TY - JOUR
T1 - Impact of an education-centered medical home on quality at a student-volunteer free clinic
AU - Russi, Abigail E.
AU - Bhaumik, Smitha
AU - Herzog, Jackson J.
AU - Tschoe, Marianne
AU - Baumgartner, Andrea C.
N1 - Funding Information:
We thank CommunityHealth for their partnership and support of the FSM ECMH clinic. Specifically, we thank Sylvia Dziemian for her help in learning the ‘Quality Management’ aspects of the Athena® EMR system. We also thank the numerous donors who make patient care at CommunityHealth possible. We thank the Northwestern ECMH leadership (Jennifer A Bierman, MD; Dan B Evans, MD; Bruce L Henschen, MD, MPH; Elizabeth R Ryan, EdD; John X Thomas, PhD; and Diane B Wayne, MD) for their support and guidance of this project. We thank Dr. Andrew Karaba, MD, PhD and Dr. Sara Karaba MD, PhD for the initial discussion and suggestions for this project. The authors would like to thank the Northwestern Open Access Fund for their support in funding their study's article processing charge.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: The continuity provided by longitudinal clerkships has documented benefits to medical student education. Yet, little quantitative data exist on the association between longitudinal clerkships and patient outcomes. Objective: This study compares screening metrics of a longitudinal clerkship called the education-centered medical home (ECMH) with the standard clinical model at a student-volunteer free clinic (SVFC). In the ECMH model, the same attending physician staffs one half-day of clinic with same group of students weekly for 4 years. Standard clinical models are staffed with students and physicians who come to the SVFC based on availability. Design: ECMH students aimed to increase human immunodeficiency virus (HIV) screening rates in their patient panel as part of a quality improvement project. Students prepared individualized care plans prior to patient visits that included whether screening had been performed. They were also reminded to confirm completion of testing. Percentages of patients screened for HIV before and after establishment of the ECMH were compared with four standard clinical models. Screening rates for breast, colon, and cervical cancer, as well as hepatitis C, served as secondary endpoints. Results: While screening rates were initially similar between models (43.2% and 34.8% for the ECMH and standard clinical panels, respectively, p = 0.32), HIV screening rates increased from 43.2% to 95.0% in the ECMH compared with a significantly smaller increase from 35.0% to 50.0% in the standard clinical panel (p < 0.0001). Additionally, the ECMH resulted in statistically significantly increased screening rates for cervical cancer (p < 0.001) and hepatitis C (p < 0.0001). Conclusions: This study demonstrates an association between a longitudinal ECMH clerkship and improved quality metrics at an SVFC. Even measures not targeted for intervention, such as colorectal cancer and hepatitis C, showed significant improvement in screening rates when compared with the standard clinical model.
AB - Background: The continuity provided by longitudinal clerkships has documented benefits to medical student education. Yet, little quantitative data exist on the association between longitudinal clerkships and patient outcomes. Objective: This study compares screening metrics of a longitudinal clerkship called the education-centered medical home (ECMH) with the standard clinical model at a student-volunteer free clinic (SVFC). In the ECMH model, the same attending physician staffs one half-day of clinic with same group of students weekly for 4 years. Standard clinical models are staffed with students and physicians who come to the SVFC based on availability. Design: ECMH students aimed to increase human immunodeficiency virus (HIV) screening rates in their patient panel as part of a quality improvement project. Students prepared individualized care plans prior to patient visits that included whether screening had been performed. They were also reminded to confirm completion of testing. Percentages of patients screened for HIV before and after establishment of the ECMH were compared with four standard clinical models. Screening rates for breast, colon, and cervical cancer, as well as hepatitis C, served as secondary endpoints. Results: While screening rates were initially similar between models (43.2% and 34.8% for the ECMH and standard clinical panels, respectively, p = 0.32), HIV screening rates increased from 43.2% to 95.0% in the ECMH compared with a significantly smaller increase from 35.0% to 50.0% in the standard clinical panel (p < 0.0001). Additionally, the ECMH resulted in statistically significantly increased screening rates for cervical cancer (p < 0.001) and hepatitis C (p < 0.0001). Conclusions: This study demonstrates an association between a longitudinal ECMH clerkship and improved quality metrics at an SVFC. Even measures not targeted for intervention, such as colorectal cancer and hepatitis C, showed significant improvement in screening rates when compared with the standard clinical model.
KW - Longitudinal clerkships
KW - preventive medicine
KW - primary care
KW - student-run free clinic
KW - undergraduate medical education
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U2 - 10.1080/10872981.2018.1505401
DO - 10.1080/10872981.2018.1505401
M3 - Article
C2 - 30343644
AN - SCOPUS:85055077952
VL - 23
JO - Medical Education Online
JF - Medical Education Online
SN - 1087-2981
IS - 1
M1 - 1505401
ER -