Flip No. 11

Bring back the home visit

Engage with patients in their own space.

By Flip the Clinic

This flip is one that surfaced during our research—and it seems worth exploring—but we haven’t gotten much further than the big idea. We’re putting it here as an early test. We’d love your feedback. What might we consider when thinking about this flip? Who is already exploring this idea? What is a new and creative approach to this problem? Let us know in the comments section. If there’s enough to develop the idea, we’ll give it the full flip treatment.

Comments

  • Adam Dole

    Leveraging technology in simple ways can make aspects of a “home visit” more scalable. Having a patient take a picture of the inside of their refrigerator or pantry can not only provide insight into their daily diet habits, but can also be a great way to start a conversation about healthy eating.

    • Jo Ann Woodward N P

      I really like this idea

    • http://crhi.org Steve North

      I see lots of patients at the local grocery store. I often do a “grocery cart biopsy” and see what they are buying. This can be a starting point for a great, impromptu conversation. Also, they see my cart which has veggies and berries but I do eat carbs and we have frozen chicken nuggets sometimes. I feel that when they see I’m not perfect and struggle to balance healthy eating with a busy schedule they are more willing to talk with me down the road.

  • ruraldreams

    My daughter has developmental disabilities and we’ve had early
    intervention therapists in our home since she was a very young infant. I
    wonder if an offshoot of this might be to integrate those professionals
    already providing in-home support as respected, compensated members of the care team.

  • Jo Ann Woodward N P

    I believe in this idea. Many prenatal visits could be done in the home. In Nurse Practitioner school we made post parting home visits. I was never turned away and patients were helped in their homes.

  • Dr Greg Weidner

    Support ongoing asynchronous communication with the healthcare team about goals, progress, barriers and wins. Use digital communication tools to enhance the relationship – SMS messaging, email, patient portals, mobile apps, video, interactive learning, the telephone and secure online communities. Imagine a practice as a community with the shared goal of health, and all of its members working collaboratively toward that goal. How much could we learn from and support one another, with expert clinicians facilitating the effort?

  • http://uclaibd.com/ UCLAibd

    Here at UCLA Center for Inflammatory Bowel Diseases, we have “virtual visit” with patients at their homes or any other setting outside of the clinic. This is carried out through our accessible web-based/mHealth platform (eIBD) at any time of the day.

    We get to learn about their lives outside the clinic by allowing our patients to directly
    message our IBD team. This enables us to learn directly from patients about their daily lives and the impact of everyday activities, social and physical environments of their health status and well-being.

    Technologically enabled eVisits are proving an effective means to monitor patients and to
    maintain an open channel to their lives beyond the clinic walls. These “eVisits” were not available or even imagine at an early time in U.S. medicine when physician house calls were a norm.

    An example is seen in developing our Surgical Tight Control Scenario. Daily measurements are taken by the patient, and this information is sent to our team directly. We ask the patient to take a picture of their surgical incision wound every day for a few weeks after discharge. This way we can monitor the healing progress of their wound, and intervene if we see any need to. Patients are very satisfied with the Surgical Tight Control Scenario because they feel like they are being cared for every day at home.

    Progressing further with continuing advances in wireless networks, wearable technology, and mobile health applications, we are able to finesse the eVisit to accurately measure chronic disease activity and adjust their care accordingly.

    To learn more about our center please visit: http://uclaibd.com/

  • http://crhi.org Steve North

    I feel the answer here is not so much about technology but about being present in the community. Much easier for rural and small town docs since we mostly live and work in the same community. For larger areas it is making house calls, visiting local resources and introducing yourself, and working to connect with the community your patients live in at coffee shops, the local mechanic’s and corner stores.

  • M. Swift

    Patients view their doctor as a highly intelligent person. And when they come to the doctor’s office they are looking for some help in some way. The physician can better help his patients if he knew more about them. Why doesn’t the physician create something for the patients that will help them lesrn their patient. The physician will decide what he wants to know. It could be mailed to the patient or give it to them at the office. Give them a time frame to complete it and go from there. It could ask them to track blood sugar levels or blood pressure. It could track meals, daily routines, thoughts, whatever. Sometimes you just have to ask what you want to know.

  • David D

    Current reimbursement rules limit this highly rewarding approach to healthcare.
    As does an overly narrow focus on productivity.
    But within these constraints, we love home visit model and want to do more!

  • Marsha Hazel-RN

    I believe that this idea would find the greatest support in rural areas or smaller communities. Patients are needing health care providers to be more flexible during instances when they are unable to get into the local clinic. In our society the aging population is increasing resulting in a growing numbers of elderly patients that need more complex care. And too often these individuals are unable to receive the care they need due to financial or physical limitations. By implementing the return of the home visit we can provide the care this generation needs resulting in a better quality of life for these individuals. This idea would also benefit patients that are low income and simply do not have the means to travel to the nearest clinic. We can provide the care, patient education and support that these individuals need and might not receive otherwise. Reaching out to others in need should be our driving force, by bringing back the home visit we are helping individuals that have some of the greatest need.

  • Angela Gorrell

    I see home visits as a GREAT way for healthcare professionals to engage in
    patient-centered care and see the patient as a “whole,” as this simply cannot
    be done in a 15 min doctor visit. Home visits are an excellent way for health
    professionals to effectively advocate for their patients, and to empower
    patients to take control of their overall health, increase patient
    satisfaction, reduce non-compliance, as well as many others things. Thus,
    reducing morbidity and mortality rates. Increased clinician utilization of
    eHealth applications (ex. Telemedicine, Telehealth) may be an approach to
    consider in facilitating this idea.