Student-run free health clinics, a hallmark of most medical schools across the country, not only provide valuable clinical experience for the students who volunteer there, but may actually reduce hospital utilization by the patients in their care, according to a Vanderbilt study recently published in the Journal of Health Care for the Poor and Underserved.
Although there are more than 200 student-run free clinics (SRFC) in the country, they have been relatively understudied. The Vanderbilt study is the first to look at potential impact of an SRFC on hospitalizations and emergency room visits, said first author, Pierce Trumbo, MD, a Vanderbilt University School of Medicine alumnus and internal medicine resident.
In a pre-post observational study, Trumbo and colleagues used multivariable modeling to test the hypothesis that patients of Shade Tree Clinic, the SRFC affiliated with Vanderbilt University Medical Center, would have decreased hospital utilization after joining the clinic.
The study reviewed the records of Shade Tree Clinic patients from 2007 through 2013 and looked at utilization of the health care system two years prior to being treated at Shade Tree and two years after. With this model, the patients served as their own control in a pre-post comparison.
“For a lot of medical students, Shade Tree was the most meaningful part of our medical school experience because, for some of us, it was our first introduction to patients, certainly our first introduction to underserved patients, and it was an opportunity to integrate the science we were learning in the classroom with patient care,” Trumbo said.
The study found that hospitalizations did decrease from 148 admissions in the pre-Shade Tree cohort to 119 in the post-Shade Tree cohort. Among patients referred from Vanderbilt to Shade Tree, these numbers were 76 and 52, respectively, a statistically significant decrease.
These results suggest that Shade Tree does not result in an additional burden on the health care system and may reduce hospital utilization.
“When we looked at data, it appeared we might be reducing low acuity hospitalizations. When someone comes into the emergency room and we make a decision to admit, we consider their follow-up care. We observed a reduction in admissions — perhaps because our patients now have a primary care home,” Trumbo said.
“Giving these patients a medical home does not increase hospitalization, and it may be a viable option to take care of patients who are very ill and need a lot of medical attention.
“A lot of us feel that taking care of people who are vulnerable is the right thing to do, and it’s rewarding to see that it’s beneficial to the entire system, which is quite strained. The study results are validating,” Trumbo said.
Contributing to the study were Kelly Schuering; Justiss Kallos, MD, MS; Nicolas Baddour; Shayan Rakhit; Li Wang, MS; Michael Fowler, MD; Eduard Vasilevskis, MD, MPH; and Robert Miller, MD.
The study was funded by the Vanderbilt Institute for Clinical and Translational Research.
“We very much appreciate VUMC’s longstanding support of Shade Tree, both in providing access to specialty care for our patients and in terms of educational opportunities that it offers students,” Trumbo said.
