Transcript Methods: Home Visits

Impact of a Social Home Visit on
High-Utilizing Patients in a
Residency Continuity Clinic
January 31, 2015
Stephanie Nothelle, MD; Colleen Christmas, MD FACP;
Laura Hanyok, MD
Johns Hopkins Bayview Medical Center
1
Disclosures
• I love home visits
1/31/15
2
Roadmap
•
•
•
•
Background
Methods and Objectives
Results
Conclusions
1/31/15
3
Background: The struggle
•
•
1/31/15
The majority of health care resources are used by
a small group of people often called “high utilizers”1
“High utilizers” often have complex social needs in
addition to complex medical needs2,3 and are
more likely to be perceived as “frustrating” by their
provider4
4
Background: The Bayview
Patient Connection
• Multi-faceted intervention based on
knowledge of high social needs and that
knowing your patient well can help
physicians feel more competent about the
care they provide5
• Home visits may be a way to help
physicians better understand their patients’
lives6 and could be particularly useful in
working with “high utilizers”
1/31/15
5
Methods: Patient Selection
• 2011-2012: Medicaid patients with 4 or more
inpatient admissions or ED visits and
attended at least 3 clinic visits in the prior
year
• 2013-2014: A separate program, Johns
Hopkins Community Health Partnership (JCHiP) identified Medicare and Medicaid
patients using a risk model
1/31/15
6
Methods: Home Visits
• Each patient is contacted and offered a home
visit, matched with a PGY-1 (n=45)
• Goal to learn about the patient’s barriers and
facilitators to care and health beliefs and
given worksheet to help guide visit
1/31/15
7
Methods: Home Visits
• PGY1 records what they learned about the
psychosocial aspects of the patient’s care in
the medical record
• PGY1 debriefs their experience with the
group, reflecting on how the experience could
contribute to patient care.
1/31/15
8
Methods: Home Visits
• Supervised introductory home visits for high
utilizing patients started in the summer of
2011 and was repeated in 2012 and 2013
• All residents were surveyed in 2014
1/31/15
9
The home visit…
Helped me
provide better
care for my
patient
Helped me
get to know
my patient as
a person
Was
important in
building a
relationship
with my
patient
1/31/15
10
The home
visit was a
personally
rewarding
experience
Based on
this
experience I
am more
likely to do
another
home visit
1/31/15
11
• I found that she was doubling up on her statin
taking the "generic" and "brand name" daily,
which she believed to be different
medications.
• I felt like I really had a connection with my
patient after the home visit. I was able to be
more sympathetic to her pain after
understanding how demanding it is to have 5
kids to care for at home.
• I have done home visits for other outpatients
due to this training.
12
Conclusions
•
•
A home visit focused on a patients psychosocial
characteristics prior to the first medical visit can be
a powerful tool for interns to understand a high
utilizing patient better as a person
Visiting a patient at home prior to seeing them in
the office improves the physician’s perception of
care they are able to provide, which has previously
been associated with decreased burnout
13
Conclusions
• Completing a home visit on a high
utilizing patient may influence a house
officer’s care of other patients and is a
rewarding experience.
14
References
1. NHE Fact Sheet National Health Expenditure Data.
https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_sheet.asp.
Accessed 8/30/2011, 2011.
2. Super Utilizer Summit “Common Themes and Innovative Complex Care
Management Programs” October 2013
http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf407990
3. R.G. Kronick, M. Bella, and T.P. Gilmer. The Faces of Medicaid II: Recognizing
the Care Needs of People with Multiple Chronic Conditions. Center for Health
Care Strategies, Inc., October 2007.
4. Lin et al “Frustrating Patients” Journal of General Internal Medicine. May, June
1991. Volume 6, Issue 3, pp 241-246.
5. Schultz et al, “Emotional effects of continuity of care on family physicians and
the therapeutic relationship.” Canadian Family Physician. February 2012 Vol 58
No 2 pp 78-85
6. Young et al “The Home Visit in the Multidisciplinary Teaching of Primary Care
Physicians” Academic Medicine April 1981 Volume 56 Issue 4
1/31/15
15