Home Visit Program

The multidisciplinary home care curriculum is integrated with residents' continuity practice and block rotations. All residents are required to conduct a minimum of four patient home visits per year, with additional visits scheduled within their continuity practice as need dictates. Home visits will be conducted by a multidisciplinary team including a faculty preceptor, resident, social worker, pharmacist, and nurse.

Goals

1. Strengthen Family Practice and Community Medicine curricula through the integration of home care into residents' continuity practice.

2. Provide experience in planning and implementing home visits in an urban environment.

3. Expand traditional notions of office-based practice to include the home and surrounding community.

Objectives

After completing the components of the home visit curriculum the resident will be able to:

1. Identify patients appropriate for a home visit according to criteria established by Cauthen (1981) and Scanameo (1995);

2. Complete at least two home visit sessions including pre- and post-briefings during their PGY2/3 year;

3. Identify health indicators sensitive to home care interventions;

4. Devlop competency in comprehensive biopsychosocial patient assessment;

5. Demonstrate understanding/appreciation of the home visit as a useful tool for patient care;

6. Demonstrate understanding of family dynamics and their influence on individual health, illness, and disease management;

7. Demonstrate understanding of the multiple factors that affect patient health: psychological, cultural, social, economic, community.

Patient Criteria for Home Visit

1. Patients who have recently experienced a transition:

-- Hospital discharge

-- Recent catastrophic diagnosis

-- New baby

2. Polypharmacy for home med assessment

3. Multiple chronic illness/non-adherent

4. Need for nursing home placement

5. Excessive use of services

Scheduling

Patient home visits will be conducted during the Community Medicine block. A minumum of 2 sessions will be scheduled per block, with 2 patients scheduled per session. Each session will include pre- and post-briefing sessions with the team.

Residents should identify potential patients for a home visit, preferrably prior to the start of their Community Medicine block. Once patients have been identified, residents will call and schedule the home visit with the patient. Please notify Heather Klusaritz once this has occurred (a minimum of one week prior to the scheduled visit) and a reminder letter will be sent to the patient.

Logistics

 

1. Transportation

Transportion reimbursement is available at the current University of Pennsylvania rate. See:

http://www.finance.upenn.edu/comptroller/travel/ground/mileage.shtml

 

Car-pooling will be arranged among home visit team members when possible.

 

2. Safety

•Always inform the home visit coordinator regarding the patient name(s) and address(es) you are visiting and the anticipated length of time you will be there. If your schedule changes, notify the home visit coordinator;

•When possible travel with a partner;

•Dress comfortably and avoid wearing or carrying valuable items, such as jewelry, or a purse. If you carry a pager, cell phone, or palm, conceal it;

•Treat your patient and their family with dignity and respect;

•In homes or areas known to be dangerous, do not stand in front of the door when you knock, stand to the side;

•Introduce yourself clearly, letting the family know who you are and why you are there;

•Be observant of your environment;

•Do not enter the home if the situation seems questionable (e.g. drunk family members, family quarrel, combativeness, unleashed pets, exposed syringes, etc.);

•Carry a cell phone;

•Be aware of exits from home and neighborhood. Conduct the visit in a room near an exit, and plan your escape route;

•Trust your instincts. If you feel threatened or uncomfortable with the situation, (i.e. the participant is becoming upset, threatening or angry) or suspect you are danger, exit the home;

•Don’t forget your common sense.

 

 

3. Documentation

Document all home visits in EPIC by:

• Go to Patient Care Menu
• Create an encounter of type "Out of Office"
• Document as you normally would
• E&M is Home visit - type "home visit" in LOS and select appropriate level based on new or established and usual E&M coding criteria for Level 2-5. No home visit by a physician is Level 1. All home visits are GC. Home visit established patient Level 3 = 99349.
• Route chart to Charo Harvey in our billing office and to supervising attending.

 

 

 

Readings

Recommended readings are availabe in pdf or word format on the Department server: (\\uphsfam1\Public\Home Visit Reading List)

Health Ecology Worksheet

Content should be reviewed prior to home visit for each neighborhood scheduled.

See Community Medicine Materials