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In-Home Medical Care Practice Models: The Mount Sinai Visiting Doctors Program Theresa Soriano, MD, MPH November 13, 20 PowerPoint Presentation
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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

Theresa Soriano, MD, MPH

November 13, 2008

Photographs by Ana Blohm, MD

overview
Overview
  • Organizing efforts and history
  • Program Development
  • Outcomes
  • Replicability
  • Q&A
msvd organizing efforts
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.
msvd organizing efforts4
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
msvd services
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
who are msvd patients
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
msvd program development
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
msvd program development10
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
msvd patient centered outcomes
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
msvd funding outcomes
MSVD: funding outcomes
  • Funding sources:
    • Clinical revenue 25-30%
    • Institutional support ~60%
    • Philanthropy/grants ~10%
msvd program challenges
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

msvd replicability
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
msvd replicability16
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

msvd sharing our expertise
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

contact info
Contact info

Theresa Soriano, MD, MPH

theresa.soriano@mountsinai.org

(212) 241-4141

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“Doctor in the House”

For more information contact Julie Winokur at: jwinokur@mindspring.com

To purchase: http://www.talkingeyesmedia.com/visiting_doctors.php