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Best Poster Award Presented

The Academy's 2003 Best Poster Award was presented by President Wayne McCormick, MD, at an awards reception on May 16. Congratulations go to Christine Chang, Susan S. Jackson, Christina Conforti, and Elizabeth L. Cobbs for "Outcomes of a Medical House Call Program in an Urban VA Medical Center." Abbreviated abstract appears below:

BACKGROUND: The Home-Based Primary Care Program (HBPC) was established in 1983 to provide coordinated, comprehensive medical care to homebound patients of the Washington, DC Veterans Affairs Medical Center (WVAMC).

PROGRAM STRUCTURE: The HBPC teams consists of a medical director (0.5 FTE), nurse practitioners (2.0 FTE), registered nurses ( 2.0 FTE), social workers (2.0 FTE), pharmacists (0.2 FTE), a dental hygienist (0.2 FTE), a dietician (0.2 FTE), and a nurse coordinator (1.0 FTE). Home visits are made at least monthly.

PARTICIPANTs: Patients are eligible for HBPC if they live within a 30-mile radius of the WVAMC and meet the Medicare definition of homebound.

METHODS: A retrospective review of the electronic medical records for patients admitted to HBPC from January 1, 2001 to October 27, 2002, was completed. Satisfaction surveys completed by patients and families were also reviewed.

RESULTS: 366 patients were admitted to HBPC during the study period. 97% were male with a mean age of 78 years (range 36-96 years). Mean functional scores were: Mini-Mental Status Score 22.5/30; activities of Daily Living 6.5/12; and Instrumental Activities of Daily Living 13.8/29. (Lower scored reflected more dependency.) Thirteen percent lived alone; 49% utilized home health aide services; 19% attended adult day care programs; 33% utilized inpatient respite services. The most prevalent diagnoses were: hypertension (57%), diabetes (51%), stroke (37%), CAD (30%), dementia (22%), anemia (20%), COPD (17%), chronic renal insufficiency (12%), and cancer (10%). Hospitalization rate was 720 hospital days of care per year per 1,000 enrollees. 93 patients were discharged: 30% died at home, 9% died in hospice, 13% were hospitalized, 39% moved to a nursing home, 7% returned to outpatient care, and 2% moved out of the area. Of the 22 randomly chosen participants surveyed, 80% rated HBPC services as excellent or very good.

CONCLUSIONS: Use of an interdisciplinary medical house call program for frail, chronically ill patients in an urban VAMC is associated with low rated of hospitalization and high rates of patient and family satisfaction.

For additional information, contact: Christine Chang, Home-Based Primary Care Program, WVAMC, 50 Irving St NW, Washington, DC 20422.