Medical home
A "medical home" is a model of health care that emphasizes a holistic, patient-centered approach, originally introduced by the American Academy of Pediatrics in 1967 as a centralized place for a child's medical records. Over time, the concept has evolved to encompass a broad spectrum of care for both children and adults, focusing on collaboration among the patient, their family, and a diverse team of health care providers. This approach involves a personal physician who serves as the primary point of contact, coordinating comprehensive care across various settings, including specialists and community services.
Key characteristics of a medical home include whole person orientation, where care is tailored to individual needs, and an emphasis on quality and safety through evidence-based practices. Enhanced access to care is facilitated through extended clinical hours and improved communication channels like telehealth. Payment models for medical homes recognize the value of care coordination and the various services that extend beyond traditional office visits. This model not only aims to improve health outcomes but also involves patients and families as essential partners in the care process, respecting diverse perspectives and cultural differences. Overall, the medical home approach seeks to create a supportive environment that improves health care experiences and outcomes for all patients.
Medical home
Treatment
Anatomy or system affected: All
Definition: The base for children's medical and nonmedical care.
In 1967, the American Academy of Pediatrics (AAP) coined the term “medical home,” which was at first a center of a child's medical records. Since then, the idea of a medical home has transitioned.
Health care is a multidisciplinary approach encompassing patient, family, primary-care provider, and other disciplines providing care for the patient, such as specialists and community support. Within this model, the patient and patient's family is the focus around which the medical home is built. In addition, medical homes now encompass pediatrics as well as adults.
In 2007, the AAP, the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) united to form the Joint Principles of the Patient Centered Medical Home. These combined organizations now state that a medical home possesses the seven following characteristics:
Personal physician. Each patient has a continuous relationship with an individual physician who provides first contact and comprehensive and continuous care.
Physician directed medical practice. The personal physician coordinates and leads a team of colleagues at the practice that together works to provide continuing care for the patient.
Whole person orientation. The personal physician supplies direct care to the patient, or orchestrates care from other providers. This encompasses health-care demands for all different pathologies and stages of life, including acute care, chronic care, end-of-life care and preventive care. In addition, coordinating with the patient and their families necessitates understanding each patient's different needs, values, and cultural backgrounds. The medical home helps patients manage their own care at the level the patient desires. By perceiving the patients and families as integral parts of the health care team, the medical home facilitates their role as knowledgeable allies in creating the care plan.
Care is coordinated and/or integrated. It is done so across the various modalities of health care and across the patient's community. This can include hospitals, specialty care, home health care, and community services and supports. The medical home practice involves the entire health-care team, which can include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators, to build open and clear communication. Other smaller practices may use virtual tools to link various types of providers with patients.
Quality and safety. By using evidence-based medicine and clinical decision-support tools, the primary-care medical home is committed to quality and safety. Patients and families share in the decision-making process in order to attain best outcomes that are patient-centered. Information technology assists in providing best patient care, reviewing performance outcomes, providing patient education and strengthening communication with patients. Providers and staff seek feedback to make sure that patients are satisfied with their care and outcomes. The medical home demonstrates a continuous dedication to improvement by conducting performance measurements. A nongovernmental organization reviews the medical home to ensure that it is maintaining patient-centered services that align with the model of a medical home.
Enhanced access to care. The medical home delivers accessible care. This is made possible by longer clinical hours, shorter waiting times for urgent needs, and additional modes of communication between patients and a member of the care team, such as after-hours email and telephone care. The medical home is receptive to patients' choices about access.
Payment. Because patient-centered medical homes provide added value to patients, payment is based on the below guidelines:
- • It should recognize the work by the health-care team that falls outside of the face-to-face visit.
- • It should pay for coordinating care across various different specialties.
- • It should pay for implementing new health information technologies.
- • It should pay for care provided through enhanced communication options, such as email and phone.
- • It should support physician work, including remote monitoring of clinical data through new technology
- • It should grant payment to separate fee-for-service payments.
- • It should recognize case-mix differences in patient population
- • It should allow grant savings to health-care providers for reduced hospitalizations that are associated with their care
- • It should allow for additional payments for achieving measurable and continuous quality improvements.
Bibliography
American College of Physicians. “What is the Patient-Centered Medical Home?” http://www.acponline.org/running‗practice/delivery‗and‗payment‗models/pcmh/understanding/what.htm
Coffin, Janis, Carla Duffie, and Megan Furno. “The Patient-Centered Medical Home and Meaningful Use: A Challenge for Better Care.” Journal of Medical Practice Management: MPM 29.5 (2014): 331–34. MEDLINE Complete. Web. 19 Mar. 2015.
Kern, Lisa M., Alison Edwards, and Rainu Kaushal. “The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care.” Annals of Internal Medicine 160.11 (2014): 741–49. Academic Search Complete. Web. 19 Mar. 2015.
Patient Centered Medical Home Resource Center: http://pcmh.ahrq.gov/
Robeznieks, Andis. “At Home with the Specialist. Oncologists and Other Specialists Launching Patient-Centered Medical Homes.” Modern Healthcare 44.42 (2014): 22. MEDLINE Complete. Web. 19 Mar. 2015.