COVID-19 brought back old-fashioned house calls

UCLA Health’s 4-year-old home care program was up to the challenge.

The COVID-19 pandemic has changed society in myriad ways, but it’s unlikely anyone foresaw it would bring back the old-fashioned doctor’s house call.

UCLA Health was ready, nonetheless.

Four years ago, the health system created the Extensivist Program, a back-to-the-future home care approach that has been a particular success during the pandemic, benefiting patients at high risk for COVID-19.

Sun Yoo, MD, MPH, medical director of the Extensivist Program, said the program already was expanding to provide better care for patients at high risk prior to the pandemic. It was especially useful for those who are elderly and homebound, or weakened from their medical conditions, and those who have compromised immune systems.

So, the Extensivist Program was literally a lifesaver for some patients when the pandemic hit the region in full force.

“We have a team here that does those home visits for patients who have trouble leaving the house,” Dr. Yoo said. “Many of these patients are elderly and frail. We already needed this kind of home care program, but it really did help those patients survive through COVID.”

The program so far has focused mostly on patients in Westwood and Santa Monica, with recent expansion into the Northwest Valley. But the home care team expanded services to other areas, including South Los Angeles and East Los Angeles, during the pandemic.

“We have a lot of patients in those areas who are traveling pretty far distances to see us,” Yoo said. “We’ve just started our expansion. Westlake opened on July 1 – our first Extensivist program in the Northwest Valley so far, led by Dr. Dana Howard. We are hoping that we continue to expand region by region each year.”

Sun Yoo
Dr. Sun Yoo is medical director of the UCLA Health Extensivist Program.

When COVID-19 vaccinations became available, it was a natural progression for Dr. Yoo’s team to visit at-risk patients in their homes to administer them.

“Of course, that became a priority,” she said. “We were very fortunate that we had the infrastructure established for getting to these high-risk patients and treating them in their homes. We have a very good team of experienced people who know how to think outside of the box and figure out how best to treat each individual patient.”

The team-based infrastructure, which consists of 11 Extensivist faculty members and two fellows with a willingness “to just roll up their sleeves,” has proven invaluable in recent months, Dr. Yoo said. Among the team leaders are geriatrics extensivist Valerie Wong, MD, and Virginia Galan-Burns, NP, who are leading the COVID-19 home vaccine program.

UCLA Health also has partnered with home health companies such as AccentCare and Accredited on home COVID-19 vaccines.

Patients can be referred to the Extensivist Program by their UCLA primary care or specialty doctors. Dr. Yoo said the team considers factors such as the type of medical condition a patient has and the number of times a patient has been in the hospital. The UCLA Population Health Team also developed an algorithm to identify the highest-risk patients in the UCLA Health system, which further assists with identifying patients for the Extensivist Program.

On a typical home visit, the UCLA practitioner will monitor a patient’s chronic conditions, ask about any new symptoms, and check on how the patient is taking any medications and how the medications are working. If necessary, the team can provide IV treatments just as if the patient were in the hospital.

So far, more than 600 patients are benefiting from the program, and that number is growing, said Dr. Yoo.

“In addition to the doctors, our team includes nurses and care coordinators, our pharmacists and social workers just to really provide that whole-person care,” she said. “And we tailor our care based on the patient’s needs.”

Learn more about the UCLA Health Extensivist Program.

Tina Daunt is the author of this article.