The Patient-Centered Medical Home: Will It Stand the Test of Health Reform?

Department of Family and Community Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2009; 301(19):2038-40. DOI: 10.1001/jama.2009.691
Source: PubMed


The fundamental challenge for health care reform in the United States is to expand access to all US residents, while rapidly reengineering the delivery system to provide consistently high-quality care at lower overall cost. Current reform discussions recognize that success will require a shift in emphasis from fragmentation to coordination and from highly specialized care to primary care and prevention.One prominent model of delivery system reform is the patient-centered medical home (PCMH). Crafted by the primary care professional organizations in 2007, the model has been endorsed by a broad coalition of health care stakeholders, including all of the major national health plans, most of the Fortune 500 companies, consumer organizations and labor unions, the American Medical Association, and a total of 17 specialty societies.1 Currently, 22 multistakeholder demonstration pilot projects are under way in 14 states, and the Centers for Medicare & Medicaid Services will conduct Medicare demonstration pilot projects in 400 practices in 8 regional sites in 2009.2- 3 Twenty bills promoting the PCMH concept have been introduced in 10 states.4

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    • "Many of the system barriers could be improved through more effective use of collaborative, team-based approaches to primary care that are consistent with a Patient Centered Medical Home model [31]. The PCC team including RNs and HTs need to work together to address administrative issues such as opioid agreements, urine toxicology screens, and telephone communication, as well as caring for patients who unexpectedly "walk-in" to clinics with concerns about their pain treatments. "
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    ABSTRACT: Recent national estimates from the U.S. reveal that as many as one-third of all Americans experience chronic pain resulting in high prevalence rates of visits to primary care clinics (PCC). Indeed, chronic pain appears to be an emerging global health problem. Research has largely ignored the perspective of PCC staff other than physicians in providing care for patients with chronic pain. We wanted to gain insights from the experiences of Registered Nurses (RNs) and Health Technicians (HTs) who care for this patient population. Krippendorff's method for content analysis was used to analyze comments written in an open-ended survey from fifty-seven primary care clinic staff (RNs-N=27 and HTs-N=30) respondents. This represented an overall response rate of 75%. Five themes emerged related to the experience of RNs and HTs caring for patients with chronic pain: 1) Primacy of Medications and Accompanying Clinical Quandaries; 2) System Barriers; 3) Dealing with Failure; 4) Primacy of Patient Centered Care; and 5) Importance of Team Based Care. This study demonstrates that nursing staff provide patient-centered care, recognize the importance of their role within an interdisciplinary team and can offer valuable insight about the care of patients with chronic pain. This study provides insight into strategies that can mitigate barriers to chronic pain management while sustaining those aspects that RNs and HTs view as essential for improving patient care for this vulnerable population in PCCs.
    Full-text · Article · Sep 2014 · The Open Nursing Journal
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    • "In addition, despite the fact that organizational solutions might vary according to the context, all of them tend to have GPs working in collaboration with other health care professionals (e.g., nurses, specialists) with the aim of organizing processes of care that are patient centered, generate a prompt and appropriate response to most common problems, avoid inappropriate and inefficient admissions to the hospital, and improve clinical outcomes (Berenson et al., 2008). The current discussions in the United States about patient-centered medical homes clearly testify to the relevance of the topic and the widespread experimentation and evaluation that is being performed with these organizational arrangements (e.g., Crabtree et al., 2011; Jaén et al. 2010; Rittenhouse & Shortell, 2009). Numerous indicators and indexes have been devised to measure the extent of implementation of the medical home model in primary care practices (Cooley, McAllister, Sherrieb, & Clark, 2003; Gilfillan et al., 2010; Jaén et al., 2010; Reid et al., 2009; Rittenhouse, Casalino, Gillies, Shortell, & Lau, 2008; Rittenhouse et al., 2011). "
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    ABSTRACT: Multiprofessional primary care models promise to deliver better care and reduce waste. This study evaluates the impact of such a model, the primary care unit (PCU), on three outcomes. A multilevel analysis within a "pre- and post-PCU" study design and a cross-sectional analysis were conducted on 215 PCUs located in the Emilia-Romagna region in Italy. Seven dimensions captured a set of processes and services characterizing a well-functioning PCU, or its degree of vitality. The impact of each dimension on outcomes was evaluated. The analyses show that certain dimensions of PCU vitality (i.e., the possibility for general practitioners to meet and share patients) can lead to better outcomes. However, dimensions related to the interaction and the joint works of general practitioners with other professionals tend not to have a significant or positive impact. This suggests that more effort needs to be invested to realize all the potential benefits of the PCU's multiprofessional approach to care.
    Full-text · Article · Jul 2014 · Medical Care Research and Review
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    • "An engaged patient is essential for delivery models focused on chronic disease treatment and prevention of health risk behaviors such as the Chronic Care Model [4] [5]. Also clinical models such as the patient-centered medical home [6] highlight the importance of enabling an accessible and responsive care system, care coordination and an effective communication with the health providers in order to promote patient engagement and achieving increasing rates of treatment adherence, thus improving patient health outcomes and reduced costs of care. Engaging people is considered critical to understanding their experience of health and care; this, in turn, can lead to patient centered changes in practice and service delivery thus augmenting the quality of care [7] "
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    ABSTRACT: Academic and managerial interest in patient engagement is rapidly earning attention and becoming a necessary tool for researchers, clinicians and policymakers worldwide to manage the increasing burden of chronic conditions. The concept of patient engagement calls for a reframe of healthcare organizations' models and approaches to care. This also requires innovations in the direction of facilitating the exchanges between the patients and the healthcare. eHealth, namely the use of new communication technologies to provide healthcare, is proved to be proposable to innovate healthcare organizations and to improve exchanges between patients and health providers. However, little attention has been still devoted to how to best design eHealth tools in order to engage patients in their care. eHealth tools have to be appropriately designed according to the specific patients' unmet needs and priorities featuring the different phases of the engagement process. Basing on the Patient Engagement model and on the Positive Technology paradigm, we suggest a toolkit of phase-specific technological resources, highlighting their specific potentialities in fostering the patient engagement process.
    Full-text · Article · May 2014 · Studies in health technology and informatics
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