- HMS Community Values
- Introduction to Clinical Research Training
- Letter from the Chairman
- Medical Education
- Application Form and Instructions
- United Kingdom Clinical Scholars Research Training
- Award Listing
- Vanderbilt Hall
- Award Summaries
- Financial Aid
- Spring Preview
- Frequently Asked Questions
- Office of the Registrar
- Award Recipients
- Campus Planning and Facilities
- Ombuds Office
- Research Administration Contacts
- Committee on Microbiological Safety
- Contact Us
- Human Resources
- The Academy
- Office for Academic and Clinical Affairs
- Joint Committee on the Status of Women
- Global Health Research Core
- Administration Who's Who
- Cafeteria Menus
- Community Announcements
- HR Stories
- Faces of HMS
- Safety Tips
- Longwood Shuttles & MBTA
- Spotlight Stories
- Inaugural Pride on the Quad Day
- Spring Cleaning: Earth Week 2015
- Celebrating the Past, Preparing for the Future
- Spotlight on External Education
- A Work in Progress
- HMS to Oversee Undiagnosed Diseases Network
- New Recycling and Reuse Resource
- Growing Green: Sustainability Committee Covers Harvard Longwood Campus
- Study by HMS student evaluates FDA approval of cardiac devices
- Play Me, I'm Yours!
- Exploring the Nervous System
- HMS Brings Comfort and Convenience to New Mothers
- RIA Program
- Spotlight on Angela DePace
- Spotlight on Admissions
- Spotlight on Rick Born
- Spotlight on the New Year
- Combating a Crisis
- Strengthening Collaborations
- Contact Us
- Global Clinical Scholars Research Training Program
- HMA Standing Committee on Animals
- Office of Research Compliance
- Harvard Medical School Event Calendar
- Office of Diversity RIA Program
- The Dean's Perspective
- Department of Pathology
- Harvard Mahoney Neuroscience Institute
- OHRA Home
- Office of Research Subject Protection
- Alumni Association
- Cancer Biology & Therapeutics Program
- Celiac Program
- Department of Medicine
- HMS Information Technology
- HMS TransMed Program
- Introduction to the Practice of American Medicine
- Office of Communications & External Relations
- Big Data In Healthcare
- Institutional Planning and Policy
- Master of Medical Sciences In Clinical Investigation
- Office of Global Education
- Portugal Clinical Scholars Research Training Program
- Safety Quality Informatics and Leadership
- South American Clinical Research Training Program | SACRT
- Southeast Asia Leadership Program
- Shenzhen-HMS Initiative in International Education
- Contact @HMS
- Office of Global Education
- Human Resources
- Jobs @ HMS
- Dental Medicine
- Harvard University
- Contact us
All in the Family
The Boston Family Van is an urban mobile health clinic that travels to some of the city’s poorest and most medically underserved communities—Dorchester, Roxbury, East Boston, Hyde Park and Mattapan—caring for patients with the highest rates of preventable illness, hospitalizations and avoidable emergency department visits.
Now, a new study shows the Family Van model is leading to improved patient health while at the same time leading to reduced costs for emergency care.
In a study published in the January 2013 issue of Health Affairs, patients who arrived with high blood pressure on an initial visit to Harvard Medical School’s Family Van showed significant reductions in blood pressure and risk of heart attack and stroke during follow-up visits, the HMS researchers said.
In addition to reducing risk for heart disease and stroke the Family Van model also saves costs by lowering emergency department usage.
The Van, staffed by community health workers, and sometimes by doctors and nurses, makes regular visits to the neighborhoods it serves.
“We can meet people where they’re at,” Jennifer Bennet, executive director of the Family Van and one of the study’s authors, said. “We’re not bringing the hospital to the community. We’re a part of the community.”
The researchers used a longitudinal sample of 5,900 patients who made a total of 10,509 visits from January 2010 to June 2012.
To assess the average change in blood pressure between patients’ initial and follow-up visits, investigators used a linear regression model, controlling for potential confounders. They found that patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg in systolic blood pressure and 6.2 mmHg in diastolic blood pressure during their follow-up visits. Through modeling, the researchers determined that these changes would be associated with a 32 percent reduction in relative risk of myocardial infarction and a 45 percent reduction in relative risk of stroke.
Using modeling techniques, they also ruled out the influence of other interventions that were part of patient care.
“The more you engage with the mobile clinic, the better your outcome,” said study co-author Caterina Hill, the organization’s research program director.
In order to present a welcoming environment to at-risk groups who might hesitate to share personal information, many mobile clinics do not collect personal data on patients, so it has been challenging to conduct studies that measure the impact of these services on individual patients. Like many other innovations in this patient-driven operation, researchers said, the idea to collect data to analyze effectiveness came from the patients.
“They wanted us to know how they were doing,” said Nancy Oriol, HMS Dean for Students and associate professor of anaesthesia, who founded the Van program in 1992.
A previous study using standardized measures of the statistical benefits of the program’s interventions showed a strong return on investment, but this was the first study to track the effectiveness of a particular intervention for specific individuals, measuring real improvements in the lives of Family Van patients.
“These results are new, but not a surprise,” Oriol said. “We know that people are healthier if you can meet them where they live and work each day.”
Treating their patients as whole people, not as a collection of symptoms, is critical to the success of their work, the researchers said.
“No health care problem exists in a vacuum. For any person, the effectiveness of a particular treatment might depend as much on their social, cultural or economic conditions as on their medical diagnosis,” Oriol said.
This integrated approach to dealing with health is a key facet of many health reform initiatives—including experiments with accountable care and medical home models in federal health reform plans, and experiments being developed by private providers and health insurance companies attempting to control the rising costs of health care.
“Innovations in health care delivery are needed to both lower the costs and improve the quality of care. Mobile clinics like the Family Van provide an example of a care delivery model that tries to think out of the box and engage vulnerable populations in a more active way, especially as it relates to preventive care. Our study offers just one small piece of evidence that suggests this kind of patient-inspired care can be clinically beneficial and potentially cost-effective,” said co-author Zirui Song, an HMS medical student.
Stay informed via email on the latest news, research, and
media from Harvard Medical School.