Patient-Centered Medical Homes in the United States

National Committee for Quality Assurance, Washington, District of Columbia 20005, USA.
The Journal of ambulatory care management 03/2011; 34(1):20-32. DOI: 10.1097/JAC.0b013e3181ff7080
Source: PubMed


The concept of a medical home is receiving increased attention as a potential means to improve care and reduce costs. This study describes the characteristics and capabilities of practices that have achieved recognition of National Committee for Quality Assurance as a "patient-centered medical home" (PCMH). Both small and large practices demonstrate capabilities related to the goals of PCMH of accessible, coordinated, and patient-centered care; however, practices affiliated with larger organizations achieve higher levels of PCMH recognition compared with unaffiliated small practices. Efforts to support practices to implement medical home capabilities are needed, particularly in the use of data for population management and patient self-management.

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Available from: Robert Saunders, Sep 09, 2014
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    • "However , to achieve maximal effect the key elements of these programs need to be supported by health professionals [5], because their proficiency for self-management support correlates with better patient outcomes [6] [7] [8] [9] [10] [11]. In the United States (U.S.), patients have expressed the desire for self-management support [12], and selfmanagement support has been added to national healthcare quality indicators [13] [14] [15] [16] [17] [18]. The accountable care organizations and patient centered medical homes promoted by the 2010 Patient Protection and Affordable Care Act (PPACA) will need to provide self-management support for certification [14] [15] [16]. "
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    ABSTRACT: OBJECTIVE: To evaluate a web-based self-management training for health professionals. Patients spend 99% of their time outside the healthcare system. Thus self-management support from health professionals is central to optimal care. Our objective was to teach health professionals the skills to provide this support. METHODS: Primary care residents and practicing providers enrolled in six groups. Each group received four web-based interactive training sessions derived from self-efficacy theory. Retrospective-pre/post assessed changes in self-management beliefs and confidence. Wilcoxon signed-rank tests with Bonferroni correction compared responses. Focus groups solicited qualitative feedback. RESULTS: Fifty-seven residents and providers across the United States enrolled. Residents demonstrated positive changes on all belief questions (P 0.001-0.012). Practicing providers had a non-significant positive change on one and significant changes on the remainder (P 0.001-0.018). Both types of participants demonstrated significant increases on confidence questions regarding their ability to support self-management (P<0.01 for all). Participants described learned techniques as being useful, reducing burnout, and increasing acceptance of patient involvement in care planning. CONCLUSION: The web-based self-management support training for health professionals was feasible and changed beliefs and confidence. PRACTICE IMPLICATIONS: The program may maximize patient self-management by increasing provider self-efficacy and skill for self-management support.
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    ABSTRACT: The purpose of this study was to evaluate the feasibility of incorporating chronic disease navigation using lay health care workers trained in motivational interviewing (MI) into an existing mammography navigation program. Primary-care patient navigators implemented MI-based telephone conversations around mammography, smoking, depression, and obesity. We conducted a small-scale demonstration, using mixed methods to assess patient outcomes and provider satisfaction. One hundred nine patients participated. Ninety-four percent scheduled and 73% completed a mammography appointment. Seventy-one percent agreed to schedule a primary care appointment and 54% completed that appointment. Patients and providers responded positively. Incorporating telephone-based chronic disease navigation supported by MI into existing disease-specific navigation is efficacious and acceptable to those enrolled.
    No preview · Article · Jan 2012 · The Journal of ambulatory care management
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    ABSTRACT: The patient-centered medical home model holds the potential for reducing disease complications and improving health, and the federal government is now promoting the adoption of the model within federally qualified community health centers. In a group of Los Angeles community health centers, we found that all would have qualified as patient-centered medical homes under a widely used assessment tool developed by the National Committee for Quality Assurance and endorsed by the federal government for the community health center program. However, we also found that there was no significant relationship between how well these centers performed on the assessment and whether they achieved a range of process or outcome measures for diabetes care. These findings suggest that the federal government is promoting medical home redesign that may not be sensitive to, or inclusive of, services that will actually improve diabetes care for low-income patients. Therefore, additional methods are required for measuring and improving the capabilities of community health centers to function as medical homes and to deliver the scope of services that impoverished patients genuinely need.
    Preview · Article · Mar 2012 · Health Affairs
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