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patient-centered medical home (PCMH)

Concept introduced in 1967 by the American Academy of Pediatrics. Initially, a central location of a patient medical record Concept expanded to incorporate accessible, continuous, comprehensive, family-centered, coordinated, compassionate & culturally effective care. Components: - having a usual source of care - having a personal physician or nurse - receiving needed referrals for specialty care - receiving needed help coordinating care - receiving family-centered care Attributes & functions [6] - comprehensive care - patient centered - coordinated care - accessible services - quality & safety Participating practices usually need to make structural & organizational changes Physicians work in healthcare teams with emphasis on patient self management Capitated payment is not essential A patient-centered medical home should include: - access & connection - patient tracking & registry (disease registry) [1] - case management - patient self-management support - electronic prescribing - interoperable electronic health records not essential [1] - test tracking - onsite basic laboratory & imaging not essential [1] - referral tracking - continuous quality improvement [1] - electronic communications Notes: - may provide higher quality of patient care at the cost of increased expense [2] - no benefit for primary care practices [5] - editorialist suggests benefit may be restricted to patients with high utilization of medical care [5]

General

medical organizational structure

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Nocon RS et al. Association between patient-centered medical home rating and operating cost at federally funded health centers. JAMA 2012 Jun 24 PMID: 22729481 http://jama.jamanetwork.com/article.aspx?articleid=1197012
  3. Agency for Healthcare Research and Quality Closing the Quality Gap: Revisiting the State of the Science The Patient-Centered Medical Home July 2012 http://www.ahrq.gov/clinic/tp/gappcmhtp.htm
  4. Strickland BB et al. The medical home: Health care access and impact for children and youth in the United States. Pediatrics 2011 Apr; 127:604. PMID: 21402643
  5. Friedberg MW et al. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA 2014 Feb 26; 311:815. PMID: 24570245 http://jama.jamanetwork.com/article.aspx?articleid=1832540 - Schwenk TL The Patient-Centered Medical Home. One Size Does Not Fit All. JAMA. 2014;311(8):802-803 PMID: 24570242 http://jama.jamanetwork.com/article.aspx?articleid=1832517
  6. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  7. Arend J, Tsang-Quinn J, Levine C, Thomas D. The patient-centered medical home: history, components, and review of the evidence. Mt Sinai J Med. 2012 Jul-Aug;79(4):433-50. Review. PMID: 22786733
  8. Lauffenburger JC, Shrank WH, Bitton A et al Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study. Ann Intern Med. 2016. Nov 15. PMID: 27842386 http://annals.org/aim/article/2583379/association-between-patient-centered-medical-homes-adherence-chronic-disease-medications - Heisler M Do Patient-Centered Medical Homes Enhance Patients' Medication Adherence? Findings on the Next Frontier in Quality Improvement. Ann Intern Med. 2016. Nov 15. PMID: 27842385 http://annals.org/aim/article/2583382/do-patient-centered-medical-homes-enhance-patients-medication-adherence-findings
  9. Gimm G, Goldberg DG, Ghanem N et al. Provider experiences with a payer based PCMH Program. J Gen Intern Med. 2019;34(10):2047-2053 PMID: 31011976 PMCID: PMC6816616 Free PMC article https://link.springer.com/article/10.1007/s11606-019-05005-7
  10. NCQA: Patient-Centered Medical Home http://www.ncqa.org/tabid/631/Default.aspx
  11. http://www.acponline.org/running_practice/pcm