Medical Homes: "Where You Stand on Definitions Depends on Where You Sit"

Texas A&M Health Science Center, School of Rural Public Health, Department of Health Policy & Management, Center for Health Organization Transformation, College Station, TX 77842, USA. .
Medical Care Research and Review (Impact Factor: 2.62). 05/2010; 67(4):393-411. DOI: 10.1177/1077558710367794
Source: PubMed


The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes. This lack of consensus has contributed to uncertainty among providers about the medical home. We conducted a systematic review of the literature on the medical home and identified 29 professional, government, and academic sources offering definitions. While consensus appears to exist around a core of selected features, the medical home means different things to different people. The variation in definitions can be partly explained by the obligation of organizations to their members and whether the focus is on the patient or provider. Differences in definitions have implications at both the policy and practice levels.

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    • "ment of Defense Patient Safety Program , has invested significant resources in developing and implementing the Team - STEPPS program ( Agency for Healthcare Research and Quality , 2008 ) . Another example of teamwork in healthcare is the patient - centered medical home model whose aim is to improve quality in primary care ( Stange et al . , 2010 ; Vest et al . , 2010 ) . The work system of the patient - centered medical home can be characterized as fol - lows ( Wetterneck et al . , 2012 ) : person : Members of the team include physicians , nurses , and other staff at the primary care clinic . The implementation of patient - centered medical home often relies on the hiring of nurse case managers whos"
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    • "In his article, Fields opted for a more empirical approach to this question by identifying 4 common features across 7 of the most successful examples of medical homes— dedicated nonphysician care coordinator, expanded access to providers, accessible realtime data to manage performance and track patients, and effective incentive payments (Fields et al., 2010). Vest et al. (2010) resorted instead to a systematic literature review that confirmed the variation in definitions , noting that the differences largely reflect the different perspectives and interests of the 29 sources offering definitions. Although this helped by highlighting the areas of greatest commonality (accessibility, coordination of care, broad scope, continuity, information system support, patient centeredness ), other areas with less agreement also seem fairly important (provider types, quality, active care management, payment). "
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    ABSTRACT: Medical homes are widely viewed as a solution to the problems with American medical care, despite lack of answers to many important questions. Review of articles from issues of 5 journals devoted to the medical home in 2010 provides few answers to those questions. However, with some exceptions, those answers seem more likely to come from real-life efforts to implement medical homes than from the research literature. In any other industry, that would be the case, especially the key questions about the financial viability of both the transformation of traditional practices and sustainability of the new care model.
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    ABSTRACT: Purpose: The patient-centered medical home is often discussed as though there exist either traditional practices or medical homes, with marked differences between them. We analyzed data from an evaluation of certified medical homes in Minnesota to study this topic. Methods: We obtained publicly reported composite measures for quality of care outcomes pertaining to diabetes and vascular disease for all clinics in Minnesota from 2008 to 2010. The extent of and change in practice systems over that same time period for the first 120 clinics serving adults certified as health care homes (HCHs) was measured by the Physician Practice Connections Research Survey (PPC-RS), a self-report tool similar to the National Committee for Quality Assurance standards for patient-centered medical homes. Measures were compared between these clinics and 518 non-HCH clinics in the state. Results: Among the 102 clinics for which we had precertification and postcertification scores for both the PPC-RS and either diabetes or vascular disease measures, the mean increase in systems score over 3 years was an absolute 29.1% (SD = 16.7%) from a baseline score of 38.8% (SD = 16.5%, P ≤.001). The proportion of clinics in which all patients had optimal diabetes measures improved by an absolute 2.1% (SD = 5.5%, P ≤.001) and the proportion in which all had optimal cardiovascular disease measures by 4.4% (SD = 7.5%, P ≤.001), but all measures varied widely among clinics. Mean performance rates of HCH clinics were higher than those of non-HCH clinics, but there was extensive overlap, and neither group changed much over this time period. Conclusions: The extensive variation among HCH clinics, their overlap with non-HCH clinics, and the small change in performance over time suggest that medical homes are not similar, that change in outcomes is slow, and that there is a continuum of transformation.
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