Impact of an education-centered medical home on quality at a student-volunteer free clinic

Abstract

Background: The continuity provided by longitudinal clerkships has documented benefits to medical student education. Yet, little quantitative data exist on the association between longitudinal clerkships and patient outcomes.Objective: This study compares screening metrics of a longitudinal clerkship called the education-centered medical home (ECMH) with the standard clinical model at a student-volunteer free clinic (SVFC). In the ECMH model, the same attending physician staffs one half-day of clinic with same group of students weekly for 4 years. Standard clinical models are staffed with students and physicians who come to the SVFC based on availability.Design: ECMH students aimed to increase human immunodeficiency virus (HIV) screening rates in their patient panel as part of a quality improvement project. Students prepared individualized care plans prior to patient visits that included whether screening had been performed. They were also reminded to confirm completion of testing. Percentages of patients screened for HIV before and after establishment of the ECMH were compared with four standard clinical models. Screening rates for breast, colon, and cervical cancer, as well as hepatitis C, served as secondary endpoints.Results: While screening rates were initially similar between models (43.2% and 34.8% for the ECMH and standard clinical panels, respectively, p = 0.32), HIV screening rates increased from 43.2% to 95.0% in the ECMH compared with a significantly smaller increase from 35.0% to 50.0% in the standard clinical panel (p < 0.0001). Additionally, the ECMH resulted in statistically significantly increased screening rates for cervical cancer (p < 0.001) and hepatitis C (p < 0.0001).Conclusions: This study demonstrates an association between a longitudinal ECMH clerkship and improved quality metrics at an SVFC. Even measures not targeted for intervention, such as colorectal cancer and hepatitis C, showed significant improvement in screening rates when compared with the standard clinical model.

Continuity in Undergraduate Medical Education: Mission Not Accomplished

“…36 O'Neill et al showed the feasibility of tracking quality metrics as part of a longitudinal clerkship with promising trends towards improved preventative care. 37 Patient outcomes data from one longitudinal clerkship demonstrated improved influenza vaccination rates and increased rates of screening for HIV, cervical cancer, and hepatitis C. 16,38 If structured and supervised properly, students may be able to serve as health coaches and quality managers for complex patients. 39 Further studies are clearly needed to replicate these early findings-but these future studies can only be done if longitudinal programs are sustained and expanded to additional institutions.…”

Understanding Student-Run Health Initiatives in the Context of Community-Based Services: A Concept Analysis and Proposed Definitions

“… 21 , 30 , 54 Other concepts that were used interchangeably with student-run included student-created ; student-developed , student-directed , student-driven , student-initiated , student-managed , student-operated , student-organized , student nurse-delivered , student pharmacist-led , student pharmacist-run , and student-volunteer . 6 , 7 , 29 , 55 - 63 In some cases, more than one term was used interchangeably within the same article, such as student-run and student-led . 6 , 62 - 67 …”

“…21,30,54 Other concepts that were used interchangeably with student-run included student-created; student-developed, student-directed, student-driven, student-initiated, student-managed, student-operated, student-organized, student nurse-delivered, student pharmacist-led, student pharmacistrun, and student-volunteer. 6,7,29,[55][56][57][58][59][60][61][62][63] In some cases, more than one term was used interchangeably within the same article, such as student-run and student-led. 6,[62][63][64][65][66][67] Several articles provided substantial and explicit descriptions of the student-run health initiative 6,29,35,61,63,68 and 16 authors provided definitions for the concept they used (see Table 2).…”

Breast and Cervical Cancer Screening Rates in Student-Run Free Clinics: A Systematic Review

“…16,29,30,32,36 If comparing with national screening rates for the uninsured only, all studies on breast cancer screening and five in ten studies on cervical cancer screening met or surpassed the national average. 28,31,32,36,37 This suggests that, while there is substantial variation, people receiving care at SRFCs can achieve similar rates of breast and cervical cancer screening when compared with insured and uninsured populations receiving care at established settings, but further work is needed to close gaps in preventative care.…”