ESPDT School Health Nurse Grant Program: Clinical Evaluation Indicators Summary Report

Kaye Bender, PhD, RN, FAANBower Foundation Board Meeting

August 21, 2006

Components of the EPSDT Visit

• Physical Assessment with appropriate lab

• Developmental Assessment

• Vision Testing

• Hearing Screening

• Oral Health Assessment

• Counseling and Education

• Referral and Followup

Clinical Evaluation Indicators

Assessment According to Standards

?

Nursing Diagnosis Appropriate for

Assessment ?

Intervention Appropriate ?

Results of Intervention ?

EPSDT Screenings2002-2006

Total = 13,747 Assessments

$1,037,167.80 Billed

$703,414.59 Paid (68%)

*Data from Screen-Plus

Assessment According to Standards

• Age Appropriate

• Billable

• Intervention and Follow-up According to School Nurse Protocol and EPSDT Guidelines

Assessment by ServiceVision Screening (4,290)Preliminary Data 2005

Normal82%

Abnormal18%

Assessment by ServiceVision Screening (12,925)

2002-2006

Normal84%

Abnormal16%

Assessment by Service: Vision Screening (12,925)

• Nursing Diagnoses– Sensory/perceptual alternations

• Intervention– Notification of parents or guardian– Referral to Physician

• Follow-up – 92%

Assessment by Service: Dental Screening (4,261)Preliminary Data 2005

Normal65%

Abnormal35%

Assessment by Service: Dental Screening (13,008)

2002-2006

Normal69%

Abnormal31%

Assessment by Service: Dental Screening (1331)

• Nursing Diagnoses– Altered oral mucous membrane– Dental caries

• Intervention– Notification of parents or guardian– Referral to Dentist

• Follow-up – 38%

Assessment by Service: Developmental Screening (4,248)

Preliminary Data 2005

Normal96%

Abnormal4%

Assessment by Service: Developmental Screening (11,120)

2002-2006

Normal96%

Abnormal4%

Assessment by Service: Developmental Screening (11,120)

• Nursing Diagnoses– Altered growth and development– Impaired social interaction– Impaired verbal communication– Self-esteem, alteration in

• Intervention– Notification of parents or guardian– Referral to Physician or other appropriate provider

• Follow-up – 86% (includes in-school referrals)

Assessment by Service: Hearing Screening (4,290)

Preliminary Data 2005

Normal89%

Abnormal11%

Assessment by Service: Hearing Screening (10,406)

2002-2006

Normal94%

Abnormal6%

Assessment by Service: Hearing Screening

• Nursing Diagnoses– Sensory/perceptual alterations

• Intervention– Notification of parents or guardian– Referral to Physician or Nurse Practitioner

• Follow-up – 88%

Assessment by Service: Hct/Hgb(4,677)

Preliminary Data 2005

Normal83%

Abnormal17%

Assessment by Service: Hct/Hgb(12,673)

2002-2006

Normal91%

Abnormal9%

Assessment by Service: Hgb/Hct Screening

• Nursing Diagnoses– Anemia– Potential for Anemia

• Intervention– Notification of parents or guardian– Referral to Physician or Nurse Practitioner– Standing Order for Iron

• Follow-up – 90%

Assessment by Service: Urinalysis (11,913)

2002-2006

Normal94%

Abnormal6%

Assessment by Service: Urinalysis

• Nursing Diagnoses– Altered urinary elimination– Diabetes related symptoms– Potential for urinary tract infection

• Intervention– Notification of parents or guardian– Referral to Physician or Nurse Practitioner

• Follow-up – 68%

Random Findings From Initial Physical Assessment Data

5-11 Years• Activity intolerance• Altered health maintenance• Dressing/grooming self-care deficit• Impaired skin integrity• Potential for infection• Potential for trauma• Pain• Coping deficits

* 2002-2006 Data

Random Findings From Initial Physical Assessment Data

12-17 Years• Activity intolerance• Altered health maintenance• Impaired skin integrity• Potential for infection• Pain• Rape/trauma syndrome

* 2002-2006 Data

Implications of This Evaluation Strategy

• Validation of credibility and safety of the program

• Nursing training

• Referral gap identification

• Clinical lab and other quality assurance

• Baseline data for long-range tracking

Complete Report on this Phase of the Clinical Evaluation Indicators will be available October 2006.

Next Clinical Evaluation Report Scheduled for December 2006.

For questions, contact Dr. Kaye Bender, 601-984-6220; kbender@son.umsmed.edu