美国国家公共电台 NPR Can Home Health Visits Help Keep People Out Of The ER?（在线收听）

RACHEL MARTIN, HOST:

When people with simple, non-urgent medical problems go to the emergency room for treatment, it creates all kinds of problems - ERs get overcrowded, treatment is expensive, it's often inefficient. This is a big issue here in Washington, D.C., which has the highest per capita 911 call volume in the country. The District government, insurers and health providers are all trying to figure out how to bring ER visits down. One proposal is to go to Medicaid patients' homes and use telemedicine for primary care. Selena Simmons-Duffin from member station WAMU explains.

SELENA SIMMONS-DUFFIN, BYLINE: When Dennis Lebron Dolman went to a health screening fair over the summer, he found out he had crazy high blood pressure - 180 over 100 - stroke-level high. He's 41 years old and hated doctor's offices, didn't want to go. Three months later...

GRACE KELLY: So what I want you to do is listen to this while I take your blood pressure...

DENNIS LEBRON DOLMAN: OK.

KELLY: ...Because I do not want it to be high.

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UNIDENTIFIED WOMAN: As you breathe in, be aware of breathing in.

SIMMONS-DUFFIN: Dolman's on a cushy brown couch getting his blood pressure taken by medical assistant Grace Kelly. She's part of a new telemedicine program at Mary's Center, a community health center in D.C. They've had several of these appointments. Today, the blood pressure reading is OK.

KELLY: It's a lot better than before, but it's still high. You might have to actually take something. Hi.

GITA AGARWAL: Hi.

SIMMONS-DUFFIN: That's Dr. Gita Agarwal video calling in from across town.

AGARWAL: Hi. How are you, sir?

DOLMAN: I'm fine, and yourself? How are you today?

SIMMONS-DUFFIN: Dr. Agarwal checks out Dolman's vitals that Kelly has entered into her system - temperature, blood pressure and weight.

AGARWAL: Great. Let's see how your weight is. Oh, what happened with the weight?

DOLMAN: I haven't made it to the gym yet. That's the problem.

SIMMONS-DUFFIN: He weighs 210 pounds, which isn't too bad for his height, but he lost weight with diet and exercise to get his blood pressure down. And now it's crept back up.

AGARWAL: What should we do? What do you think? Do you want to see a nutritionist?

DOLMAN: I mean, that would be - that would be fine.

AGARWAL: And how about an exercise program?

DOLMAN: Yes.

SIMMONS-DUFFIN: This exchange, connecting patients with different health care providers and services that can help them, is the real promise of telemedicine in D.C. according to Erin Holve. She's the director of health care reform and innovation at the D.C. Department of Health Care Finance.

ERIN HOLVE: It's still early days for telemedicine, but there are lots of reasons to believe that establishing the kind of relationship between a patient and provider and having that continuity of care will ultimately reduce some of the non-emergent visits to the ER and result in better outcomes for the long run.

SIMMONS-DUFFIN: The patients being targeted by this program otherwise wouldn't go to a regular doctor visit, meaning they'd miss out on preventive care. Some patients like Dennis Lebron Dolman just really don't want to go to the doctors. Others can't get there because of mobility or child care issues or because they can't get time off work. In the immediate sense, this program might have prevented an ER visit. If Dolman's blood pressure had gone unchecked, he could have had a stroke. But it's also connected him to a provider he can go to in the future for any issue with his health that might come up.

AGARWAL: Do you want a flu shot?

DOLMAN: I usually do fine without a flu shot.

AGARWAL: But how do you know you'll be fine this year?

SIMMONS-DUFFIN: Dr. Gita Agarwal talks Dolman into it. Medical assistant Kelly has a flu shot with her, and he gets it on the spot there in his mom's living room.

DOLMAN: Dr. Gita's good. I like her.

SIMMONS-DUFFIN: Dolman walks Kelly out at the end of the visit. He's now linked with a provider he trusts who comes to him.

DOLMAN: Because it's convenient and like just good company and all of the above.

SIMMONS-DUFFIN: He likes feeling like someone is keeping track of him so he doesn't slack off, someone who'll check to see if he's gone to the gym, improved his eating habits and ultimately gotten that blood pressure down. For NPR News, I'm Selena Simmons-Duffin in Washington.

(SOUNDBITE OF MARCUS D'S "ALL AROUND THE WORLD")