Yasmin Meah

Student-Run Health Clinic: Novel Arena to Educate Medical Students on Systems-Based Practice

In recent decades, the United States has experienced substantial growth in the number of student-run clinics for the indigent. Today, over 49 medical schools across the country operate over 110 student-run outreach clinics that provide primary care services to the poor and uninsured. Despite this development, little research has been published on the educational value of such student-led endeavors. Although much has been surmised, no general methodology for categorizing the learning experience in these clinics has been established. This article represents the first literature review of the novel method of educating students through the operation of a clinic for the underserved. It highlights the student-run clinic as a unique enhancement of medical education that may supplant current curricular arenas in teaching students about systems-based practice principles such as cost containment and financing, resource allocation, interdisciplinary collaboration, patient advocacy, and monitoring and delivery of quality care. The novelty of the student-run clinic is that students place themselves at the forefront of problem solving and system navigation to effectively care for severely disadvantaged populations. This article underscores the student-run clinic as a potentially ideal experiential learning method for preparing young physicians to confront a US healthcare system currently facing crises in cost, quality of care, and high rates of uninsurance. The article stresses the need for outcomes research on the long-term effectiveness of the student-run clinic experience in affecting medical student practice behaviors and attitudes in patient care settings that extend beyond the student-run clinic.

Quality of Diabetes Care at a Student-Run Free Clinic

Student-run clinics are emerging safety-net practices for the uninsured; despite the over 110 clinics that currently operate across the United States, however, no data exist on the quality of care being delivered at such sites. The East Harlem Health Outreach Partnership (EHHOP) of the Mount Sinai School of Medicine in New York is a medical student-run, attending-supervised free clinic that offers primary care to the uninsured of surrounding East Harlem. The aim of this study was to evaluate diabetes care quality at the EHHOP clinic. Diabetes management was assessed using common quality-of-care indicators such as glycosylated hemoglobin level and blood pressure control. Clinic rates of such diabetes quality-of-care indicators ranged from 12% to 96%, and in most areas was comparable to or better than averages previously reported for uninsured populations.

Integrating service learning into the curriculum: Lessons from the field

The authors, representing two of the “signature” community service learning (CSL) programs in the 2010 Flexner Centenary volume of Academic Medicine, provide details of their programs – Frontera de Salud, a community-based program at the University of Texas Medical Branch, and the East Harlem Health Outreach Partnership, a clinic-based program at the Mount Sinai School of Medicine – specific to the task of integrating CSL into the medical school curriculum. They explain the nature and purpose of CSL, note gaps in the present curriculum which CSL aims to fill and highlight elements of CSL that are highly pertinent to Association of American Medical Colleges, Accreditation Council for Graduate Medical Education and Liaison Committee on Medical Education guidelines for undergraduate and graduate medical education. They also discuss barriers to the integration of CSL into the medical school curriculum and detail ways to overcome the logistic and fiscal challenges involved in making this highly effective and rewarding educational experience available to students of medicine.

The Role of Social and Community Service in Medical Education: The Next 100 Years

Abraham Flexners focus on science in medical school curricula was not intended to exclude or marginalize the importance of service in training American physicians. The erosion of service in academic medicine in the century after his report was the result of forces as wide ranging as research priorities, health care financing, and industrys influence. The authors review the historical context of these changes and make the case that reintroducing service into medical school curricula has never been more important. They describe the impact that neglecting service has had on society, patients, the medical profession, medical students, and medical education. After defining what is meant by social, public, or community service, they go on to detail signature programs at University of Texas Medical Branch, University of New Mexico Health Sciences Center, and Mount Sinai School of Medicine, focusing on the two major categories of health care delivery and education. These examples, in geographically and demographically disparate schools of medicine, demonstrate that it is possible to successfully reintegrate service into the missions of academic medical centers and medical schools.

Using Nurse Practitioner Comanagement to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program.

Abstract: Nurse practitioner (NP) co-management involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP co-management for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013. Data were collected from electronic medical records. An anonymous online survey was administered to all physicians active in the MSVD in July 2013 (n = 13). After enrollment in co-management, patients have lower annual hospitalization rates (1.26 vs. 2.27, p = .005) and fewer patients have 30-day readmissions (5.8% vs. 17.2%, p = .004). Eight of 13 physicians feel “much” or “somewhat” less burned out by their work after implementation of co-management. The high level of provider satisfaction and reductions in annual hospitalization and readmission rates among high-risk home-bound patients associated with NP co-management may yield not only benefits for patients, caregivers, and providers but also cost savings for institutions.

Strengthening value-based medication management in a free clinic for the uninsured: Quality interventions aimed at reducing costs and enhancing adherence

Skyrocketing costs of prescription medications in the USA pose a significant threat to the financial viability of safety net clinics that opt to supply medications at low to no out-of-pocket costs to patients. At the East Harlem Health Outreach Partnership clinic of the Icahn School of Medicine at Mount Sinai, a physician-directed student-run comprehensive primary care clinic for uninsured adults of East Harlem, expenditures on pharmaceuticals represent nearly two-thirds of annual costs. The practice of minimising costs while maintaining quality, referred to as high-value care, represents a critical cost-saving opportunity for safety net clinics as well as for more economical healthcare in general. In this paper, we discuss a series of quality improvement initiatives aimed at reducing pharmacy-related expenditures through two distinct yet related mechanisms: (A) promoting value-conscious prescribing by providers and (B) improving patient adherence to medication regimens. Interventions aimed at promoting value-conscious prescribing behaviour included blacklisting a costly medication on our clinic’s formulary and adding a decision tree in our mobile clinician reference application to promote value-conscious prescribing. Interventions targeted to improving patient adherence involved an automated text messaging system with English and Spanish refill reminders to encourage timely pick-up of medication refills. As a result of these processes, the free clinic experienced a 7.3%, or

Exploring Antidepressant Adherence at a Student-Run Free Mental Health Clinic

3768, reduction in annual pharmacy costs. Additionally, medication adherence in patients with diabetes on oral antihyperglycaemic medications increased from 55% to 67%. Simultaneous patient-based and provider-based interventions may be broadly applicable to addressing rising pharmacy costs in healthcare across the USA.

Wound Care in Home-Based Settings

Minority groups experience higher depression but lower treatment rates. Student-run free mental health (MH) clinics, such as the East Harlem Health Outreach Partnership (EHHOP) MH clinic, address this disparity. This study scrutinized EHHOP MH’s depression treatment by measuring adherence to antidepressants. Pharmacy data from seventy-nine patients were reviewed according to HEDIS criteria. Results compare EHHOP MH to New York State (NYS) Medicaid and NYS commercial insurance providers. In the acute treatment phase, EHHOP MH performed similarly to NYS Medicaid. In all other comparisons, EHHOP MH had lower adherence rates. Physician notes were reviewed to identify reasons for low adherence.

Resident as Teacher: The Mount Sinai Experience and a Review of the Literature

Wounds in homebound adults are common; clinicians who care for such patients require a working knowledge of prevention, diagnosis, prognosis, and therapeutics in order to minimize morbidity and maximize healing and comfort. The most frequently encountered wounds are decubitus wounds, also known as pressure wounds. Lower extremity ulcers are also common and can be venous, arterial, or neuropathic in origin. Wounds caused by malignant neoplasms are less common but are substantial causes of psychological and physical morbidity. Home-based medical providers who care for patients with wounds require a conceptual framework for dressings tailored to various types of wounds, as well as knowledge of home-based approaches such as negative-pressure wound therapy. Accurate and thorough documentation of wounds and wound care, appropriate billing, and collaboration with multiple disciplines are essential skills for the home-based clinician.