Home sweet home

HOME-BASED PRIMARY CARE MAKES A DIFFERENCE IN THE LIVES OF PATIENTS AND CLINICIANS

Oklahoman Vilda Fletcher, 82, is old enough to remember when her family’s doctor made home visits during her childhood. She never thought she would receive the same type of care as a senior.

“I grew up in the day when we had house calls,” Vilda said. “The care was so personal then, and that’s what’s great about the care I’m receiving now. I feel like I’m not just a number, but a person.”

Home-based primary care (HBPC) is quickly making a comeback in the U.S. after a decline in the 20th century. While 40% of all U.S. medical care in 1930 occurred in the home, by 1950 the number had dropped to 10%, and to only 0.6% of all patient encounters by 1980, as reported by the National Institutes of Health.

But as more healthcare systems look for enhanced ways to care for populations, expansion of care away from the

“ Being in the home brings a holistic approach to the care you provide. You can evaluate their home environment. You can identify risks and help to develop better care plans for them based on their circumstances.”

— MELISSA MONTGOMERY, APRN-CNP, ASCENSION MEDICAL GROUP ST. JOHN

acute-care setting accompanied by increased use of programs such as home visits is gaining momentum, including across Ascension.

Several Ascension Ministry Markets, including Ascension St. John in Oklahoma, have adopted HBPC models as a way to meet the needs of medically frail/complex patients. This includes patients with a chronic condition that may be poorly controlled or those with limited daily living function and/or multiple complex conditions.

“Home-based primary care is centered on in-home visits by clinicians for advanced illness, end-of-life care, or patients who are homebound and immobile, supplemented by digital tools to enable remote patient monitoring and telehealth,” said Baligh Yehia, MD, MPP, FACP, Senior Vice President, Ascension, and President, Ascension Medical Group. “This type of care exemplifies our Mission of truly serving our most vulnerable.”

Some Ascension patients and families have said that this type of care is just what they needed.

Bruce and Susan Crawford’s 42-year-old son, Jimmy, is one of Ascension St. John’s HBPC beneficiaries. After being left quadriplegic following a motor vehicle accident, Susan said, Jimmy is significantly immunocompromised and immobile, making traditional doctor visits challenging.

“When COVID-19 hit, we were terrified to take Jimmy in to see his doctor,” Susan said. “Home visits gave us peace of mind in knowing we were protecting him.”

Melissa Montgomery, APRN-CNP, Ascension Medical Group St. John, said Jimmy was the perfect candidate for HBPC. Melissa and five additional clinicians have completed more than 500 home visits since AMG St. John launched its HBPC model in September 2017.

“Patients who are at high risk should be considered for home visits to minimize exposure to other patients and healthcare workers in the clinic setting,” Melissa said. “While virtual care can be a great option for many, special consideration should be given to those patients who still need to be physically examined. There is nothing like being able to listen to a patient’s heart, listen to their lungs.”

For the Crawfords, this has been a major benefit. “Jimmy gets as good care here at home as he would in the office, if not better,” Susan said. “By [him] being able to remain in bed, Melissa can examine him more thoroughly than in his wheelchair.”

Shawna Pidge, Vilda Fletcher’s daughter, has also seen the value of home visits.

“I am always concerned about transporting Mom to the doctor,” Shawna said. “With her severe arthritis, I know it’s painful and scary for her because she is at high risk for falling.”

Being able to see patients in their home environment can also provide key insights that may be preventing patients from having better outcomes, Melissa said.

“Being in the home brings a holistic approach to the care you provide,” she said. “You can evaluate their home environment. You can identify risks and help to develop better care plans for them based on their circumstances.”

For the Crawfords and Vilda and Shawna, they couldn’t imagine care any other way.

“I’m hoping this [care model] becomes more of the norm,” Vilda said. “I actually get emotional thinking about it. Melissa is such a blessing, and she has really made me feel special.”

For Melissa, the feeling is mutual.

“I feel so grateful that I’m able to live out my own personal mission statement,” she said. “This is what God has called me to do.”