Objectives

1)    To offer services that are useful to homeless and migrant patients.

2)    To lower barriers to care and make the clinic as accessible as possible.

3)    To cut costs and reduce the existing financial burden on the healthcare system.

The CURE Clinic is therefore centered around a workflow that enables us to pursue these objectives to the fullest extent. In our attempt to bridge the healthcare inequity that homeless citizens encounter, we have launched a hybrid in-person/virtual care program to improve access to otolaryngology care for the homeless community through Rush University Medical Center and local homeless advocate organizations on Chicago's South Side, including Franciscan Outreach, Deborah’s Place, ReVive, and Heartland Alliance Homeless Shelters. The framework of this program is as follows: 

Patients are seen at the otolaryngology outreach clinic for 2 hours every Tuesday evening following the regular workday. To allow for sufficient face-to-face interaction between the provider and the patient as well as to follow-up on treatment regimens, the first and third Tuesdays of the month operate as telemedicine clinics, while the second and fourth are held in-person. The day prior to these outreach visits, medical student volunteers visit the shelters to pre-screen for eligible patients (eligibility is determined only by a shelter resident who has an ENT complaint). These eligible patients are then scheduled in the electronic medical records system. On a telemedicine day, the students return to the shelter with an iPad containing HIPAA compliant software from the academic institution and begin a video visit with the attending physician. All notes pertaining to the visit are documented by the physician. Due to the limitations of performing physical exams, audiograms, and in-clinic procedures such as cerumen removal through telemedicine, patients that require further care are scheduled to follow up at the in-person clinic the following week. 

The in-person clinics operate through a clinical office space within the academic center. To remove the barrier of transportation, a rideshare, such as Uber or Lyft, is ordered to each shelter with eligible patients. Patients are brought to the academic center where they are greeted by volunteer medical students who escort them to the clinic space. While waiting for their appointment, they are provided with a meal, as the clinic overlaps with dinner hours. Depending on their specific needs, patients are seen by the attending physician and/or an audiologist. Furthermore, a stock of commonly prescribed and over-the-counter medications is maintained and provided to patients as needed. This aids in minimizing medication wait times, medication cost, and reduces noncompliance originating from lack of access to a pharmacy. Patients who require imaging and surgical intervention are scheduled for a follow-up date, and also receive this extension of care - free of cost. They are not billed for their visit or care, regardless of insurance status. Following their appointment, they are escorted back to the front of the building by the medical student volunteers who wait with them while their pre-paid return ride to the shelter is ordered.  

Ours is the first model system for providing free otolaryngology care to the homeless and migrant community via a multimodal clinical approach – integrating telemedicine and in-person visits. The CURE Clinic would not be able to function as it does without the contributions of the various collaborating shelters and their supervisors, the Chicago Department of Public Health (CDPH), primary care providers from Lawndale Christian Health Center, the Rush audiology team, Rush medical students, and the dedicated Rush specialist physicians who spearhead our work. And as of November 2023, we have expanded our services to include a mobile migrant health clinic that goes to a migrant camp on a monthly basis to offer the standard CURE services to those living in the camps. Our clinic is also currently in the process of expanding the services available, with the recent introduction of free orthopedic care for patients as well. As we continue to actualize our mission of improving access to compassionate and high-quality specialty medical care in the medically underserved community of Chicago’s west side, we strive to include even more specialties within our clinic framework. We also hope to expand our services by working in collaboration with even more shelters.