The Philadelphia community benefits from innovative nurse-led, interdisciplinary care.
Lisa Scardigli, age 44, has suffered periodically from spasticity, a symptom of the multiple sclerosis she has lived with for more than 20 years. She had been receiving physical therapy at 11th Street Family Health Services in Philadelphia when she had a pump implanted for spinal infusion of a drug that reduces spasticity. But the pump’s catheter punctured in late 2009, and she was hospitalized for several weeks. When she returned to 11th Street, she said, she got “holy heck” from the staff there; they had been worried about her. “Even the people at the front desk were up in arms over the fact that I didn’t call,” Ms. Scardigli said. “It went from the physical therapist to the primary care person to the security guard. I was actually missed.”
This is a small story, but it illustrates a big reason for this health center’s success: it not only serves its community (there were 26,000 clinical visits in 2009); it also creates community. And that may have something to do with the fact that it is run by nurses.
This nurse-managed health center provides primary care and other services in a neighborhood in North Philadelphia where most of the 6,000 residents are Black, have low incomes, and are medically underserved. Nurse practitioners (NPs) and social workers make up teams that are augmented as needed by physicians, nutritionists, and others. Having been launched in 1998 in a recreation center, 11th Street is now a federally qualified health center housed in a $3.3 million, 17,000-square-foot facility, with a staff of 53.
The center’s work began gradually, as a joint project of the Philadelphia Housing Authority and Drexel University’s College of Nursing and Health Professions. In 1996 director Patricia Gerrity, Ph.D., RN, FAAN, placed a public health nurse at each of four housing developments in the neighborhood. The nurses responded to residents’ immediate concerns: the need for stop signs, animal control, food assistance, and training in CPR. “Over that first year or two we gained the trust of the residents because we weren’t defining the issues; they were,” Dr. Gerrity said. “And it showed that we were making a long-term commitment.”
From there, she met with area representatives to discover their visions for the community. They wanted a health care center, they said, one they could access regardless of their ability to pay. A community advisory board was formed, and the search for funding began. (Over the years the center has received funding from federal, state and private sources.)
Dr. Gerrity uses the word “transdisciplinary” rather than “multidisciplinary” or “interdisciplinary” to describe the care provided at 11th Street. “Transdisciplinary means you start to break down the barriers between disciplines. Each person learns something about the other person’s discipline, and it enriches their own practice,” Dr. Gerrity said. For example, behavioral health care has been incorporated into every primary care visit, with NPs and social workers closely collaborating.
The range of services provided is remarkably diverse. Patients like Ms. Scardigli undergo physical therapy. Patients with diabetes join cooking classes that make use of locally grown produce. First-time mothers receive home visits through the Nurse–Family Partnership. Six to eight mother–infant pairs meet through the Centering Parenting program. A fitness center with a full-time personal trainer is on-site, full dental care is available and chronic illness management groups provide peer support.
Unpublished outcome data for patients with diabetes show that in an 18-month period, the proportion who had glycosylated hemoglobin levels below 7 percent doubled and that low-density lipoprotein cholesterol and blood pressure levels fell as well. Also seen were reductions in depression and low-birthweight infants and increases in immunization and breast cancer screening.
Access to payment for care coordination through medical home designation is important to the center’s sustainability. Despite meeting the criteria set by the National Committee for Quality Assurance for qualifying as a Patient-Centered Medical Home™, 11th Street was denied the designation because it is led by nurses rather than physicians—an issue for the 250 nurse-managed health centers across the nation.
Lisa Scardigli is so impressed by all the center does that she now sits on the community advisory board. Recently, she brought in a neighbor of hers who needed new dentures. “She loves it,” Ms Scardigli said. “She’s 90, and she’s from down South, so it reminds her of when the doctor used to come to your house and knew the family and sat down and broke bread.”