Durham, N.C. — Duke University Hospital will be on the front lines of the nation's health care reform effort by training nurses to meet the increased demand for primary and preventive care, U.S. Health and Human Services Secretary Kathleen Sebelius said Monday.

Duke Hospital is one of five hospitals nationwide that will share in $200 million in federal funding over four years to train more advanced practice registered nurses. The APRN group includes nurse practitioners, clinical nurse specialists, nurse anesthetists and nurse midwives.

"With today's investment, we'll put more nurses on the ground in communities across the country, shortening waiting lists for appointments, (boosting) community health centers, decreasing delays from discharging patients from hospitals," Sebelius said at a Durham news conference.

The other four hospitals in the initiative are the Hospital of the University of Pennsylvania in Philadelphia, Scottsdale Healthcare Medical Center in Scottsdale, Ariz., Rush University Medical Center in Chicago and Memorial Hermann-Texas Medical Center Hospital in Houston.

Duke plans to double the number of APRNs it trains, with 216 more enrolled by 2016. Officials estimate it will cost about $49,000 a year to provide the graduate education for each nurse practitioner.

“The complexity of the challenge to make care more accessible and affordable, while enhancing quality, is exacerbated by the continuing decline in the number of primary care physicians and the expected influx of patients into the health care system as a result of health care reform," Dr. Victor Dzau, president and chief executive of Duke University Health System, said in a statement.

The funding will open up more clinical training opportunities for APRNs. In the project, half of the training is required in non-hospital settings to give the nurses needed skills in primary care, preventive care and the chronic care management, officials said.

Nurses training at Duke will work at sites that collaborate with Duke’s network of community clinics, three community hospitals and affiliated primary care practices, as well as Duke's School of Medicine and the School of Nursing.

The nurses will then help fill gaps in community-based settings nationwide, including in under-served rural and inner-city areas.

"This will have a big impact, especially in states like North Carolina, which contains both the rural and urban communities that we know suffer most from lack of access to care," Sebelius said.