A proposal for devloping a nurse-led mobile health unit to address persistent barriers to care, such as mistrust, access to transportation, and unaffordable out-of-pocket costs.
Academic Partner: University of Illinois College of Nursing
Brief Summary
Many communities face persistent barriers to care, including limited transportation, unaffordable out-of-pocket costs, and mistrust of traditional care systems. To address these barriers, the University of Illinois College of Nursing partnered with a community organization to develop a nurse-led mobile health unit—a clinic on wheels that brings high-need primary and preventive services directly to patients with limited access to care. Clinicians assess, treat, and coordinate care at the top of their licenses, supported by interdisciplinary teams, while electronic health records are updated in real time at the point of care.
Guiding Principles Alignment
This case model aligns with AACN/AONL Guiding Principles by advancing human-centered care, equity, and access through innovative delivery models. The partnership responds directly to community needs, brings care to underserved populations, and integrates academic expertise with practice-based service delivery. By aligning education, practice, and population health goals, the model strengthens collaboration and ensures that nursing practice addresses real-world barriers to care.
Problem Statement & Goals
Problem/Need Identified:
Many communities experience persistent barriers to care, including limited transportation, unaffordable costs, and lack of access to primary and preventive services. Rural residents, unhoused individuals, and neighborhoods with significant health disparities are often unable to access traditional healthcare settings. Health systems and academic partners needed innovative care delivery models to expand access, reduce gaps in treatment, and address population-level health needs.
Goals & Objectives:
- Expand access to primary and preventive care for underserved populations
- Reduce avoidable emergency department visits
- Improve preventive care and patient satisfaction
- Use real-time data to inform population health interventions
Intervention & Strategy
Description of Intervention:
The University of Illinois College of Nursing partnered with a community organization to develop a nurse-led mobile health unit that delivers care directly to high-need populations. Clinicians assess, treat, and coordinate care at the top of their licenses, supported by interdisciplinary teams that include community health workers and social workers. Electronic health records are updated in real time, ensuring continuity of care across settings.
Roles & Responsibilities:
Academic faculty contributed clinical expertise, population health analysis, and educational oversight. Practice partners managed mobile unit operations and community engagement. Interdisciplinary team members delivered care, supported coordination, and addressed social needs. Together, partners used EHR data to identify trends and guide targeted interventions.
Resources Utilized:
Resources included a mobile health unit, nursing and interdisciplinary staff, and electronic health record technology capable of real-time documentation and population health tracking. Academic and practice partners shared responsibility for staffing, data analysis, and care delivery.
Outcome Metrics
Educational Outcomes:
- Enhanced experiential learning in community-based and population health settings
Workforce Outcomes:
- Expanded nursing roles practicing at the top of licensure
- Strengthened interdisciplinary collaboration
Clinical Outcomes:
- Expanded access to care
- Increased preventive services
- Improved patient satisfaction
- Reduced avoidable emergency department visits
Sustainability & Scalability
Sustainability Plan:
Sustainability is supported by integration of mobile services into community partnerships, use of real-time EHR data, and alignment with population health goals. Data-driven insights allow partners to adapt services and allocate resources effectively.
Replication Potential:
This model can be replicated by other academic–practice partnerships seeking to address access barriers through mobile care delivery. Nurse-led units supported by interdisciplinary teams and integrated EHR systems can be adapted to rural, urban, and underserved communities.
Lessons Learned
Key Success Factors:
- Bringing care directly to communities reduced access barriers
- Real-time EHR documentation supported continuity and population health tracking
- Interdisciplinary teams enhanced care coordination
Challenges & Solutions:
Addressing diverse community needs required flexibility in service delivery. Using EHR data to identify patterns and gaps allowed partners to tailor interventions and prevention strategies to specific populations.
Supporting Documents
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