A Curriculum to Teach Internal Medicine Residents to Perform House Calls for Older Adults
Jennifer L. Hayashi MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorKarran A. Phillips MD, MSc
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorAlicia Arbaje MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorAnirudh Sridharan MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorRachelle Gajadhar MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorStephen D. Sisson MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorJennifer L. Hayashi MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorKarran A. Phillips MD, MSc
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorAlicia Arbaje MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorAnirudh Sridharan MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorRachelle Gajadhar MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorStephen D. Sisson MD
From the * Division of Geriatric Medicine and Gerontology † Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorAbstract
Physician house calls are an important but underused mode of delivering health care to a growing population of homebound elderly patients. One major barrier to internal medicine physicians making house calls is a lack of training in this setting. This article describes a needs assessment survey of residents from nine internal medicine residency programs for a house call curriculum that combines a longitudinal clinical experience with Internet-based learning. Implementation of the curriculum was begun in July 2006, and data will be collected and results evaluated for at least 2 years. Several educational outcomes from the intervention are anticipated, including increased learner knowledge of house call medicine, improved learner confidence in making house calls, and program director satisfaction with the curriculum. This early work lays the foundation for determining the effect of a carefully designed curriculum on the number of practicing internists with the skills, knowledge, and attitudes necessary to meet the growing need for physician house calls.
REFERENCES
- 1 Levine SA, Boal J, Boling PA. Home care. JAMA 2003; 290: 1203–1207.
- 2 Meyer GS, Gibbons RV. House calls to the elderly—a vanishing practice among physicians. N Engl J Med 1997; 337: 1815–1820.
- 3 Di Pollina L, Gold G, Meier DE. Health care for the homebound older adult: A medical model. Mt Sinai J Med 1993; 60: 488–491.
- 4 Reuben DB, Fried TR, Wachtel TJ et al. When the patient cannot come to the doctor: A medical housecalls program. J Am Geriatr Soc 1998; 46: 226–231.
- 5 Philbrick JT, Connelly JE, Corbett EC Jr. Home visits in a rural office practice: Clinical spectrum and effect on utilization of health care services. J Gen Intern Med 1992; 7: 522–527.
- 6 Muramatsu N, Mensah E, Cornwell T. A physician house call program for the homebound. Jt Comm J Qual Saf 2004; 30: 266–276.
- 7 Ramsdell JW, Swart JA, Jackson JE et al. The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc 1989; 37: 17–24.
- 8 Ramsdell JW, Jackson JE, Guy HJ et al. Comparison of clinic-based home assessment to a home visit in demented elderly patients. Alzheimer Dis Assoc Disord 2004; 18: 145–153.
- 9 Stuck AE, Egger M, Hammer A et al. Home visits to prevent nursing home admission and functional decline in elderly people: Systematic review and meta-regression analysis. JAMA 2002; 287: 1022–1028.
- 10 Cummings JE, Hughes SL, Weaver FM et al. Cost-effectiveness of veterans administration hospital-based home care. A randomized clinical trial. Arch Intern Med 1990; 150: 1274–1280.
- 11 Hughes SL, Weaver FM, Giobbie-Hurder A et al. Effectiveness of team-managed home-based primary care: A randomized multicenter trial. JAMA 2000; 284: 2877–2885.
- 12 Boling PA, Retchin SM, Ellis J et al. Factors associated with the frequency of house calls by primary care physicians. J Gen Intern Med 1991; 6: 335–340.
- 13 Ingram CJ, O'Brien-Gonzales A, Main DS et al. The family physician and house calls. A survey of Colorado family physicians. J Fam Pract 1999; 48: 62–65.
- 14 Keenan JM, Boling PE, Schwartzberg JG et al. A national survey of the home visiting practice and attitudes of family physicians and internists. Arch Intern Med 1992; 152: 2025–2032.
- 15 Leff B, Kaffenbarger KP, Remsburg R. Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care. J Am Geriatr Soc 2000; 48: 943–948.
- 16 Adelman AM, Fredman L, Knight AL. House call practices: A comparison by specialty. J Fam Pract 1994; 39: 39–44.
- 17 American Academy of Home Care Physicians. Medical malpractice in doctor's house calls. AAHCP, USA, 2003 [on-line]. Available at http://www.aahcp.org/malpracticecrisis.shtml Accessed October 20, 2006.
- 18 Taler G. House calls for the 21st century. J Am Geriatr Soc 1998; 46: 246–248.
- 19 Leff B, Burton JR. The future history of home care and physician house calls in the United States. J Gerontol A Biol Sci Med Sci 2001; 56 (10): M603–M608.
- 20 Accreditation Council for Graduate Medical Education web site [On-line]. Available at http://www.acgme.org/outcome/comp/compFull.asp Accessed October 1, 2006.
- 21 Thomas DC, Leipzig RM, Smith LG et al. Improving geriatrics training in internal medicine residency programs: Best practices and sustainable solutions. Ann Intern Med 2003; 139: 628–634.
- 22 Sullivan GM, Boling PA, Ritchie C et al. Curriculum recommendations for resident training in home care. J Am Geriatr Soc 1998; 46: 910–912.
- 23 Education committee of the American Geriatrics Society. Curriculum guidelines on the care of the elderly for internal medicine residency training programs. Am J Med 1997; 103: 260–262.
- 24 Stoltz CM, Smith LG, Boal JH. Home care training in internal medicine residencies: A national survey. Acad Med 2001; 76: 181–183.
- 25 Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam Med 1991; 23: 57–59.
- 26
Kern DE,
Thomas PA,
Howard DM et al. Curriculum Development for Medical Education: A Six-Step Approach. Baltimore, MD: Johns Hopkins University Press, 1998.
10.1111/j.1553-2712.2007.tb01807.x Google Scholar
- 27 Sisson SD, Hughes MT, Levine D et al. Effect of an Internet-based curriculum on post-graduate education: A multicenter intervention. J Gen Intern Med 2004; 19: 505–509.
