Bringing Rheumatology Care Directly to Homebound Veterans in Connecticut

Yale faculty are now delivering at-home rheumatology care to homebound veterans throughout most of Connecticut through the VA Connecticut Home-Based Primary Care (HBPC) program.

“This remarkable program, which represents a unique partnership between the HBPC Program and the Section of Rheumatology at the VA Connecticut Healthcare System, allows us to see veterans right in their own homes, so they don’t have to worry about figuring out where the office is, arranging transportation, or fussing with technology,” says David Podell, MD, PhD, clinical professor of medicine (rheumatology) and former chief of medicine at Waterbury Hospital.

The Section of Rheumatology at VA Connecticut provides care to approximately 2500 veterans each year across two medical campuses. Access to rheumatology care for homebound veterans is extremely difficult, which may lead to interruptions in treatment and disease flares, and exacerbate the veteran’s health and quality of life. The HBPC Rheumatology program bridges this important gap.

Through the HBPC program, Podell provides personalized care for people with rheumatological conditions such as osteoarthritis, shoulder arthritis, tendonitis, and bursitis, among others, in coordination with multidisciplinary colleagues. Podell and his colleagues administer steroid injections, take blood work, monitor patients' medicines, and assess their rheumatologic conditions.

“When I see a patient in their own home, it changes the dynamic of the typical patient-physician relationship. I’m now a guest in their home,” says Podell. “As a result, patients often feel more at ease and empowered to ask pertinent health questions, share stories about their family, and tell us about their experiences. It also allows us to see their living situation firsthand and assess if they need additional supportive services. The patients are more easily engaged in their health care journey and outcome.”

Although the program launched just a few months ago, demand is already high. “We are the only VA HBPC program in New England to offer rheumatology services, and that’s because Dr. Podell was highly motivated and driven to provide the best care for our veterans,” says Maura Singh, MD, assistant professor of medicine (geriatrics) and medical director of the West Haven VA Homebound Primary Care Program. “Dr. Podell immediately recognized the needs of our older patients and the improved care that home visits can provide. It has already significantly improved the quality of life for many veterans who struggle to attend office visits for injections and other rheumatology care.”

VA Connecticut has offered a home-based primary care program to homebound veterans with complex needs for several decades, but the program has grown and evolved over recent years. Currently, approximately 325 veterans are enrolled in the primary care program, which is geared towards patients who find it challenging to participate in office-based care for a variety of reasons. Many of the veterans enrolled in the program are medically complex or at high risk for nursing home placement or repeat hospitalizations. “We want to make sure they don’t fall through the cracks,” says Singh.

Patients in the program are assigned to a dedicated multidisciplinary team, which includes physicians, advanced care providers, pharmacists, nurses, social workers, and others to deliver comprehensive primary care. Fellows and residents from Yale rotate through the home-based care program to give them exposure to this unique model of patient care.

“The program has incredibly high patient and family satisfaction,” says Singh. “Patients love the time we can spend with them and the personal care we can provide. Staff satisfaction is also high, because we get to know our patients as people and see them in the context of their home and their family.”

Podell, who has spent more than four decades practicing medicine, says that providing rheumatology care to veterans in their homes has brought him immense career satisfaction.

“In my forty years of practicing medicine, I’ve had the privilege of caring for countless wonderful patients. Yet never before have I felt such a profound sense that my work is truly making a difference in their lives,” says Podell. “It’s truly a labor of love and at the core of our medical mission at the VA and at Yale.”

Rheumatology, Allergy and Immunology, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to providing care for patients with rheumatic, allergic, and immunologic disorders; educating future generations of thought leaders in the field; and researching fundamental questions of autoimmunity and immunology. To learn more, visit Rheumatology, Allergy, and Immunology.