Peter Gliatto, MD, director of Mount Sinai's Visiting Doctor Program, said one of the greatest advantages to working in a home-based care program is that it gives physicians more time with patients and in turn humanizes the healthcare experience.
Mount Sinai's Visiting Doctor program has been around for more than 25 years.
The program encompasses a team of physicians, social workers, nurses, nurse practitioners, administrative support and community health workers, to improve the quality of life of homebound people, as well as their caregivers.
Today, the program serves as one of the largest academic home-visit programs, with clinicians conducting more than 6,000 home visits annually to more than 1,000 patients.
Becker's spoke to Dr. Gliatto about the work that has been done since the program began and how home-based care is humanizing the care physicians give to patients.
Question: When did Mount Sinai initiate the idea for the Visiting Doctors Program? Why did patients need care in the home?
Peter Gliatto: It was started by three residents of internal medicine and a nurse at Mount Sinai and they did it for two main reasons.
One is they were fairly advanced in their training, and were feeling kind of burnt out and they were looking for some way to kind of reconnect with why they went into medicine.
The other thing was that they were observing people, who were unable to leave their homes, struggling to come into their physician's office because they were in a wheelchair or because they needed major assistance.
They wanted to make it easier for those patients.
So, they reached out to Boston Medical Center to get advice and soon they were able to collaborate with this nursing agency that was doing homecare and that's where they were able to get the program off the ground.
Q: Medical students, residents, and fellows participate in the program — how does the program aim to prepare the next generation of healthcare professionals?
PG: Many patients are homebound or can be economically disadvantaged and socially disadvantaged and that ties into social determinants of health, which is a much bigger emphasis in medical education these days.
So that's our goal, is to really have people pause when they're thinking through how to deliver healthcare.
In the program, we try to teach the next generation of healthcare professionals to meet the patients where they're at.
We also want them to think of how to take a more patient-centered approach to caring for different patients who have different needs.
Q: The program has been around for 25 years, what has changed since starting the program and where do you see the program developing in the next three to five years?
PG: We're definitely a lot bigger. We now cover all of Manhattan, whereas before we were covering mostly just the area around Sinai. We've also expanded our patient size quite a bit.
Because we take on patients who are in value-based contracts with the health system, we're able to reduce costs in terms of unnecessary ER visits and unnecessary admissions.
Q: What are some of the pros and cons of home-based healthcare?
PG: One of the cons for patients is that you can't just walk in if you have an urgent visit, because home-based care is largely determined by when clinicians come to see their patients based on their level of sickness.
But the upside for clinicians is that you get to spend a lot of time with patients.
It's really awesome seeing patients in their home setting and it humanizes them so much. In a hospital, we do so much to take away people's identity — they're all dressed the same and I don't even get to see how tall a patient is because they are laying in bed. But in a patient's home you get to know a bit of their lives by looking at pictures on the wall, looking at their bookshelves and that's really fascinating.
Q: As staffing problems become exacerbated by the Great Resignation, how do you continue to invest in the infrastructure and hire and/or train staff to deliver care in the home?
PG: Fortunately, we have been pretty lucky with our own practice. We've had a couple of people leave in the last few years, which is new, but it wasn't really a Great Resignation kind of thing.
We've not been able to hire back 100 percent so it is a little challenging as we've had to downsize a little bit in terms of the total number of patients that we're taking on.
But, the challenge comes with nursing agencies.
If we refer up to a nursing agency to help us manage a patient's chronic illness, it can often result in delays. So we've had to reach out to other agencies that we don't have as much of a track record with which has come with mixed results.
People everywhere are asked to do more with less and that's definitely true in our space as well.