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There Is a Doctor in the House

There Is a Doctor in the House
USC physician Patricia Harris, far right, makes an in-home visit to check on the progress of patient Marvin Miyashiro, as his daughters, Paula, far left, and Irene assist with his care.

For some Los Angeles seniors, it may not be a salesperson ringing the doorbell — it just might be their doctor.

The USC Home Visit Program, led by Wayne Chen and Patricia Harris, assistant professors of clinical medicine in the Keck School of USC’s Department of Medicine, provides care for Los Angeles-area patients who have difficulty leaving their homes to attend medical appointments.

“The population is aging and we are living longer, but we are living longer with chronic illness rather than in good health,” Harris said. “Health care is growing ever more complicated and difficult to negotiate.

“Most practitioners who make home visits believe that they take can control costs by taking care of patients in a less fragmented, more comprehensive fashion,” she explained. “If medical professionals can prevent just one hospital admission, which costs an average of $9,000, there are great potentials for cost savings.”

Home visit services include the treatment and management of common medical conditions such as diabetes, hypertension, wound care, physical therapy and fall prevention.

The Home Visit Program staff also helps manage medications, coordinates with home health agencies and makes referrals to specialists for additional care.

For patients like Marvin Miyashiro, home visits from doctors have been a lifeline. Stricken 18 months ago with a viral infection that left him with significant neurologic impairment, the 61-year-old Miyashiro is cared for around-the-clock by his daughters Lydia, Paula and Irene.

“The regular care Dr. Harris provides has just been wonderful,” Irene said. “She can monitor his progress and point out changes and developments that we don’t notice because we’re with him every day.”

Miyashiro, who recently was recognized for 40 years of work with the U.S. Customs and Border Protection Service, has limited mobility, but, according to Harris, has made considerable progress and is now awaiting word on acceptance into a temporary residential rehabilitation program.

To participate in the program, patients must pay cash or have medical insurance, such as Medicare, a combination of Medicare and Medi-Cal or Medicare and a PPO. HMOs typically have their own home visit programs.

“I feel strongly that I provide better care to these patients in their homes than I ever could by seeing them in the clinic,” Harris said. “I can see how they live, who is helping them, what obstacles — stairs, fall hazards, no bathroom on the first floor — prevent them from maintaining better health, etc. I also believe that I have prevented many hospitalizations and worsening of health status by following patients closely and catching and treating deteriorating health status before patients become so sick that they needed hospitalization.”

The program provides a 24-hour patient access telephone line that can direct calls to a USC physician who is on call.

“We have used the help line for when we have issues or questions come up late at night, after midnight,” Irene said. “It is very reassuring to have a doctor answer our questions and let us know what to do. It has prevented us from unnecessary emergency room visits.”

While the Home Visit Program currently treats about 100 homebound seniors, Harris aspires to see the program grow to meet the needs of an aging population. “I hope that, with Dr. Chen and myself, we can pool our resources, formalize and eventually expand the program,” she said.

Irene Miyashiro also hopes the program will grow to serve more patients.

“I wish there were more of these types of programs available for people,” she said. “As a family, we feel more relaxed, knowing that the doctor can come to see my dad in his home. They can really take their time and get to know their patients.”

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