Incorporating the principles of the patient-centered medical home into a student-run free clinic

Figures & data

Table 1 Student and faculty positions at the Weill Cornell Community Clinic (New York, NY, USA)

Title	Qualifications	Description	Minimum commitment
Clinical Directors	Two third to fourth year medical students	• Monitor all patient care through close interactions with Senior Clinicians	1 year
		• H andle long-term patient follow-up
		• Meet weekly with Faculty Medical Director to discuss patient care
		• Conduct board meetings
Executive Directors	Two MD–PhD students in graduate school	• Work with Clinical Directors to set clinic protocols and policies	2–3 years
		• Manage budgeting and fundraising
		• Conduct board meetings
Faculty Medical Director	One faculty physician	• Meet regularly with Clinical Directors to discuss patient care	Open-ended
		• Provide guidance on patient issues that arise between clinic sessions
Board	20+ medical students – most are first or second year	• Roles include patient scheduling, social work coordination, insurance screening, quality assurance, data management, and information technology	1 year
		• Attend board meetings to review all patients seen at most recent clinic, address ongoing issues, and resolve clinic matters smoothly and efficiently
Senior Clinicians	Third or fourth year medical students	• Conduct history and physical with Junior Clinician	6 weeks
		• Work with Junior Clinician to present patient to attending physician, formulate an assessment and plan, and order all necessary tests
		• Follow-up with patients
		• Attend board meetings to ensure smooth patient hand-off
Junior Clinicians	First or second year medical students	• Conduct history and physical	1 night
		• Present findings and work with attending physician and session coordinators to formulate an assessment and plan
Attending Physician	Faculty volunteer board certified in internal medicine, psychiatry, or gynecology	• See all patients on clinic night with student medical team	1 night
		• Advise Senior Clinicians regarding patient management
		• Approve all clinical decisions on clinic night

Table 2 Incorporation of the principles of the patient-centered medical home into the Weill Cornell Community Clinic (New York, NY, USA) practice

Components of the PCMH	Implementation within the WCCC
A personal physician within a physician-directed medical practice	• Clinical Directors oversee patient care for a full year
	• Senior Clinicians act as primary care providers for 6 week blocks
	• The Continuity of Care Program matches medical students with patients
	• Board and directors meet weekly with Senior Clinicians to discuss all patients seen during the week and care is reviewed as a team
	• Policies and practices are discussed as a board
Whole-person orientation and integrated care	• All new patients receive psychosocial screening and evaluation for insurance eligibility; this is repeated annually
	• WCCC encourages regular appointments for health care maintenance by scheduling follow-up care at the end of an appointment
	• In-house women’s health and mental health nights occur every 3 weeks
	• Agreements with various specialists for low-cost referrals paid for by the WCCC
Quality and safety	• Adoption of EpicCare (Epic Systems Corporation, Verona, WI, USA) for EHR
	• Health care maintenance lists with screenings and vaccinations are created for each patient at the beginning of a clinic night to encourage appropriate preventative care
	• Measurement made of health care provider hand-washing compliance
	• Nightly checklist ensures all patient needs are met before leaving clinic
	• Clinical operations are updated annually to ensure continuity during annual board transition
Enhanced access	• Patients can contact the clinic via phone or email, with messages rapidly triaged by the clinical directors to ensure appropriate and timely follow-up

Abbreviations: EHR, electronic health records; PCMH, patient-centered medical home; WCCC, Weill Cornell Community Clinic.