A Multidisciplinary Program for Delivering Primary Care to the Underserved Urban Homebound: Looking Back, Moving Forward

Abstract

The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth. Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader. These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost-benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program.

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

“…A care model previously described elsewhere, 28 the MSVD is a joint program of the Division of General Internal Medicine and Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital that provides care for more than 1000 homebound older patients annually. It employs 14 physicians, 2 nurse practitioners (NPs), 2 nurses, 4 social workers, and 5 clerical staff.…”

The Critical Role of Social Workers in Home-Based Primary Care

“…Ornstein, Hernandez, DeCherrie, & Soriano, 2011; Smith et al, 2006). What started as a small pilot project in [XX] in 1995 has grown into the largest academic home based primary care program in the U.S. and currently cares for more than 1000 homebound individuals across [XX] each year.…”

“… The growing homebound population has many complex biomedical and psychosocial needs and requires a team based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The [XX] Visiting Doctors Program (MSVD), a large interdisciplinary home based primary care program in [XX], has a vibrant social work program that is integrated into the routine care of homebound patients.…”

Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population

“…The structure and patient population of MSVD patients have been described previously. 13 Briefly, the program employs 8 physicians, 2 nurse practitioners, and support personnel including 2 registered nurses, 4 social workers, and 4 clerical staff members to serve over 1000 homebound patients annually. To be enrolled in the program, patients must meet the Medicare definition of homebound (ie, they must be able to leave home only with great difficulty and for infrequent or short absences).…”