A Multidisciplinary Program for Delivering Primary Care to the Underserved Urban Homebound: Looking Back, Moving Forward

Authors

  • Kristofer L. Smith BA,

    1. From the *John F. Kennedy School of Government, Harvard University, Cambridge, MassachusettsSchool of Medicine, Boston University, Boston, MassachusettsSamuel Bronfman Department of Medicine§Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkDepartment of Epidemiology, School of Public Health, Columbia University, New York, New York.
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  • Katherine Ornstein MPH,

    1. From the *John F. Kennedy School of Government, Harvard University, Cambridge, MassachusettsSchool of Medicine, Boston University, Boston, MassachusettsSamuel Bronfman Department of Medicine§Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkDepartment of Epidemiology, School of Public Health, Columbia University, New York, New York.
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  • Theresa Soriano MD,

    1. From the *John F. Kennedy School of Government, Harvard University, Cambridge, MassachusettsSchool of Medicine, Boston University, Boston, MassachusettsSamuel Bronfman Department of Medicine§Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkDepartment of Epidemiology, School of Public Health, Columbia University, New York, New York.
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  • David Muller MD,

    1. From the *John F. Kennedy School of Government, Harvard University, Cambridge, MassachusettsSchool of Medicine, Boston University, Boston, MassachusettsSamuel Bronfman Department of Medicine§Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkDepartment of Epidemiology, School of Public Health, Columbia University, New York, New York.
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  • Jeremy Boal MD

    1. From the *John F. Kennedy School of Government, Harvard University, Cambridge, MassachusettsSchool of Medicine, Boston University, Boston, MassachusettsSamuel Bronfman Department of Medicine§Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkDepartment of Epidemiology, School of Public Health, Columbia University, New York, New York.
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Address correspondence to Jeremy Boal, MD, Associate Professor of Medicine, Geriatrics, The Mount Sinai School of Medicine, The Mount Sinai Visiting Doctors Program, Box 1216, One Gustave L. Levy Place, New York, NY 10029. E-mail: jeremy.boal@mssm.edu

Abstract

The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth.

Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader.

These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost–benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program.

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