Download Family Medicine Resident Home Visit Curriculum - 82.76 KB

Family Medicine Resident Home Visit Curriculum
Objectives for Resident Home Visit Curriculum:
Demonstrate care for complex homebound patients in their home environments.
1. Describe challenges and opportunities unique to patient care in the home
environment.
2. Review medication use and adherence while identifying medications that are
no longer effective, are duplicative or carry greater burden than benefit.
Identify medications that you would recommend stopping and create a
schedule for stopping these medications.
3. Practice culturally sensitive shared decision making with patients and
families/caregivers in the context of their goals of care, health literacy and
methods of communication such as tele-health and e-technologies.
4. Develop and implement a safety plan to make the patient’s home
environment safer.
5. Collaborate with patients, caregivers, interprofessional health care team and
community service providers to develop a care plan for a home visit patient
maximizing skill sets of each team member to address the social
determinants of health impacting the patient.
6. Develop a personal plan to integrate home visits into your future practice.
Feedback form prompts:
1. Resident will complete medical reconciliation and make recommendations
for medications that are no longer effective, are duplicative or carry greater
burden than benefit.
2. Resident will practice culturally sensitive shared decision making with
patients and families/caregivers in the context of their goals of care, health
literacy, desired level of participation and methods of communication such as
tele-health and e-technologies.
3. Resident will develop a safety plan to make the patient’s home environment
safer.
4. Resident will collaborate with patients, caregivers, interprofessional health
care team and community service providers to develop a care plan for a
home visit patient maximizing skill sets of each team member and addressing
the social determinants of health impacting the patient
Overall level of independence: Resident will demonstrate care for a complex
homebound patient in her home environment.
Methods:
1. Home Visit Experience with Graduated Autonomy: ½ day sessions
a. Pre-work:
i. Independent study of online material and journal article
ii. Chart pre-visit planning and preliminary answers to 3 debrief
questions addressing social determinants of health (SDH),
medication recommendation and safety plan with completion
of pre-visit planning template in EMR
b. Visit itself
R1 – Participate with attending. Seeing Home-Based Primary Care patients.
Goal: modeling.
Learning focus: ID patients
Additional debrief questions:
 What made this patient a good home visit patient?
 What makes this patient homebound?
 What SDH’s are contributing to being homebound?
R2 – Run visit with attending in role of observation. Seeing at least one
continuity patient, others can be HBPC patients
Goal: increased autonomy
Learning focus: medication reconciliation, safety plans, identifying
SDH, preferred form of communication
R3 – Independent visit with student or intern with phone precepting
Goal: increased autonomy, opportunity for teaching, leading a case
conference
Learning focus: professionalism – lead group discussion, ID
community resources in your area, incorporating into practice (for
instance schedule as last patient of the day)
c. Debrief with attending: touch on 1. Med list 2. Home safety 3. SDH
i. R1 visits during Intro to FMC month will include lunch with
attending
d. Afterwork:
i. All – personal, written reflection, complete documentation and
billing to be reviewed by attending
ii. R2 – utilize preferred form of communication to address follow
up questions, complete home health paperwork longitudinally
iii. R3 – teach intern or med student
2. Reflections: completed by all residents after session. One reflection/session, can
choose one patient or combine
3. R3 Interdisciplinary Case Conference with Family Medicine Center Practice
Meeting using Interdisciplinary Problem Based Learning
a. Resident will give brief synopsis of visit and identify primary SDH or
safety issue impacting patient
b. Resident will break room into interdisciplinary small groups to
discuss problem, come up with one resource, then advocate for their
solution as the best solution
c. Group will vote on best resource and R3 will add this to the Evernote
resource book
4. Evernote Resource Book: R3 will add a resource page based on the new resource
identified during case conference along with other resources identified from
geriatric fellows case conference and through other home visits.
Didactics:
1. Elder abuse: bring in someone from APS and address cases through PBL
approach in small groups with input from guest
2. Panel of current home visit providers
- focus on incorporating home visits into practice
- start session with one minute free write about previous home visit
experiences, patient in mind that could benefit from home visits, what
barriers they perceive with continuing home visits in practice; then share out
3. Patient, family and caregiver panel: geriatric fellows will plan and facilitate
Resident Home Visit Schedule Breakdown
R1:
Intro to FMC: 1 morning session per resident with lead HBPC faculty
GeRIE: 2 sessions per resident with HBPC faculty
R1 total = 3 sessions, 4-6 visits
R2:
FMC/QI Month: 2 sessions per resident, at least one will include their own patient,
goal 2
R2 total = 2-4 visits
R3:
1-2 sessions
1 set in pediatric month or elective month
1 additional session as part of global health month if it involves a local component
Ideally see patient from 2nd year for additional continuity
R3 total = 2-4 visits
Total: minimum 8 home visits over the course of three-year residency