A faculty family nurse practitioner accompanied the resident-in-training and provided education, which included how to 1) conduct a home visit, 2) assess the patient’s home environment and needs, 3) document a home visit in the electronic medical record, and 4) bill for services. Home visits were done approximately 2 half-days per month with 4 to 5 patients. Following patient identification, the patients (or family member if patient was <18 years old) were asked if they would like to voluntarily participate in a home visit(s). Patients (if 18 years of age or older, or their family member if under 18) who may benefit from a home visit were identified based on resident feedback and recommendations. Home visits were conducted for a variety of patients of any age, gender, or health problem who presented to our residency clinic over a 6-month period in 2017. The project was approved as non-human subjects research by the local institutional review board. We conducted a pilot quality improvement study that incorporated home visits through 1 family medicine residency clinic in Milwaukee, Wisconsin. Therefore, the purpose of our quality improvement project was to examine which aspects of the home visit experience patients and residents find meaningful as well as whether the experience makes them more likely to participate in home visits in the future. ![]() 8 Despite this, few training programs and studies incorporating home visits have focused on the value of the experience to the resident physician and their patients. 8, 13 It is also recognized that home visits add value to residency education and fulfill all 6 ACGME competencies 8, 12 and at least 16 of the 22 Family Medicine Milestone Project subcompetencies. 4, 6, 7 One study that surveyed initial and recertifying physicians reported there was a desire for graduating residents to have experience with a broader scope of care, including home visits. ![]() Multiple studies have touched on physician-patient satisfaction from home visits. 12 Additionally, it was estimated by program directors that only one-third of the residents intended to provide home visits after graduation. 4, 7, 10, 12 Even so, while home visits are being conducted during residency, Sairenji et al identified that residents were going out on only 2 to 5 visits by graduation, limiting their exposure to the home visit experience. 12 There are some primary care programs that still regularly incorporate home visits into their core curriculum. ![]() ![]() In this age of training, most primary care residents have little to no exposure to home visits in medical school and residency, 5 especially since ACGME transitioned away from completion of home visits during residency in 2014. 3 We believe that home visits are the ultimate example of whole-person, patient-centered, continuous care ─ the kind of care that most family physicians strive to provide their patients ─ and a model of care worth introducing to resident physicians as it presents an opportunity to learn all Accreditation Council of Graduate Medical Education (ACGME) core competencies. It has been well documented that home visits provide high quality care, 4 encourage the practice of good communication and team-based care, 4, 5 improve health outcomes, 6 strengthen physician confidence in working with community agencies, 7 reach a frail population that is often least likely to benefit from hospitalization, 2– 5, 8 eliminate the burden of patient travel, 4 empower patients and their caregivers, 1, 8, 9 give physicians a better understanding of a patient’s environmental and social determinants of health, 4, 5, 8, 10, 11 and provide emotional support for homebound patients. There is a need to revive home visits to improve quality of and access to care, especially with aging and vulnerable populations. 2 With the increase in value-based health care, the pendulum is swinging to shorter hospital stays and more comprehensive outpatient management. Even so, a recent review by Schuchman et al suggests home visits, as well as visits to group homes and assisted living facilities, are currently on the rise and have doubled from 1996 to 2016. 1 However, the movement towards more hospital-based medicine with advancing technology contributed to a significant decrease in home visits. Home visits were a heavily utilized form of health care delivery in the preindustrial United States.
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