Family adoption through community PaJR patient driven telemedicine and homehealthcare ProJR

This project plan outlines a shift in clinical delivery, moving from traditional hospital-centric models to a Patient Journey Record (PaJR) and Project Journey Record (ProJR) framework. It emphasizes domiciliary (home-based) care for complex, non-ambulatory cases.

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IMRaD Analysis: Family Adoption & Domiciliary PaJR

Introduction (The "Narketpally Syndrome")

Narketpally Syndrome is an emerging, patient-centered, and context-driven medical education framework, rather than a clinical disease. It emphasizes a team-based, holistic approach to patient care, utilizing tools like PaJR (Patient Journey Record) to integrate real-life patient narratives with clinical research. [1, 2, 3]

Key highlights of this approach include:

• Origin: Rooted in collaborative, patient-centered, and evidence-based studies at Narketpally, India.
• Philosophy: It adopts a "together we flow" mentality, transforming medical research into a collective response to individual patient needs, rather than just population-based data.
• Patient-Centered Approach: Encourages active patient participation in their own care journey, focusing on lived experiences, symptoms, and outcomes.
• Methodology: Uses Web 2.0 tools for case-based, blended learning (CBBLE). [1, 2, 3, 4]

It aims to improve high-impact, low-resource research, particularly in clinical trial settings. [1]

 This project addresses the gap between community medicine surveys and tertiary specialist intervention. It utilizes the Family Adoption Programme as a vehicle to transition from "Mediocristan" (standardized, one-size-fits-all hospital care) to "Extremistan" (personalized, high-complexity home care).

Methods (Patient & Project Journey Records)

The methodology employs a dual-track recording system:

• PaJR (Patient Journey Record): Initiated via a community survey and a preliminary video consultation between the patient’s bedside and the Professor of Medicine.

• ProJR (Project Journey Record): The administrative "paper trail" or digital workflow required to mobilize resources. This includes formal correspondence between the HOD of Community Medicine, the Principal, and the Medical Superintendent to secure specialist consent and logistical support (transportation).

Results (Operational Milestones)

• Feasibility Confirmation: Dr. — (Medicine) consented to a home visit, bypassing the need for a resident Rheumatologist by bringing specialist evaluation to the patient.

• Logistical Integration: The transition of the workflow from identification (April 7) to scheduled execution (April 9, 10:15 AM) demonstrates a rapid-response administrative protocol.

• Digital Transition: The successful mobilization of a "car" and specialist signifies the physical manifestation of a "telemedicine-to-homecare" bridge.

Discussion (Thematic Synthesis)

The project illustrates a "User-Driven Healthcare" model. By documenting the administrative hurdles (the need for two formal letters and multiple signatures for a single 2-hour visit), the project highlights the "friction" in current medical systems. The goal is to move toward Holographic Presence—where the specialist’s expertise is delivered at the patient’s home, reducing the physical and emotional burden on the severely deformed or non-ambulatory patient.

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Keywords

• PaJR/ProJR: Integrated patient and project tracking.

• Domiciliary Care: Hospital-grade assessment in a home setting.

• Family Adoption Programme: Community-based medical education and service.

• Narketpally Protocol: Specialized outreach for non-ambulatory chronic illness.

• Operational Feasibility: Testing the limits of traditional hospital bureaucracy.

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Thematic Analysis

Theme	Description
Systemic Friction	The heavy administrative requirement (formal letters for transport and permissions) for a standard clinical evaluation.
Specialist Outreach	Solving the "Rheumatologist Gap" by sending a Professor of General Medicine for on-site evaluation.
Humanizing Medicine	The "wish to meet the patient at home" signifies a shift from viewing a case as a "deformity" to viewing the patient in their lived environment.
Telemedicine Bridge	Video consultation acts as the "triage" that justifies the physical resource allocation (the home visit).

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Last Year’s Context: Narketpally Syndrome & PaJR

Recent publications and discussions regarding Narketpally have focused on the longitudinal clinical data analysis of patients who fall through the cracks of the traditional OPD. By using PaJR, the team has been able to create a "Rhapsody" of clinical care—mapping the patient's journey not as a single point of contact, but as a continuous rhythm of interventions. This specific project plan serves as a practical application of "Extremistan" medicine: dealing with the outlier case (the bed-ridden girl) through radical, non-standard logistical maneuvers.

Background events (recent):

An initial community survey in a particular Village by the department of community medicine revealed a bed ridden young girl with multiple joint deformities and a video consultation was done with Prof Medicine in Narketpally OPD and the patient's bedside at home following which the Prof medicine expressed a wish to meet the patient at home.

Initial correspondence for permission:

From

Professor & HOD

Narketpally

Date: 07/04/2026

To

The Principal

Narketpally

Dear Sir,

*Subject: Request for Permission – Domiciliary Care Assessment (Rheumatoid Arthritis Case) Regarding*

I humbly submit that, as part of the Family Adoption Programme, our department has come across a case of Rheumatoid Arthritis with severe deformities, rendering the patient non-ambulatory.

With a view to exploring the operational and feasibility aspects of providing domiciliary care/treatment, it is proposed to assess the patient at home. Since a Rheumatologist is not available at , I have requested Dr.  to undertake a home visit for clinical evaluation. He has kindly consented to do so, subject to necessary permission from the hospital authorities.

In this regard, I request your good office to kindly initiate and accord necessary permission from the Medical Superintendent, , and the Professor & HOD of General Medicine, to facilitate the proposed home visit and assessment.

I shall be grateful for your kind consideration and necessary approval.

Thanking you.

Yours faithfully,

Prof HOD Community Medicine 

*Copy for information to:*

- The Director,  Narketpally

- The Medical Superintendent, Narketpally

- The Professor & HOD of General Medicine, Narketpally

- Dr. , Professor of General Medicine, Narketpally

*Handwritten notes on the document:*

- “ok we can help.. we are responsible to fix up date / time with Dr. ” (signed illegible).

- “Dear Dr. Ji, Please fix up date & Time, so that we will make relevant arrangements. Y/t” (signed Dr. 

 7/4/26).

Second letter for transportation:

*From*

Professor & HOD of Community Medicine

Kamineni Institute of Medical Sciences

Narketpally

*To*

The Director

Narketpally

*Respected Sir,*

*Sub:* Request for transport arrangement (Car) for domiciliary visit – Reg.

I humbly submit that, as part of the Family Adoption Programme, a case of Rheumatoid Arthritis with severe deformities requiring domiciliary assessment has been identified. Necessary permission has been accorded by the hospital authorities, and Dr. Professor of General Medicine, has kindly consented to undertake the home visit.

In this regard, I request your good office to kindly arrange a vehicle (car) for transportation of Dr. from Narketpally to ... village and back. The proposed visit may be scheduled between *10:15 AM* and *12:15 PM* *on 9-04-2026*.

I shall be grateful for your kind consideration and necessary arrangements.

Thanking you, Sir.

Yours sincerely,

Professor & HOD

Department of Community Medicine

*Copy to:*

- The Transport Manager, Narketpally

- Dr. Professor of General Medicine,, Narketpally – for information

*Handwritten note at the bottom of the page:*

"Dear Sir,

please fix up date & Time, so that we will make relevant arrangement

y/t