Improving Specialty Care to the Medically Underserved

The purpose of the Doctor of Nursing Practice (DNP) scholarly project was implementation of a clinical practice change, use of a DNP student developed patient referral form (PRF), and evaluate medically underserved (MU) patients’ access to and utilization of specialty care services. The major objectives of the scholarly project were to evaluate if PRF implementation improved MU patients’ access to or utilization of specialty care services in an urban community health center (CHC), and to identify barriers to patients utilizing prescribed specialty care services. Donabedian’s Model guided the quality improvement project that utilized data from a retrospective chart review to evaluate an urban CHC’s specialty care referral process before and after the implementation of a DNP student developed PRF (N = 48). The DNP student observed for any difference in MU’s access and utilization of specialty care services after a clinical practice change implementing the patient referral form. Further, the DNP student evaluated potential causes of MU patients not utilizing the prescribed specialty care services. Data analysis showed that there was no statistically significant difference in specialty care access (χ2 (1) = .000, p > .05) and utilization (χ2 (1) = 1.4182, p = 0.2337) after the implementation of a DNP student developed patient referral form. The primary reason MU patients cited as not utilizing specialty care services was lack of knowledge about the appointment. Additional data analysis showed that MU patients who were referred for breast services received appointments at a statistically significantly higher rate than all other specialties (χ2 (3) = 8.800, p = 0.0321). The initial assumption of the DNP student was that specialty care services were not readily accessible to the MU population. However, the results of the scholarly projected refuted this assumption as specialty care services were found to be available to the MU population. However, the services were often not utilized due to a breakdown in the referral process. The use of system-based approaches can improve the coordination and delivery of specialty care services. Doctor of Nursing Practice (DNPs) can address challenges to healthcare access and utilization by supporting patients’ navigation through the complex healthcare system.

Abbreviations: DNP: Doctor of Nursing Practice; PRF: Patient Referral Form; MU:Medically Underserved; CHC: Community Health Center; ACA: Affordable Care Act; IOM: Institute of Medicine; FQHCs: Federally Qualified Health Centers; CHCs: Community Health Centers; SFGH: San Francisco General Hospital and Trauma Center; HIV: Human Immunodeficiency Virus; STI: Sexually Transmitted Infection; FPL: Federal Poverty Level