Pulse
Briefs
Building the Home Team
Later this fall, some medical, pharmacy, and nursing students from the University of Minnesota and Bemidji State University will get a glimpse of what goes into providing home health care in a rural community.
As part of an initiative being coordinated through Iverson Corner Drug Inc. and North Country Home Care in Bemidji, students from the three disciplines will see firsthand how physicians, pharmacists, and nurses work together to care for patients in their homes and, in the process, learn to view patients and their problems through the lenses of the different professions.
The idea came from pharmacist Paul Iverson, who provides community pharmacy experience to fourth-year University of Minnesota pharmacy students and has been involved in a project that exposes pharmacy students to the roles of various professionals involved in hospice care. “We were familiar with the interdisciplinary approach in hospice and realized home care has many of the same pieces,” he says.
Students participating in the home care initiative will take part in sessions during which a physician, pharmacist, and home care nurse will discuss the needs of a patient with complex medical conditions. The students will develop recommendations for that patient’s care and work with their preceptors to present their ideas to the patient’s primary physician. If their recommendations are implemented, they will evaluate how well they worked.
Participants also may accompany a nurse on a home visit and go with the patient to the doctor’s office and pharmacy in order to see how all the pieces fit together. “That’s the dream,” says Iverson, who hopes to start the program later this month, when a third-year medical student from the university’s Rural Physician Associate Program begins a nine-month rotation in Bemidji. “We’ll see how it actually works.”—Kim Kiser
Neighborhood Doc
Jon Hallberg, M.D., became fascinated with the idea of house calls as a boy living in Brussels, Belgium. He remembers the neighborhood doctor coming to his house, sitting at his bedside, and diagnosing him as having strep throat.
Hallberg didn’t forget that encounter, and when he became a family physician, he knew that one day he wanted to practice medicine in that way. Hallberg, who is also an assistant professor in the University of Minnesota’s department of family medicine and community health, will get such opportunities as medical director of the Mill City Clinic, a new University of Minnesota Physicians’ clinic that will open in early November in downtown Minneapolis. Located across from the Guthrie Theater, the primary care clinic will serve people moving into the area, many of whom are empty nesters and young professionals.
In addition to providing same-day appointments with Hallberg, the clinic’s full-time physician, a nurse practitioner, or a physician assistant, the clinic will offer what Hallberg describes as “atypical visits.”
He says these might include making calls to hotel guests, actors who are performing at the Guthrie, employees of companies that are headquartered downtown, and residents of the newly built condos and renovated mill buildings. Because the clinic serves a small geographic area, Hallberg says they’ll be able to make these visits on foot or by bike.
“I’ve done house calls of a variety of kinds in the past, and it’s fun,” he says. “It deepens my sense of who the person is, and it creates a bond.”—Kim Kiser
Taking It to the Streets
At a staff retreat a couple of years ago, some Mayo Clinic investigators raised questions that had bothered them for years: Who were they excluding by primarily studying only people who could travel to Mayo Clinic? What groups of individuals were they missing? And what weren’t they learning about the causes of disease as a result?
That discussion led to an idea—to take their clinical research on the road. The plan was to get a vehicle that would serve as a mobile research unit. “We thought that we should go to people in society if we were to really be able to understand why a disease occurs and how to deal with it,” says Sreekumaran Nair, M.D., Ph.D., director of research resources for the Mayo Clinic Center for Translational Science Activities, which coordinates Mayo Clinic’s resources for conducing clinical research.
Using money from an NIH award, Mayo purchased an RV-style vehicle that will bring research to broader and more diverse populations.
By July, the mobile unit was up and running, equipped with two exam rooms, equipment for conducting lab tests, audio/visual technology for patient education, and a laboratory.
Thus far, the vehicle has gone only to county fairs in nearby towns for a study on risk factors for heart disease. But Nair says he envisions that it will be useful for researchers with wide-ranging interests. He says, for example, the unit could be used to study the prevalence of diabetes in a community, examine the effects of a vaccine on schoolchildren in a designated district, or evaluate the effectiveness of educational strategies on a certain patient population. To use the new unit, researchers will need to gain approval from Mayo’s Institutional Review Board and a research resource review panel.
With the mobile unit, Nair hopes that researchers might reach age groups such as the elderly and school-aged children or immigrant groups such as Somalis and Hispanics who haven’t been well-represented in many Mayo Clinic studies before. “We can go to them instead of them coming here,” he says.—Carmen Peota
Medicare-Certified Agencies
Medicare certification is the highest level of licensure a home health agency can obtain in Minnesota. It allows agencies to deliver skilled nursing, therapy, nutritional services, medical social services, aide services, and medical supplies and equipment, and be reimbursed for them by Medicare, Medical Assistance (MA), and other third-party payers. Since 2000, a number of Medicare-certified home health agencies (which also hold a Class A license) have closed, including 37 that were operated by county public health agencies that could no longer afford to provide direct services. Here’s a look at the state of these full-service agencies in Minnesota.
Number of home care patients covered by Medicare and MA: 60,000
Number of Medicare-certified home health agencies: 209
Net number of Medicare home health agencies that have closed since 2000: 43
Number of counties that have fewer than two Medicare-certified home health agencies: 48
Sources: Minnesota Home Care Association, Stratis Health