PatientCentered Medical Home (PCMH)Building a Better ：以病人為中心的醫(yī)療之家（PCMH）建立一個更好的

1、the patient-centered medical home (pcmh): building a better health care model objectives identify current priorities to enact health care reform. describe the patient-centered medical home (pcmh) model of care. understand how the pcmh model is an appropriate method to address priority health reform

2、issues. understand family medicines role in the development and adoption of the patient- centered medical home. patients today are savvy consumers of health care and have higher expectations. communication access convenience coordination responsiveness source: medfusion, an aafp affinity partner, 20

3、08 patient expectations 75% want the ability to interact with their physician online (appointments, prescriptions, test results). 77% want to ask questions without a visit. 75% want email access as part of their overall care. 62% of patients say access to these services would influence their choice

4、of physicians. source: medfusion, an aafp affinity partner, 2008 family medicine is leading the way to make health care more patient-centered. “will family medicine teachers prepare their students and residents to help practices transform and meet the infrastructure principles? i believe that we wil

5、l, not simply because doing so will likely increase our financial situation but because building pcmhs that meet the care and infrastructure principles will improve the care we provide to meet our patients and our communities needs. we will build our pcmh practices, because it is the right thing to

6、do and it reflects our core values.” john c. rogers, md, mph, med past-president, society of teachers of family medicine fam med 2008;40(1):11-2.) health care reform priorities for us health care reform quality-who (world health organization) identifies the us health care system as the “most individ

7、ually responsive” who ranks us health care 37th overall (among 191 countries) efficiency people with acute and chronic medical conditions receive only about two-thirds of the health care that they need. between 20 and 30% of tests and procedures provided to patients are neither needed nor beneficial

8、. *leatherman and mccarthy, quality of health care in the united states: a chartbook, 2002. the commonwealth fund *schuster, mcglynn, and brook. health care reform priorities for us health care reform cost the u.s. spends more on health care per capita than any other nation. the u.s. spends more on

9、health care as a proportion of gdp (gross domestic product) than any other nation. patient-friendly public confidence in hospitals and personal doctors remains relatively high. while individuals report generally positive experience with medical care, public confidence and trust in the system at larg

10、e is eroding. *leatherman and mccarthy, quality of health care in the united states: a chartbook, 2002. the commonwealth health care reform priorities for us health care reform access lack of insurance is a major reason for not obtaining access to needed care. the 40 million americans without insura

11、nce coverage are less likely to obtain needed medical care and preventive tests even with insurance, barriers to care still exist: lack of an established relationship with a doctor language and cultural barriers social determinants of health transportation issues geography high out-of-pockets costs

12、even for those with insurance ie: high deductibles, underinsured, etc. health care reform priorities for us health care reform automation infrastructure for health care delivery has not kept pace with the electronic innovations of other industries. many institutions still rely on systems that are no

13、t automated and allow opportunities for human error, even though technology exists to minimize errors and improve efficiency. an effective and efficient health care system is a primary care- based health care system provides access to basic health care services manages health disparities coordinates

14、 care controls cost offers sustainability /valueoffamilymedicine brief history of the pcmh aap “medica l home” record s aap medical home provider policy aafp future of family medicine pcpcc joint principles of pcmh ncqa- pcmh ppaca cmmi acos private payer initiatives direct primary care

15、cpci advanced primary care 1960s 2000s 2010s future 1990s innovative solution: history of the pcmh concept introduced by american academy of pediatrics (aap) in 1967 initially referred to a central location for medical records the medical home concept was expanded in 2002 to include: accessible cont

16、inuous comprehensive family-centered coordinated compassionate culturally sensitive care in 2007, the aap, the american academy of family physicians (aafp), the american osteopathic association (aoa), and the american college of physicians (acp) adopted a set of joint principles to describe a new le

17、vel of primary care. “joint principles” of the patient-centered medical home a personal physician who coordinates all care for patients and leads the team. physician-directed medical practice a coordinated team of professionals who work together to care for patients. whole person orientation this ap

18、proach is key to providing comprehensive care. coordinated care that incorporates all components of the complex health care system. quality and safety medical practices voluntarily engage in quality improvement activities to ensure patient safety is always being met. enhanced access to care such as

19、through open- access scheduling and communication mechanisms. payment a system of reimbursement reflective of the true value of coordinated care and innovation. growing support for the patient- centered medical home partnerships are developing as more and more stakeholders see value in the joint pri

20、nciples. the patient centered primary care collaborative (pcpcc)* is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and others to develop and advance pcmh. the pcpcc has well over 1,000 members. * patient-centered | p

21、hysician-directed the patient centered medical home the family medicine model family medicine foundation health it patient experience health it practice organization quality care heath information technology patient- centered care risk-stratified care management culture of improvement medical neighb

22、orhood understand ways to identify patients risk status plan out care for chronic conditions and preventive care identify “high-risk” patients use tools to track populations by risk category establish baseline performance measures collect and analyze data discuss best practices and improvement condu

23、ct regular clinical team meetings manage care transitions and build linkage to community resources coordinate care with specialists and outside facilities evaluate care transition process quality care shared decision making convenient accesspatient experience same-day appointments and extended hours

24、 e-mail communication with patients (e-visits) web portals for rx refill and appointments translation and culturally appropriate services understanding the patients social barriers, goals and priorities create care plans in collaboration with patient/caregiver monitor progress between visits conduct

25、 patient satisfaction surveys on a regular basis establish patient advisory panel and qi activities conduct patient focus groups patient- centered care quality care lab testing prescriptions registries practice organization culture of changepractice environment establish a pcmh leadership team engag

26、e all members of the practice in a shared vision provide staff education and training to support patient- centered care staffing model supports team-base care define roles for team members include health coach and care coordination functions financial management all staff are aware of the most effic

27、ient ways to deliver care national policies support the investment of resources into primary care practices that are effective and efficient quality care patient- centered care technology infrastructure family medicine foundation digitally connected evidence-based medicine ehr reporting tools patien

28、t reminders patient notification for new information reminders for recommended care or health maintenance makes patient registries possible can quickly pull clinical data for quality analysis can enhance business processes population health management through patient registries enhances care coordin

29、ation by improving information flow with other physicians, practices, and providers improves patient - physician communication point-of-care learning , alerts and reminders clinical decision support (e.g., epocrates) practice organization quality care patient centered care health information technol

30、ogy family medicine foundation great outcomes good for patients patients enjoy better health. patients share in health care decisions. good for physicians physicians focus on delivering excellent medical care. good for practices team works effectively together. resources support the delivery of exce

31、llent patient care. good for payors and employers ensures quality and efficiency. avoids unnecessary costs. great outcomes practice organization quality care patient- centered care health information technology does pcmh work? fully implemented the pcmh hits the triple aim, better health, better car

32、e, lower costs improves practice organization, work environment and job satisfaction no longer a pilotnow a program with proven results 21 the pcmh model in family medicine residency training “preparing the personal physician for practice” (p4) the p4 initiative was designed to inspire and examine i

33、nnovation in family medicine residency training. sponsors are the american board of family medicine, the association of family medicine residency directors, and transformed. different approaches range from moving the continuity clinic into a new community setting, to expanding to a four-year program

34、, to providing the opportunity for tracking and obtaining additional degrees while in training, and more. the aim of p4 is to spur innovation in all family medicine residencies to best prepare family physicians be the excellent personal physicians of tomorrow. initially, 84 family medicine residenci

35、es applied to participate in the p4 initiative. the 14 p4 residencies were selected as participants for more intensive evaluation of outcomes to determine what works best. http:/ pcmh model and health care reform attempts to fix part of the problem without addressing it comprehensively will not lead

36、 to viable solutions. advocacy by all stakeholders is necessary. community projects through local hospitals and resource networks state projects for regional payors and state medicaid programs national support for changing how care is delivered and for ensuring a prepared workforce to deliver care f

37、amily physicians and the pcmh pcmh is a place, not a person. patient-centered, physician-directed. family physicians provide comprehensive care care for all patients coordinate care provide care that is effective and efficient* future of family medicine *starfield data practice organization quality

38、care patient- centered care health information technology family physicians how we provide care: acute injuries and illnesses health promotion and behavior change hospital care chronic disease management maternity care well-child care and child development primary mental health care supportive and e

39、nd-of-life care family physicians how we view patients: consider all of the influences on a persons health. know and understand peoples limitations, problems, and personal beliefs when deciding on a treatment. are appropriate and efficient in proposing therapies and interventions. develop rewarding

40、relationships with patients. provide a continuous healing relationship over time. individuals and families women and men regardless of age or disease infants, children, and adolescents regardless of disease communities and public health global health family physicians who we care for: primary care d

41、elivers better health outcomes mortality morbidity medication use per capita expenditures patient satisfaction greater equity in health care source: b. starfield, et al., “the effects of specialist supply on populations health,” health affairs (march 2005); w5-97 the patient-centered medical home as a preferred model of care change is here! patients want more