Impact of an education-centered medical home on quality at a student-volunteer free clinic

• Published in: Medical education online 2018-01, Vol.23 (1), p.1505401-7
• Main Authors: Russi, Abigail E., Bhaumik, Smitha, Herzog, Jackson J., Tschoe, Marianne, Baumgartner, Andrea C.
• Format: Article
• Language: English
• Subjects: Adult; Breast cancer; Breast Neoplasms - diagnosis; Care plans; Cervical cancer; Clinical Clerkship - organization & administration; Clinical outcomes; Clinics; Colorectal cancer; Colorectal Neoplasms - diagnosis; Data; Family physicians; Female; Health care access; Health education; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; HIV; HIV Infections - diagnosis; Human immunodeficiency virus; Humans; Learning; Longitudinal clerkships; Male; Mass Screening - organization & administration; Medical education; Medical screening; Medical students; Middle Aged; Models, Educational; Patient safety; Patient-Centered Care - organization & administration; Patients; Physicians; Preventive medicine; primary care; Primary Health Care - organization & administration; Quality; Quality Improvement - organization & administration; Quality management; Student Run Clinic - organization & administration; student-run free clinic; Students; Task forces; undergraduate medical education; Uterine Cervical Neoplasms - diagnosis
• ISSN: 1087-2981; 1087-2981
• DOI: 10.1080/10872981.2018.1505401

Background: The continuity provided by longitudinal clerkships has documented benefits to medical student education. Yet, little quantitative data exist on the association between longitudinal clerkships and patient outcomes. Objective: This study compares screening metrics of a longitudinal clerkship called the education-centered medical home (ECMH) with the standard clinical model at a student-volunteer free clinic (SVFC). In the ECMH model, the same attending physician staffs one half-day of clinic with same group of students weekly for 4 years. Standard clinical models are staffed with students and physicians who come to the SVFC based on availability. Design: ECMH students aimed to increase human immunodeficiency virus (HIV) screening rates in their patient panel as part of a quality improvement project. Students prepared individualized care plans prior to patient visits that included whether screening had been performed. They were also reminded to confirm completion of testing. Percentages of patients screened for HIV before and after establishment of the ECMH were compared with four standard clinical models. Screening rates for breast, colon, and cervical cancer, as well as hepatitis C, served as secondary endpoints. Results: While screening rates were initially similar between models (43.2% and 34.8% for the ECMH and standard clinical panels, respectively, p = 0.32), HIV screening rates increased from 43.2% to 95.0% in the ECMH compared with a significantly smaller increase from 35.0% to 50.0% in the standard clinical panel (p