209090 A commitment to our community: Integrating a multidisciplinary home visit component into an urban Family Medicine residency curriculum

Monday, November 9, 2009

Heather A. Klusaritz, MSW , Dept of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
Peter Cronholm, MD , Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
Tanya Dougherty, PharmD , Presbyterian Medical Center, Philadelphia, PA
Richard Neill, MD , Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA

Impoverished urban neighborhoods experience poor healthcare access and health outcomes due to multiple barriers: under-insurance, stressed safety-nets, public transportation dependence, and spatial mismatches between provider location and patient communities. Academic medical centers have are obligated to respond to the needs of the surrounding communities, however face challenges in countering barriers. Clinical services delivered in traditional practices have not addressed the needs of marginalized populations. Family Medicine practices are uniquely suited to respond to these challenges through the discipline's commitment to treating patients in the community context and emphasis on disease prevention and health promotion.


A multidisciplinary home visit program that bridges continuity gaps was integrated with family medicine physician training. The curriculum emphasizes culturally sensitive collaborative care, understanding of socio-cultural determinants of health, and social services education. Patient care emphasizes coordination and continuity of care as patients transition between the home/community and the office/hospital. Home visits are made by a team of resident and attending physicians, pharmacy students, and social worker.


Since implementation, 16 residents and 17 students have participated in 76 home visits including newborn/postpartum evaluations, hospice care, elderly long-term care needs assessments, hospital discharge transitions, polypharmacy and medication adherence evaluations, home care needs and safety assessments, and insurance counseling. Qualitative feedback was positive; residents reported an increased likelihood of incorporating home visits into future practice and improved understanding of the divide between the office and patients' homes/neighborhoods. Quantitative outcomes indicate increased understanding of access barriers, environmental and socio-cultural influences on health, and social services.

Learning Objectives:
1. Describe a successful residency training home visit program. 2. Identify key components of a residency training program that increase the likelihood phsyicians will participate in home visits in future practice.

Keywords: Community-Based Health Care, Urban Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Social work coordinator of the residency training home visit program upon which this research is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.