of Community Health Clinic. Ms. Glazer worked at Community Health for ten years, first as a volunteer and then as clinic manager. In addition to overseeing the daily operations of the clinic, she established numerous programs, including the Neighborhood Referral Program with Cook County Hospital and resident, nursing and medical educational programs. Ms. Glazer is involved in community outreach in addition to supporting volunteer providers and responding to patient requests and concerns.

John O'Brien MD, the interim medical director and president of the Board of Helping Hands Health Center, is the director of Internal Medicine at Illinois Masonic Medical Center. For the past several years, Dr. O'Brien was medical director of the Commercial Health Care Plan at Illinois Masonic Medical Center, a program that provided health care at reasonable cost to small business owners. Dr. O'Brien became one of the original task force members for the Helping Hands Health Center as a direct result of the discontinuation of this program. He is a long-time volunteer and Board member at Community Health clinic.

The Board has identified several goals for the Health Center this year. These include establishing policies and procedures, community outreach, volunteer orientation, fund-raising, and evaluation. There is a committee working on each goal. Policies and procedures, volunteer orientation and evaluation standards should be in place within the first three months of 2003. Evaluation standards have already been agreed upon and volunteers have been identified to set up a computer program and to input data. Encounter forms, which are completed on every patient, include demographic data, financial information, and diagnosis, including referrals, medication and lab tests. Fund-raising and community outreach are on-going. Reports are made at monthly Board meetings.

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C. Evaluation

Board members have identified two initial goals, based on their work experience and the literature concerning the uninsured population.

The first goal is to improve health care to persons with diabetes by providing diabetes prevention activities, case finding, and self-management classes for patients. Diabetes is a large cause of morbidity and mortality and a major problem in the uninsured. Evaluation of HgbA1c before and after treatment will be used as an outcome measure. The goal will be to lower the HgbA1c by an average of 0.5%. Laury Quinn RN PhD, a well-known nursing specialist in diabetes, Board member and member of the American Diabetes Association, has volunteered to lead this project.

A second goal is to improve the health care of children. According to the Chicago Public Schools, uninsured children are seven times more likely to be unimmunized than those children with insurance. According to the Centers for Disease Control (CDC), 72% OF Chicago toddlers have received the necessary vaccinations. This is far from the 90-95% rate of immunization compliance needed to fully protect children. With the establishment of a patient recall program at the Health Center, Helping Hands will increase the pediatric immunization rate to at least 80%. This outcome measure would examine children at two years of age for compliance with CDC recommendations for this age group. The city has offered to assist in the records review for this outcome measure.

Evaluation of the diabetes and childhood immunization programs will be done in April and November 2003, after 6 months and one year of operation respectively. Results will be presented to the Board for review and further planning. Further goals for the upcoming year will be identified at that time.

The Board of Helping Hands feels that our mission to serve the medically underserved coincides with the mission of the VNA Foundation. Thank you for your consideration of Helping Hands Health Center.

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