Original Article

Impact of an Academic–Community Partnership in Medical Education on Community Health: Evaluation of a Novel Student-Based Home Visitation Program

Authors: John A. Rock, MD, MSPH, Juan M. Acuña MD, MSc, Juan Manuel Lozano, MD, MSc, Iveris L. Martinez, PhD, Pedro J. Greer, MD, David R. Brown, MD, Luther Brewster, PhD, Joe L. Simpson, MD

Abstract

Objectives: Current US healthcare delivery systems do not adequately address healthcare demands. Physicians are integral but rarely emphasize prevention as a primary tool to change health outcomes. Home visitation is an effective method for changing health outcomes in some populations. The Florida International University Herbert Wertheim College of Medicine Green Family Foundation NeighborhoodHELP service-learning program assigns medical students to be members of interprofessional teams that conduct household visits to determine their healthcare needs.


Methods: We performed a prospective evaluation of 330 households randomly assigned to one of two groups: visitation from a student team (intervention group) or limited intervention (control group). The program design allowed randomly selected control households to replace intervention-group households that left the program of their own volition. All of the households were surveyed at baseline and after 1 year of participation in the study.


Results: After 1 year in the program and after adjustment for confounders, intervention group households proved more likely ( P ≤ 0.05) than control households to have undergone physical examinations, blood pressure monitoring, and cervical cytology screenings. Cholesterol screenings and mammograms were borderline significant ( P = 0.05 and P = 0.06, respectively).


Conclusions: This study supports the value of home visitation by interprofessional student teams as an effective way to increase the use of preventive health measures. The study underscores the important role interprofessional student teams may play in improving the health of US communities, while students concurrently learn about primary prevention and primary care.


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References

1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.

 

2. Peacock S, Konrad S, Watson E, et al. Effectiveness of home visiting programs on child outcomes: a systematic review. BMC Public Health 2013;13:17.

 

3. American Academy of Pediatrics, Council on Child and Adolescent Health. The role of home-visitation programs in improving health outcomes for children and families. American Academy of Pediatrics, Council on Child and Adolescent Health. Pediatrics 1998;101:486-489.

 

4. Markle-Reid M, Browne G, Weir R, et al. The effectiveness and efficiency of home-based nursing health promotion for older people: a review of the literature. Med Care Res Rev 2006;63:531-569.

 

5. Paul IM, Phillips TA, Widome MD, et al. Cost-effectiveness of postnatal home nursing visits for prevention of hospital care for jaundice and dehydration. Pediatrics 2004;114:1015-1022.

 

6. Thompson DK, Clark MJ, Howland LC, et al. The Patient Protection and Affordable Care Act of 2010 (PL 111Y148). An analysis of maternal-child health home visitation. Policy Polit Nurs Pract 2011;12:175-185.

 

7. Cuff PA, Vanselow N, eds. Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula. Washington, DC: Institute of Medicine/The National Academies Press; 2004.

 

8. American Association of Medical Colleges. Behavioral and social science foundations for future physicians. https://www.aamc.org/download/271020/data/behavioralandsocialsciencefoundationsforfuturephysicians.pdf. Published 2011. Accessed May 19, 2013.

 

9. Association of American Colleges. Cultural competence education for medical students: assessing and revising curriculum. https://www.aamc.org/download/54338/data/culturalcomped.pdf. Published 2005. Accessed May 19, 2013.

 

10. Eisenberg L. Does social medicine still matter in an era of molecular medicine? J Urban Health 1999;76:164-175.

 

11. Lee JW. Public health is a social issue. Lancet 2005;365:1005-1006.

 

12. Marmot M. Social determinants of health inequalities. Lancet 2005;365:1099-1104.

 

13. Stonington S, Holmes SM. Social medicine in the twenty-first century. PLoS Med 2006;3:e445.

 

14. Sales CS, Schlaff AL. Reforming medical education: a review and synthesis of five critiques of medical practice. Soc Sci Med 2010;70:1665-1668.

 

15. Maeshiro R. Responding to the challenge: population health education for physicians. Acad Med 2008;83:319-320.

 

16. Koo D, Thacker SB. The education of physicians: a CDC perspective. Acad Med 2008;83:399-407.

 

17. Maeshiro R, Evans CH, Stanley JM, et al. Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change. Am J Prev Med 2011;40:232-244.

 

18. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011.

 

19. Frenk J, Chen L, Butta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-1958.

 

20. Woollard RF. Caring for a common future: medical schools’ social accountability. Med Educ2006;40:301-313.

 

21. Dambach G, Simpson JL, Rock JA. Florida International University Herbert Wertheim College of Medicine. Acad Med 2010;85:S140-S143.

 

22. Rock JA, Simpson JL, Dambach G, et al. Florida International University: development and accreditation of Miami’s public college of medicine. Acad Med 2009;84:1454-1458.

 

22a. Liaison Committee on Medical Education. IS-14-A. An institution that offers a medical education program should make available sufficient opportunities for medical students to participate in service-learning activities and should encourage and support medical student participation. http://www.lcme.org/connections/connections_2014-2015/IS-14-A_2014-2015.htm. Accessed February 23, 2014.

 

23. Underwood JM, Townsend JS, Stewart SL, et al. Surveillance of demographic characteristics and health behaviors among adult cancer survivors-Behavioral Risk Factor Surveillance System, United States, 2009.MMWR Surveill Summ 2012;61:1-23.

 

24. Phares TM, Morrow B, Lansky A, et al. Surveillance for disparities in maternal health-related behaviors-selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. MMWR Surveill Summ 2004;53:1-13.

 

25. Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol-United States, 1999-2002 and 2005-2008.MMWR Morb Mortal Wkly Rep 2011;60:103-108.

 

26. Shea JA, Beers BB, McDonald VJ, et al. Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Fam Med 2004;36:575-581.

 

27. Lee SY, Bender DE, Ruiz RE, et al. Development of an easy-to-use Spanish health literacy test. Health Serv Res 2006;41(4 Pt 1):1392-1412.

 

28. Leinster S. Evaluation and assessment of social accountability in medical schools. Med Teach 2011;33:673-676.

 

29. Boelen C, Woolard R. Social accountability: the extra leap to excellence for educational institutions. Med Teach 2011;33:614-619.

 

30. Palsdottir B, Neusy AJ, Reed G. Building the evidence base: networking innovative socially accountable medical education programs. Educ Health (Abingdon) 2008;21:177.

 

31. van den Akker-van Marle ME, yan Ballegooijen M, yan Oortmarssen GJ, et al. Cost-effectiveness of cervical cancer screening: comparison of screening policies. J Natl Cancer Inst 2002;94:193-204.

 

32. National Business Group on Health. http://www.businessgrouphealth.org. Accessed January 16, 2013.

 

33. Kostis JB, Cabrera J, Cheng JQ, et al. Association between chlorthalidone treatment of systolic hypertension and long-term survival. JAMA2011;306:2588-2593.

 

34. Lund IV, Hartman J. Roadmap for reform: outlook for imaging under accountable care. Radiol Manage 2011;33:22-26.