Marc Matthews, M.D., had a patient who couldn't shake a nasty infection and kept turning up at the hospital. Matthews and his colleagues couldn't put a finger on why the treatments weren't working.
It wasn't until Matthews visited the patient in his home that he finally started "getting a grip" on the problem. The house was cluttered, healthy foods were scarce and transportation was an issue.
"It was eye-opening just to free me up from the constraints of the clinic and go into his house, sit in his space and spend time with him to see how his environment could potentially be impacting his health," says Matthews, who is medical director of Mayo Family Clinic Kasson (Minn.), part of the Mayo Clinic.
Mayo has been searching for ways to transform care in Kasson, which is about 15 miles outside of Rochester. Clinicians found that patients live busy lives, transportation is challenging and visiting the clinic can be an inconvenience, Matthews says. So clinicians set about looking for a way to get the doctor to the patient.
What they came up with was an "exam room in a backpack," complete with all the tools needed for a regular visit — a stethoscope, a blood pressure reader, even an iPad to access electronic health records. Rose Anderson, a designer for Mayo, admits that they weren't trying to reinvent the wheel, and the kit is really just a throwback to the older days of medicine.
"The family doc, way back in the day, was in his horse and buggy with his doctor bag, going to different farms. That's how care was delivered," Anderson says. "And so I think it is a little bit of a retro concept in terms of rethinking how we deliver care in what venue."
The experiment is just a year old, so it is too early to have concrete results, but anecdotally, Matthews says, it seems to be working. Before the home visits, the patient with the nagging infection visited the hospital four times in six months; he's been back only once since.
Nurse practitioners also have taken the bags for a spin, visiting seniors for follow-up appointments as part of a care transition program. On visits, Rita Wermers found that medication management and a lack of medical literacy needed to be addressed. Her team is looking to redesign their own bags in a more organized and color-coded fashion to match the backpack exam room.
Anderson says it's all part of a larger effort at Mayo to focus on team-based care, the patient's needs and making treatment as convenient and flexible as possible. "It's less about that kind of conveyer-belt care where they feel as though they're going from waiting room to exam room, and so on," she says. "The team has looked at what I'm coming in for, they've figured out who is the best to meet my needs today, and they've flexed to meet those needs."