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In-Home Medical Care Practice Models: The Mount Sinai Visiting Doctors Program

In-Home Medical Care Practice Models: The Mount Sinai Visiting Doctors Program Theresa Soriano, MD, MPH November 13, 2008. Photographs by Ana Blohm, MD. Overview. Organizing efforts and history Program Development Outcomes Replicability Q&A. MSVD: organizing efforts. Started in 1995

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In-Home Medical Care Practice Models: The Mount Sinai Visiting Doctors Program

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  1. In-Home Medical Care Practice Models: The Mount Sinai Visiting Doctors Program Theresa Soriano, MD, MPH November 13, 2008 Photographs by Ana Blohm, MD

  2. Overview • Organizing efforts and history • Program Development • Outcomes • Replicability • Q&A

  3. MSVD: organizing efforts • Started in 1995 • Primary goal was educational • Clinical expansion and advocacy followed • Initial support from residency training program and medical school • In 2003, huge growth in hospital support • Doubled program capacity • Now largest academic home visit program in U.S.

  4. MSVD: organizing efforts • Initial research from existing in-home medical programs (NYC, Boston, Virginia) • Future collaborators • Practical experience with community nursing agencies in East and Central Harlem • Eventual working relationship with VNSNY • Early record-keeping and data collection • Ability to have data for future funding

  5. MSVD: services • Routine and urgent home visits • Multidisciplinary staff (8MD, 2NP, 2RN, 3SW) • 24-hour MD availability by telephone • Palliative and comfort care • Family and caregiver support • Collaboration and coordination with community and nursing agencies

  6. Who are MSVD patients? • Average Age = 81 years • 75% female • Average 5 chronic medical conditions • Ethnicity: • 46% Caucasian • 26% Latino • 25% Black • 90% of patients have Medicare; 8% Medicaid • 2/3 dual-eligible • 1/3 live in public housing

  7. 45% of MSVD patients live in East, Central, West Harlem & Washington Heights

  8. MSVD: program development • Securing sources of support • educational: medical school • clinical: hospital • academic: AAHCP, MACHCM, SGIM, AGS • SGIM Clinical Practice Innovation Award 2008 • community partners • local and regional media • Frontline, NY Times, JAMA • foundations

  9. MSVD: program development • Collect information prospectively • Source of referral • Reason for referral • Insurance status • Source of prior care • Track impact on medical center/health system • Ancillary services use • Inpatient admissions • ED visits • Length of stay • Financial data if able to obtain

  10. MSVD: patient centered outcomes • Decrease in caregiver burden • High patient and caregiver satisfaction • Emphasis on prevention and goals of care: advanced directives, vaccinations • Death at home v. hospital • Low hospital and nursing home admission rates

  11. MSVD: funding outcomes • Funding sources: • Clinical revenue 25-30% • Institutional support ~60% • Philanthropy/grants ~10%

  12. MSVD: program challenges Meeting demand with fixed supply Maintaining productivity while preventing burnout Managing waitlist of ~180 Securing funding Poor reimbursement Internal External NEED for generalizable outcomes Diversity of in-home medical programs State and federal cost-effectiveness Defining population(s) best-served

  13. MSVD: replicability • Population is aging; growing number of homebound and disabled • With decreasing # NH beds, we need cost-effective care options • In-home medical care is usually in line with patient and caregiver preferences • In-home medical care can help a select population within a larger medical system

  14. MSVD: replicability • MSVD works as a coordinator of care: • Social service and government agencies • Community-based organizations • Faith-based groups Outpatient Inpatient (hospital/rehab/ER) Home

  15. MSVD: sharing our expertise Educational sessions and workshops Local, regional, national venues Consultation for developing in-home medical programs Visits from other institutions National and international

  16. Contact info Theresa Soriano, MD, MPH theresa.soriano@mountsinai.org (212) 241-4141

  17. “Doctor in the House” For more information contact Julie Winokur at: jwinokur@mindspring.com To purchase: http://www.talkingeyesmedia.com/visiting_doctors.php

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