Home health care most often occurs in a rather obvious location: a patient’s home. What though happens when a patient doesn’t have a traditional home? Enter street medicine, an emerging model that delivers care to patients where they are, be that in shelters or in the streets, in an effort to improve public health and care for some of the country’s most vulnerable patients.
Street medicine is, in many ways, similar to traditional forms of house calls, with a physician or physician assistant treating a patient where they live. The difference is the location, and sometimes the transitive nature of the patients.
A mostly grassroots model, a few health systems are keying in to the benefits of street medicine, while the Department of Veteran’s Affairs also already employs a similar model. The VA’s program, Homeless Patient Aligned Care Teams (H-PACT), serves over 5,000 patients a year in 31 locations.
One of the pioneers of street medicine, Dr. Jim Withers, founded Operation Safety Net more than 20 years ago within Pittsburgh Mercy Health System. Operation Safety Net offers a number of focused initiatives for homeless patients, treating the patient as a whole through partnerships with the area agency on aging, the VA, shelters, food banks, and more. The innovative program trains more than 100 residents and students each year and offers a one-month residency for University of Pittsburgh School of Medicine fourth-year students.
Lehigh Valley Health Network also runs a street medicine program, led by physician assistant Brett Feldman. Feldman, who was recently profiled by the Associated Press, treats about 100 patients a month in the program.
What these programs have in common is reduced rates of emergency room visits saving hospitals and health systems money while improving the overall health of the communities they serve. Estimates have shown a decrease in 30-day readmission rates at Lehigh Valley hospital down to 13 percent from 51 percent. Add to that the fact the rate of uninsured homeless has gone up nearly three fold from 24 percent to 73 percent and that’s a lot of savings for the hospital and health system. Many of the other health systems discussed in the AP article have seen similar savings and outcomes improvement.
Just like traditional home health providers are increasing their focus on preventative care, street medicine seeks to treat repeat patients before they wind up in emergent care, where care delivery is much more costly. Focusing on preventative care, and treating patients where they can be or need to be treated is a critical piece for the future of health care delivery. Street medicine, like home health care, aims to reduce readmissions and provide high-quality healthcare that truly serves the patient, especially those who are most vulnerable.