Post-Acute Care Physician House Calls in Graduate Medical Education: Enriching the Resident and Patient Experience Through a Care Transitions Curriculum

Background: Successful transitions of care are critical for improving outcomes for elder patients. Residents receive little formal training in transitions of care principles. Performing a house call is the ideal venue for teaching transitions of care. Objectives: We developed, implemented, and evaluated a house call program focused on enhancing: 1) emergency (EM) and internal medicine (IM) residents’ transitions of care education, and 2) elder patients’ care transitions following hospitalization or emergency department (ED) visit. Methods: With institutional, departmental and intramural grand support, we created a novel curriculum. Schemes for identifying and scheduling patients where developed. House call days consisted of didactic time, the home visit, and post-visit debrief and documentation. Surveys assessed patient and resident experiences. Results: Over 14 months, 23 home visits were completed with 21 residents (11 EM, 10 IM). Eighty percent (17/21) of residents and 61% (14/23) of patients returned post-visit surveys. All residents valued the experience as a teaching method for care transitions. The majority (71%) reported that they would enjoy participating in future house calls; 30% noted prevention of a medication error during their visit. Nearly all (92%) patients felt the visit helpful and reported improved understanding of their medications and treatment plans. Conclusions: Findings suggest that a home visit program for elders discharged following ED visit or hospitalization is valuable from both patient and resident perspectives. Patients reported improved understanding of their medications and treatment plans while residents noted enhanced understanding of care transition principles, patients’ functional ability and caregiver dependence