St. Francis Family Medicine near Richmond, Virginia is, like many medical practices in America, evolving into a , where health care services are coordinated to manage each patient’s care. 

That means patients come or call the practice first when they have a problem, and it means a team of physicians, nurses and other professionals take care of patients and keep tabs on their conditions over time. The team makes sure patients are taking medicines properly, getting timely preventive care and that no unnecessary tests are done. 

say that frees him up to do his job.

“You have more time to build a relationship with your patient and make those decisions that you need to, without having to worry about the small things,” Amin says.

Medical homes use computerized record-keeping to track patients and to watch for trends that might signal the need for new treatments. All of this sounds expensive, and at first it may be, but two large scale programs suggest medical homes may save a great deal of money over time.

The first of these demonstration projects began seven years ago in Richmond. It’s called the  or VCC. Linda Ford enrolled after coming down with a miserable case of shingles.

“I was in a tremendous amount of pain, and did not know what was going on with me,” Ford says. 

Ford wanted to see a doctor, but she had no insurance. By law, hospital emergency rooms must provide care for the uninsured, so Linda ended up at Virginia Commonwealth University’s medical center – home base for VCC. Through the program, she was able to see a primary care doctor at no charge. He prescribed medication to help prevent a recurrence of shingles and began treating her for high blood pressure – something she knows is important.

“Because if you don’t treat high blood pressure, you sometimes have a heart attack and die,” says Ford.

Virginia Commonwealth says it eventually enrolled more than 26,000 people in the program that helped Ford.

“Our patients had lower utilization of the emergency room, fewer in-patient admissions, and the overall cost of care went down,” says VCU Health System Vice President Sheryl Garland.

At first, it cost about $8,000 a year on average to care for a patient, but for those who stayed in the program at least three years costs dropped by 50 percent.

In California, statisticians saw a similar trend in the program. It started six years ago, funded by the city, county, local employers and donors. Thirty-seven clinics and medical practices provided care at little or no cost to about 49,000 people who were allowed to choose the “medical home” that appealed to them.

“That’s so important, because we really want to ensure continuity of care and relationship building with a particular medical home, and providers in that medical home,” says Healthy San Francisco Program Director Tangerine Brigham.

Brigham says costs dropped an average of $540 per patient per year. Many of the patients have chronic conditions – diabetes, high blood pressure, congestive heart failure or asthma. But Brigham says seeing a medical professional on a regular basis keeps them out of the hospital and emergency room – expensive places for care.

“When you get individuals with chronic conditions into stable care, where they really are able to maintain their medication regimen, their visit regimen, we can do group visits with them, all of those things really do ultimately contribute to improved health,” Brigham says.

And the program gets good reviews. A  by the Kaiser Family Foundation showed 94 percent of Healthy San Francisco’s patients were satisfied with their care (KHN is an editorially independent program of the foundation). VCC’s Sheryl Garland hopes to collaborate with Healthy San Francisco on future studies and to release updated statistics on Virginia Coordinated Care this summer.

This story is part of a partnership that includes , , and Kaiser Health News.

This <a target="_blank" href="/health-industry/medical-homes-virginia/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a partnership with , and Kaiser Heath News.

Charlottesville, Virginia – There have been lots of parties this year at the , but  is in no mood to celebrate. So far, eleven professors have retired, a full 25 percent of the whole faculty. The health law is predicted to boost demand for nurses to take care of the newly-insured, especially in primary care. “I need faculty to teach the practitioners that are going to take care of these uninsured,” she says.

Nursing students at the University of Virginia (Photo by UVa School of Nursing)

In many places, there is already a nursing shortage and it’s expected to get worse. Polly Bednash, head of the , says that while nurses – the oldest group of workers in the country – kept working during the recession, now that the economy is improving, “they are going to leave in droves.” 

But turning out more nurses doesn’t seem likely. In the last year, nursing schools turned away  because there weren’t enough professors.

Finding more professors will be difficult, because faculty members usually need a Ph.D. Of three million nurses in this country, fewer than one percent have doctorates and that’s not changing. Associate Professor  notes most nurses are unwilling to go for more years in school. “After you finish your degree,” she says, “what we want to do is take care of patients.”

Pay and lifestyle are also problems. Nurses with a master’s degree and special training can be certified as nurse practitioners – paid $120,000 a year or more. After ten years as a professor, Drake earns about $75,000. And, by the time most nurses consider a Ph.D., Dean Fontaine worries that their lives are complicated with a job, financial obligations and children.

Diversity in the teacher population is missing, too, according to Fontaine: “We want to have our faculty and students match the population we serve, so we do not have enough Hispanic nurses or faculty, as well as African-Americans and other minorities – and men!” Men make up just 10 percent of the nursing workforce, and Fontaine hopes the field can draw more them to get PhDs and step into the classroom.

Prof. Emily Drake says one solution – just increasing class size – won’t work because much of the training for nurses is hands-on: “By law, for each additional ten students we take, we need another clinical faculty member to supervise them in the hospital.”

So schools are looking for other ways to teach, according to Polly Bednash. “Faculty are getting more and more creative about how they prepare students. They bring in other clinicians to the educational experience – having pharmacists, for instance, be involved in teaching the pharmacotherapeutics.”

Schools also using technology – simulators and computer-based lessons – to supplement classroom and lab experience. Nationwide, nearly 8 percent of nursing school jobs – about 1,200 — are vacant, so the American Association of Colleges of Nursing is lobbying for more state, federal and foundation money to train PhDs. And they’re urging their most promising students to get the advanced degree before they acquire a family and a mortgage.

This story is part of a partnership with , NPR and Kaiser Heath News.

This <a target="_blank" href="/news/nursing-school-teacher-shortage/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">