Well-Stocked 'Black Bag' is Key to Successful House Calls

Pressure to control health care costs and the miniaturization of technology can transform patients' homes into the equivalent of hospital medical-surgical units, skilled nursing centers, and long-term care or rehabilitation facilities. It's in those homes, say advocates of house calls, that much of tomorrow's primary health care will occur.

With the 1983 advent of basing hospital payments on diagnosis-related groups, hospital lengths of stay have fallen to 4.8 days, down from the average 7.3 days in 1980. That means patients are returning home earlier in their recuperation process.

"Medicare's hospital reimbursement system has led to patients being discharged home 'quicker and sicker,'" said FP Thomas Cornwell, M.D., founder and medical director of HomeCare Physicians in Wheaton, Ill. As a result, "quality primary medical care in the home for these aging and sicker homebound patients is an increasingly necessary component of our overall health care system."

That care is possible because of advances in medical technology. Patients return home from the hospital with infusion therapy supplies, respiratory equipment and heart monitors. Telemedicine equipment can monitor patients' vital signs, and caregivers can learn to change medical supplies and respond to equipment alerts.

At the same time, the medical technology required by physicians has advanced dramatically with the introduction of the microchip, said Cornwell. "Just as microchips have allowed computers to fit into the palm of a hand, so too have they miniaturized modern medical equipment so that it can be easily taken to the bedside."

For example, using a portable three-lead electrocardiograph, Cornwell can quickly assess a patient's cardiac health, download the results onto his wireless cellular telephone, synchronize the phone to his computer, and print and chart the results.

"Blood tests, pulse oximetry, EKGs, Holter monitoring, pulmonary function testing, X-rays, even echocardiograms and ultrasounds, can and are being done in the home," said Cornwell. Likewise, physicians now can provide several procedures -- from wound debridement to skin biopsies to disimpaction -- in the home.

All that's required is a well-stocked black bag, according to Cornwell. In addition to standard items such as a stethoscope, a thermometer, a reflex hammer, tongue depressors, bandage scissors and blood pressure cuffs, the black bag should contain

In addition, well-stocked house call physicians will pack their cars with technology and supplies, including