4 trends in health care that were pioneered in homeless medicine

BOSTON – For health care more accessible and higher quality, insurers and providers are experimenting with a series of new approaches -. storage of patient information in the cloud for opening clinics inside grocery stores

close cousins ​​many of these tactics, however, were conducted even before the system health care homeless . unique characteristics of homeless patients – who often have multiple chronic diseases, which move around often – overlap with some of the pressures driving the evolution of care model of modern medicine. And the constraints of cost and time of the homeless revealed the weakness of the system of health care before others saw.

Here, four of those innovations that have not only shaped the medicine homeless, but now they are also finding an echo in the overall health care.

The article continues after the announcement

1. electronic health records

More and more hospitals are adopting electronic health records as Affordable Care Act it has pushed use to reduce errors and streamline care. This trend has grown steadily since the 2000s, but doctors for the homeless had integrated technology into his practice of a decade earlier.

One of the first systems of electronic medical record (EMR) was designed for Health Care for Program Boston homeless in 1994 by engineers in the Science Lab Computer Massachusetts General Hospital. Before such systems were widely available, it allowed several care providers homeless – in one case, a maximum of 50 unique providers -. Access record of a single patient

the system responds to a practical need: homeless patients are constantly in transit, and see their doctors at multiple locations :. In a clinic, hospital, on the street

“When we reached our first EMR, really this was one of the best things that had happened to us,” said Dr. Jim O ‘ Connell, president of the health care Boston for the Homeless Program.

clunky desktop computers were placed in 20 shelters across the city. Doctors and nurses dialup modems are used – no wireless Internet -. To track a patient moving

Today many health care for homeless programs across the country are based on a modernized version of the digital accounting. EHR are especially useful for medicine homeless, one initial analysis he said, because doctors often operate in the area where paper files would be burdensome. Digital records also enable organizations to better track how they are doing their patients, which is useful to inform donor agencies.

2. mixed in an environment providers

attention to more comprehensive health, a growing number of clinics are trying to integrate primary care with other fields. Some of the ideas being tested include the addition of Dentists and psychiatrists to primary care clinics to ensure that patients receive a complete workup when they come for their annual physical exam .

This type of comprehensive care is something the doctors who care for the homeless have long been practicing. For example, in the Health Care for the Program Boston homeless, doctors, psychiatrists, case managers and coaches substance abuse work in teams to health conditions, interrelated complexes are addressed through the various dimensions.

Every Thursday morning, the “street clinic” at Mass. General in Boston starts with a team meeting in which doctors, psychiatrists, nurses and case managers crammed into a single room to exchange notes on their patients.

“We were not innovative – instead it seemed to be getting nowhere and just started to find better ways,” O’Connell


This is the only clinic street in an academic medical center, but care collaboration is part of medicine programs homeless across the country – different suppliers, if not integrated, they are at least one common site, said Matt Warfield, a problem of health policy analyst at the National health Care for the homeless Council.

Having a single window means that homeless patients can take care of multiple problems in one visit – very useful provision both to save money in transit and time savings. When people without resident home to Boston Susie Holden visited the clinic on the street in June – to see your doctor for edema, as well as his psychiatrist to discuss stress – I had to lose a morning newspaper sales outside Whole Foods. “I’m very tired and I’m not really take care of myself,” he said. But he expected to be back in his usual place that evening.

And in medicine and mainstream homeless in medicine, when providers to communicate through specializations, tend to give better care. “You must take care of the whole person,” said Dr. Howard Koh, a professor at Harvard University School T. H. Chan, Public Health and former Assistant Secretary for Health at the Department of Health and Human Services of the United States.

3. The Transitional Care

hospital stays are shorter than they have ever been, thanks to minimally invasive procedures and insurers tightening reimbursement rates. The average duration of hospitalization was reduced nearly eight days in 1965 to less than five days in 2010 , according to the Centers for Disease Control and Disease Prevention. But that means more recovery takes place in nursing facilities or home. Several services have emerged to fill this gap, including an increasing number of hospitals employing “coaches transition” to help patients through the download process, and funding under the law affordable protection aimed specifically at the so-called transition assistance.

Transitional care is something that the system of health care homeless has had to deal with for decades, from shelters are often unable to support patients who need their dressings changed or drugs dosed out. There are now 78 medical relief programs across the country.

The first, Barbara McInnis House, opened in September 1985 as a group of beds cordoned off at a shelter in Boston. Now it is a center of 104 beds, the largest in the country where patients stay for an average of two weeks for anything Opiate Detoxification wound dressing at the end of life care.

For many homeless patients, respite care is “a way to hit the reset button, slow things done, get things under control,” said Dr. David Munson, medical director of the facility .

Paul Williams, a resident home to Boston, stayed in the center after his most recent hospitalization in May due to recurring seizures. Williams said the respite center staff is helping him stay sober, take your medications every day, and look for a house. “They have been helping to get back on track. Honestly, I think I can handle [living alone], whenever I am responsible and care of myself,” he said.

4. Bringing attention to you

mobile mammography vans supermarkets offering vaccines, doctors are finding that they can better reach patients if they bring the doctor’s office where are the people. patient visits to clinics block down at stores like Walgreens and CVS have increased from 1.5 million in 2006 to 10.5 million in 2014.

Caring for the homeless should be even more agile, since many patients are unable or unwilling to go to any clinic. homeless for decades doctors have pioneered the approach of medical supplies packaging in a van or even a backpack to reach patients in the narrow alleys and under bridges.

And it is not only urgent treatment – Doctors Street help homeless people managing chronic conditions like diabetes because they lack a refrigerator in which to store insulin


“for patients with diabetes trying to use your insulin is not easy to do this under a bridge,” said Dr. Monica Bharel, the commissioner of the Department of Public Health in Massachusetts.

doctors and nurses Street in Boston will have blood tests on the street, concoct patients drug regimens can handle outdoor and “squeeze pharmaceutical companies for these insulin pens” O’Connell said.

Another vehicle for health care – literally -. Are mobile clinics and medical vans that scores of health care for programs homeless across the country use to pay attention on the street

In Boston, the shelter Pine Street Inn healthcare is mixed in other needs of residents homeless. Every night of the year, an “extension are” staffed with counselors, nurses and doctors provides food, clothing and blankets for people in the streets – and if a piping patient to a concern like, “My arm hurts, “You can start a check.

“The only way a system of health care could work is if doctors and nurses left the traditional clinics and went directly to where the homeless were” O’Connell said, reflecting on the fundamental principles of the Health Care of Boston’s Homeless Program. “If we hope to come to us, the game was over.”

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