University of Cincinnati
With an aging population, the need to train primary care residents and geriatric fellows in home-based care continues to grow. A needs assessment of family medicine residents and geriatric fellows' attitudes and knowledge was performed to guide a novel, longitudinal home care curriculum based out of a Home-Based Primary Care practice within the Family Medicine Center.
Fellows are assigned a panel of two home visit patients from the Family Medicine Center's Home-Based Primary Care practice. Fellows follow these patients monthly and manage their care between visits. In today’s rapidly changing clinical environment, primary care physicains and geriatricians must be adapt at analyzing systems and processes they work under and making changes to improve patient care. A new home visit program is a natural venue for a specific, achievable quality improvement intervention with support from faculty, the Home Based Primary Care practice team and the Family Medicine Center Patient and Family Advisory Council.
The longitudinal family medicine resident curriculum is based on graded autonomy and focused objectives for each level with the ultimate goal of residents feeling empowered to include home visits in their future practice. After home visit sessions, residents complete personal, written reflections after each visit to optimize learning and retention, as well as for giving a venue for processing potentially challenging situations. Sample reflections are included. Third-year residents facilitate an interdisciplinary case conference to address various social determinants of health, home safety issues and medication concerns. By residency graduation, residents will complete 10-14 home visits.
- Describe challenges and opportunities unique to patient care in the home environment.
- Review medication use and adherence while identifying medications that are no longer effective, are duplicative or carry greater burden than benefit. Identify medications that you would recommend stopping and create a schedule for stopping these medications.
- Develop and implement a safety plan to make the patient’s home environment safer.
- Develop a personal plan to integrate home visits into your future practice.
- Develop, document and manage patient- and family-centered care plans related to patient’s health conditions and expected trajectory with emphasis on personal goals of care in collaboration with an interprofessional health care team and community service providers.
- Implement a process improvement as part of the Home Based Primary Care team.