Training for tomorrow’s healthcare environment: Incorporating principles of the patient- centered medical home into a student- run free clinic Jiahui Lin, Megan Riddle, Jonathan Steinman, Joshua Salvi, Christina Harris, Carla Boutin-Foster Weill Cornell Medical College and Weill Cornell Community Clinic, New York, NY

Call for Reform Medical Education –Little out-of-classroom experience pre-clerkship Health Care –Earlier exposure –Experiential learning –Care coordination Irby, et al

What is a PCMH? Personal physician Physician-directed medical practice Whole-person orientation Integrated and coordinated care Quality and safety assurance Enhanced access Outcome-based payment Stange KC, et al

Weill Cornell Community Clinic (WCCC) Established in 2003 Uninsured individuals in New York City NewYork-Presbyterian Hospital (NYPH) clinic space

WCCC Structure Clinical Directors Executive Directors Medical Directors –Faculty physicians Student Board –20% first-year class

WCCC Clinic Night Prior to 2013 Attending Physician 2 Junior Clinicians 2 Senior Clinicians 2 Session Coordinators Starting in 2013 Attending Physician 2 Junior Clinicians 6 – 10 Leading Clinicians Senior Clinician + Session Coordinator

Our Patients Uninsured, seeking long-term care N= appointments, 46% 1+ visit/year –22% routine exams –23% chronic health issues 63% reimbursements for chronic health management July 2011 – June 2012

Patient Visits Per Year 337 appointments per year

ICD9s Assigned

Prescriptions Reimbursed

Personal Physician within a Physician- Directed Medical Practice Session coordinators as physician –6 week – 1 year commitment Continuity of Care Program –20 students paired with 20 patients Board members coordinate administrative work

Whole-Personal Orientation and Integrated Care In-house collaboration: no cost to patients –Mental health nights –Women’s health nights –Silberman School of Social Work at Hunter College Outside collaboration: little or no cost to patients –NYPH Ambulatory Care Network –Community resources

Referral Locations

Quality Assurance and Risk Management Electronic Health Records: EpicCare Healthcare maintenance list Patient dashboard Healthcare provider hand-washing Nightly checklist HIPAA-secure database to codify best practices

Enhanced Access Open scheduling, expanded hours Alternative communication –Response to patients within 24 hours Electronic communication –Patient access to test results –New appointment requests

Why is this important? 41% of departments have implemented a PCMH curriculum, but without longitudinal exposure 40% medical students had exposure to a PCMH 37% clinics have mature EHR David A, et al Joo P, et al Saultz JW, et al

Why student-run free clinics? 111 student-run free clinics nationwide At WCCC: –70% of 1 st year class volunteered –20% of 1 st year class on Board –Low-cost and effective: $50,000 annual budget Simpson SA, Long JA

Conclusion Tomorrow’s physicians will practice in a highly collaborative, interprofessional environment. PCMH is gaining ground, and medical education must embrace new possibilities for curricular reform. Student-run free clinics provide a model for students to gain hands-on experience in PCMH.

Acknowledgments Dr. Alvin Mushlin, WCMC Donors and volunteers of the WCCC WCMC Academic Affairs

References David A, Baxley L, Adfm. Education of students and residents in Patient Centered Medical Home (PCMH): preparing the way. Annals of family medicine. May-Jun 2011;9(3): Irby DM, Cooke M, O’Brien BC. Calls for reform of medical education by the Carnegie Foundationfor the Advancement of Teaching: 1910 and Academic Medicine. Feb 2010;85(2): Joo P, Younge R, Jones D, Hove J, Lin S, Burton W. Medical student awareness of the Patient-centered Medical Home. Family medicine. Nov- Dec 2011;43(10): Saultz JW, O'Neill P, Gill JM, et al. Medical student exposure to components of the patient-centered medical home during required ambulatory clerkship rotations: implications for education. Academic medicine : journal of the Association of American Medical Colleges. Jun 2010;85(6): Simpson SA, Long JA. Medical student-run health clinics: important contributors to patient care and medical education. Journal of general internal medicine. Mar 2007;22(3): Stange KC, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. Journal of general internal medicine. Jun 2010;25(6):