Central Valley - Clinical Academic REmodel (CV-CARE)

Investigator: Lisa Thompson, RN, PhD, FNP
Sponsor: U.S. Health Resources and Services Administration

Location(s): United States


CV-CARE is an innovative clinical-academic partnership between the School of Nursing (SON) and 13 Federally Qualified Health Centers (FQHC Network). These primary care medical homes provide care for medically underserved and low-income patients in the California’s Central Valley (CV). CV-CARE will significantly expand clinical training for Family Nurse Practitioner (FNP) students enrolled in a master’s degree program, through placements in the affiliated FQHCs. The CV is the fastest growing region in CA, comprised of 19 counties ranging from isolated rural agricultural areas to rapidly expanding urban centers, all of which are HRSA-designated health professional shortage areas. The Network serves more than 600,000 patients annually in 145 community health center sites, with migrant farmworkers making up over 40% of patients served. Unmet needs for patients within the Network include management of diabetes, obesity, and asthma. Patients served by the Network are also at risk for poor pregnancy outcomes, including pre-term birth. CV-CARE addresses the current gap in clinical training for advanced practice nurses, and aims to recruit and retain diverse healthcare workforce and prepare them to provide high quality care for underserved and rural patients within a complex and evolving healthcare system. CV-CARE will:

1) enhance the existing relationship between the SON and the Network and establish new academic-clinical partnerships with two Network FQHCs;

2) design, implement, and evaluate new clinical training and curricula for preceptors and FNP students; and

3) implement a novel healthcare delivery model that includes Group Medical Visits (GMV) and Home Visits (HV) to improve access and quality of care for the population served by the Network.

To achieve these objectives, the SON will provide faculty preceptors to work on-site within the FQHCs. CV-CARE will develop preceptor trainings available to providers within the Network to address common barriers, including time management, goal setting, and preceptorstudent communication. Rapid cycle evaluations will be conducted periodically to evaluate and modify proposed activities. The FNP student curriculum will incorporate assessments and interventions to address health disparities and structural inequalities that impact social determinants of health of underserved, rural populations, including migrant and seasonal workers and their families. FNP students will participate in clinical placements to increase their exposure to innovative approaches, including a socio-environmental analysis of factors that impact health care of this population. These approaches will foster FNP student readiness to practice in Health Professional Shortage Areas. SON students and faculty preceptors will implement GMVs for diabetes and prenatal care, and provide HVs to vulnerable elders. Community GMVs and HVs will be piloted in Year 2. The Network will disseminate findings and expand grant activities to additional affiliated FQHCs in Year 2 and 3. The outcomes of CV-CARE will be a sustainable model of care for underserved and rural populations through improved preceptor support and training of the next generation of advanced practice nurses in health shortage areas. We are requesting the statutory funding preference as CV-CARE will substantially benefit underserved populations.