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MIT Medical proposes community care model

March 3, 2010

MIT Medical is proposing the establishment of a new Community Care Center that would lead to significant improvements in patient care by better utilizing our health care resources.

This proposal would involve a transition from MIT Medical’s current model of providing on-site overnight urgent and inpatient care to a major expansion and enhancement of our care management program, with a focus on coordinating on-campus and community resources to ensure that patients receive the care they need from hospital or doctor’s office to dorm or home.

MIT Medical's leadership has met and will continue to meet with numerous faculty and student groups around MIT to explain the proposal and get feedback. If you’d like to suggest that the leadership meet with a certain group, please use this form. MIT Medical also welcomes your comments and opinions (anonymous if desired) via that same form.

MIT Medical’s new Community Care Center, to be located in the current Inpatient Unit, would be staffed by nurse care managers, who would coordinate care and hospital discharge planning for students, Health Plan members, and retirees. This may involve helping to arrange for agencies to provide home care services, transportation to medical appointments, outpatient rehabilitation services, necessary medical equipment and supplies, or hospice care.

The nurse care managers would follow up with students who have been seen for sick visits at MIT Medical, and they may make assessment visits to sick students in dorms or fraternities, sororities, and independent living groups (FSILGs) if necessary. They would work closely with housemasters, residential advisors, Housing, Dining Services, and other campus resources to make sure that sick students in dorms and FSILGs are getting appropriate monitoring and care.

The nurse care managers would also continue to provide current on-site transient care services, such as infusions, observation, and post-procedure and wound care, and would be available to provide patient education and to coordinate large-scale community health activities, such as influenza vaccination clinics.

As the community care model is put into place, MIT Medical will be making plans to discontinue overnight care in its Inpatient Unit and will be closing the Urgent Care Service at 11 p.m. each night and reopening at 7 a.m. the following morning. But clinical care would still be available to the community 24 hours a day, seven days a week, stresses Medical Director William Kettyle, M.D.

“A telephone triage system will be in place. MIT Medical clinicians in internal medicine, OB/Gyn, pediatrics, and mental health will be on call and available,” Kettyle emphasizes. “And arrangements will be made to provide overnight care at local care facilities when needed.

“This proposal has been informed by a year-long assessment of how we deliver services in light of community needs and resources, as well as several real-life experiences,” Kettyle continues. He cites medical and technological advances that have made hospital stays shorter and less frequent and have created a continuum of care extending to the home for many patients who previously would have needed to be hospitalized.

“It’s probably no coincidence that overnight use of our inpatient unit has also declined—by more than 60 percent since 2005,” he says. “During the same period, the number of transient visits to the unit for supportive care, such as infusions, has more than doubled.” (See "Data support MIT Medical's proposed community care model.")

Since 2007, MIT Medical has closed the Inpatient Unit for several weeks each year during the winter holidays. In addition, during the summer of 2009, the unit was closed for overnight care while remaining open for transient care during the day, and Urgent Care was closed from 11 p.m. through 7 a.m.

“These closings do not appear to have had a large impact on the community,” Kettyle reports. “We saw no measureable increase in emergency room visits or hospital admissions.” Kettyle notes that fewer than 3 percent of Urgent Care visits occur during the 11 p.m.-to-7 a.m. time period, and few visits involve medically significant care needs. “And when our Inpatient Unit has been closed, local facilities or prearranged home care services have provided patients with the care they needed.”

Events like the H1N1 influenza pandemic have provided additional opportunities to try out the community care model, Kettyle says. “Our experience with H1N1 gave us the chance to test our ability to coordinate, communicate about, implement, and deploy resources within—and, most importantly, outside of—E23,” he notes. “We were able to mobilize our clinical services to meet the care needs of sick individuals, and we were able to coordinate with other campus services, including dining, facilities, and the Division of Student Life, to support and care for sick students within their living spaces.”

Kettyle acknowledges the attachment many members of the community feel toward MIT Medical’s Inpatient Unit, feelings that were highlighted in the 2005 final report of the Task Force on Medical Care for the MIT Community (see “Didn’t a 2005 task-force report recommend that the Inpatient Unit not be closed?” in Frequently Asked Questions About MIT Medical’s Community Care Center). But Kettyle emphasizes that the proposed changes in the care-delivery model would not compromise the quality of patient care.

“We’ll be keeping the Inpatient Unit open while the Community Care Center is being put in place; the two services would run in parallel for some period of time to ensure that the new approach is providing outstanding care and meeting the needs of the community,” Kettyle says. “What makes MIT Medical such a special place has to do with the personalized care we provide and the freedom we give our clinicians to practice good medicine and offer the best possible care to each patient. With this innovation, we can continue to provide convenient, on-site care of the highest caliber.”

*This news story has not been updated since the date shown. Information contained in this story may be outdated. For current information about MIT Medical’s services, please see relevant areas of the MIT Medical website.