History/ Description of FM-HN Inpatient Service

  • In 1997, the Department of Family Medicine (DFM) at Boston Medical Center was established with the dual mission of providing comprehensive primary care and inpatient continuity of care and building academic infrastructure for Family Medicine at Boston University School of Medicine (BUSM) as well as post-graduate training program for Family Medicine residents.
    • The Boston HealthNet, Boston University School of Medicine (BUSM), Boston Medical Center Corporation (BMC) , and  11 partner community health centers (CHCs) work closely with the DFM.
      • These CHCs are affiliated with BMC and form a strong community-academic network for BUSM
        •  approximately 35% of BUSM students receive ambulatory training at these sites
        • All of DFM residents and 40 DFM faculty members have their practices at these CHCs.
        • They are the principal training sites for BUSM medical students and residents in family medicine.
  • One of the department’s goals was to strengthen the relationship between BMC and the community it serves by providing a model for partnership between the hospital-based inpatient service and the community health centers
    • DFM faculty from participating community health centers staff the inpatient service, giving them an opportunity to maintain inpatient skills and become familiar with consult services while giving medical students with an interest in family medicine role models who provide comprehensive care to their patients.
  • By 2003, the first class of family medicine 3rd year residents were able to run an inpatient team under the supervision of a family medicine attending, paving the way for a 24-7 family medicine inpatient team by 2007.
  • Between 2006-2008, under the leadership for Dr. Brian Jack, the DFM led clinical trial, Project RED: The Re-engineered Discharge, to test the clinical effectiveness of an 11-point systematic approach to hospital discharge 0n reducing 30-day readmissions.
    • The trial demonstrated that a systematic approach to hospital discharge could reduce avoidable readmissions by 30% and has now been adopted by the National Quality Forum (NQF) as a best practice for hospital discharge.
  • In 2009, a locally-operated, consumer-governed health plan, Commonwealth Care Alliance (CCA) contracted with the Boston HealthNet and the DFM to provide inpatient coverage for its medically complex patients admitted to BMC.
  • Since 2011, the Family Medicine HealthNet Inpatient Service has been housed on an entire unit of BMC, containing 27 beds with overflow onto adjacent floor if needed.
    • This physical and temporal continuity creates an opportunity to provide a more supportive interpersonal and professional environment, allows for more rapid and frequent exchange of information between providers, and an opportunity to greatly improve for the interdisciplinary learning environment.
  • In 2018, the structure of the inpatient service changed from three teams to two teaching teams.
  • In 2019, the inpatient service re-located to Menino 7E due to BMC’s campus consolidation and added a third team.