Physician Office (Home)

Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF.Principles of the Patient-Centered Medical Home and Preventive Services Delivery. Annals of Family Medicine.2010.8(2): 108-116.http://www.annfammed.org/content/8/2/108.abstract. Accessed April 26, 2013. PURPOSE Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services. METHODS We undertook cross-sectional analyses using baseline patient and practice member surveys and chart audits from a quality improvement trial in 24 primary care offices. Association of PCMH principles with preventive services (receipt of cancer screening, lipid screening, influenza vaccination, and behavioral counseling) was examined using hierarchical linear modeling. RESULTS Higher global PCMH scores were associated with receipt of preventive services (β=2.3; P <.001). Positive associations were found with principles of personal physician (β=3.7; P <.001), in particular, continuity with the same physician (β=4.4; P = .002) and number of visits within 2 years (15% higher for patients with 13 or more visits; P <.001); and whole-person orientation (β=5.6; P <.001), particularly, having a well-visit within 5 years (β=12.3; P <.001) and being treated for chronic diseases (6% higher if more than 3 chronic diseases; P = .002). Having referral systems to link patients to community programs for preventive counseling (β = 8.0; P <.001) and use of clinical decision-support tools (β = 5.0; P = .04) were also associated with receipt of preventive services. CONCLUSIONS Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes.

August 13, 2019

Principles of the Patient-Centered Medical Home and Preventive Services Delivery

Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF.Principles of the Patient-Centered Medical Home and Preventive Services Delivery. Annals of Family Medicine.2010.8(2): 108-116.http://www.annfammed.org/content/8/2/108.abstract. Accessed April 26, 2013. PURPOSE Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed […]
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Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF.Principles of the Patient-Centered Medical Home and Preventive Services Delivery. Annals of Family Medicine.2010.8(2): 108-116.http://www.annfammed.org/content/8/2/108.abstract. Accessed April 26, 2013. PURPOSE Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services. METHODS We undertook cross-sectional analyses using baseline patient and practice member surveys and chart audits from a quality improvement trial in 24 primary care offices. Association of PCMH principles with preventive services (receipt of cancer screening, lipid screening, influenza vaccination, and behavioral counseling) was examined using hierarchical linear modeling. RESULTS Higher global PCMH scores were associated with receipt of preventive services (β=2.3; P <.001). Positive associations were found with principles of personal physician (β=3.7; P <.001), in particular, continuity with the same physician (β=4.4; P = .002) and number of visits within 2 years (15% higher for patients with 13 or more visits; P <.001); and whole-person orientation (β=5.6; P <.001), particularly, having a well-visit within 5 years (β=12.3; P <.001) and being treated for chronic diseases (6% higher if more than 3 chronic diseases; P = .002). Having referral systems to link patients to community programs for preventive counseling (β = 8.0; P <.001) and use of clinical decision-support tools (β = 5.0; P = .04) were also associated with receipt of preventive services. CONCLUSIONS Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes.
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http://www.annfammed.org/content/8/2/108.abstract

August 13, 2019

Guided Care: Care for the Whole Person, For Those Who Need It Most

Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care Nurse, based in a primary care office, works with patients and their families to improve their quality of life and make more efficient use of […]
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Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care Nurse, based in a primary care office, works with patients and their families to improve their quality of life and make more efficient use of health services. The nurse assesses patient needs, monitors conditions, educates and empowers the patient, and works with community agencies to ensure that the patient’s healthcare goals are met. In a pilot study, patients who received Guided Care rated their quality of care significantly higher than usual care patients. The average insurance costs for Guided Care patients were 25% lower over a six month period. The program is currently being tested at eight primary care sites in the Baltimore-Washington D.C. area in a randomized trial involving over 900 patients, 300 caregivers, and 48 primary care physicians. Click here for a summary of pilot outcomes and preliminary data from the trial. Guided Care is the winner of the American Public Health Association's 2008 Archstone Foundation Award for Excellence in Program Innovation, which recognizes a innovative care model for older Americans each year. Guided Care also won the 2009 Medical Economics Award for Innovation in Practice Improvement cosponsored by the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and Medical Economics magazine. Guided Care was a finalist for the British Medical Journal's 2010 Getting Research into Practice Award. The Guided Care Program at Kaiser Permanente Mid-Atlantic States won the 2010 Case In Point Platinum Award for Case Management Provider Program.
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http://www.guidedcare.org/

August 8, 2019

Integrating Care for Populations and Communities

Integrating Care for Populations and Communities (ICPC). CFMC. Web Site. Http://www.cfmc.org/integratingcare/ . 2013. Accessed July 24, 2014. Integrating Care for Populations and Communities (ICPC) is a strategic Aim where Quality Improvement Organizations (QIOs) are bringing together hospitals, nursing homes, patient advocacy organizations, and other stakeholders in community coalitions. The Centers […]
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Integrating Care for Populations and Communities (ICPC). CFMC. Web Site. Http://www.cfmc.org/integratingcare/ . 2013. Accessed July 24, 2014. Integrating Care for Populations and Communities (ICPC) is a strategic Aim where Quality Improvement Organizations (QIOs) are bringing together hospitals, nursing homes, patient advocacy organizations, and other stakeholders in community coalitions. The Centers for Medicare & Medicaid Services (CMS) looks to QIOs to implement community-based projects that effect process improvements to address issues in medication management, post-discharge follow-up, and plans of care for patients who move across health care settings.
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http://www.cfmc.org/integratingcare/

August 8, 2019

Transitions of Care Performance Measures: Paper by the NTOCC Measures Work Group, 2008

The NTOCC Measures Work Group. Transitions of Care Measures. http://www.ntocc.org/Portals/0/PDF/Resources/TransitionsOfCare_Measures.pdf. 2008. Accessed July 24, 2014. The Case Management Society of America (CMSA) convenes the National Transitions of Care Coalition (NTOCC) to develop recommendations on actions that all participants in the health care delivery system can take to improve the quality […]
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The NTOCC Measures Work Group. Transitions of Care Measures. http://www.ntocc.org/Portals/0/PDF/Resources/TransitionsOfCare_Measures.pdf. 2008. Accessed July 24, 2014. The Case Management Society of America (CMSA) convenes the National Transitions of Care Coalition (NTOCC) to develop recommendations on actions that all participants in the health care delivery system can take to improve the quality of care transitions. The multi-disciplinary members of NTOCC work collaboratively to develop policies, tools, and resources as well as recommend actions and protocols to guide and support providers and patients in achieving safe and effective transitions of care.
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http://www.ntocc.org/Portals/0/TransitionsOfCare_Measures.pdf

August 8, 2019

Improving Transitions of Care: The Vision of the National Transitions of Care Coalition

The National Transitions of Care Coalition. Improving Transitions of Care: The Vision of the National Transitions of Care Coalition. http://www.ntocc.org/Portals/0/PDF/Resources/PolicyPaper.pdf. May 2008. Accessed July 24, 2014. This paper outlines the vision of the National Transitions of Care Coalition (NTOCC) to improve transitions of care, increasing quality of care and patient […]
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The National Transitions of Care Coalition. Improving Transitions of Care: The Vision of the National Transitions of Care Coalition. http://www.ntocc.org/Portals/0/PDF/Resources/PolicyPaper.pdf. May 2008. Accessed July 24, 2014. This paper outlines the vision of the National Transitions of Care Coalition (NTOCC) to improve transitions of care, increasing quality of care and patient safety while controlling costs.
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http://www.ntocc.org/Portals/0/PolicyPaper.pdf

August 8, 2019

Multidimensional Geriatric Assessment: Back to the Future Early Effects of “Guided Care” on the Quality of Health Care for Multimorbid Older Persons: A Cluster-Randomized Controlled Trial

Boult C, et al.Multidimensional Geriatric Assessment: Back to the Future Early Effects of “Guided Care” on the Quality of Health Care for Multimorbid Older Persons: A Cluster-Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci.2008; 63 (3): 321-327.http://biomedgerontology.oxfordjournals.org/content/63/3/321.abstract. Accessed April 26, 2013.–Background. The quality of health care for older Americans […]
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Boult C, et al.Multidimensional Geriatric Assessment: Back to the Future Early Effects of “Guided Care” on the Quality of Health Care for Multimorbid Older Persons: A Cluster-Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci.2008; 63 (3): 321-327.http://biomedgerontology.oxfordjournals.org/content/63/3/321.abstract. Accessed April 26, 2013.--Background. The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed “Guided Care” (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50–60 multimorbid older patients.
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http://biomedgerontology.oxfordjournals.org/content/63/3/321.abstract

August 8, 2019

Caregiving and Chronic Care: The Guided Care Program for Families and Friends

Wolff JL, et al. Caregiving and Chronic Care: The Guided Care Program for Families and Friends.Gerontol A Biol Sci Med Sci.2009.64A (7): 785-791.http://biomedgerontology.oxfordjournals.org/content/64A/7/785.abstract. Accessed April 26, 2013. Background The Guided Care Program for Families and Friends (GCPFF) is one component of “Guided Care” (GC), a model of primary care for […]
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Wolff JL, et al. Caregiving and Chronic Care: The Guided Care Program for Families and Friends.Gerontol A Biol Sci Med Sci.2009.64A (7): 785-791.http://biomedgerontology.oxfordjournals.org/content/64A/7/785.abstract. Accessed April 26, 2013. Background The Guided Care Program for Families and Friends (GCPFF) is one component of “Guided Care” (GC), a model of primary care for chronically ill older adults that is facilitated by a registered nurse who has completed a supplemental educational curriculum. Methods The GCPFF melds support for family caregivers with the delivery of coordinated and comprehensive chronic care and seeks to improve the health and well-being of both patients and their family caregivers. The GCPFF encompasses (a) an initial meeting between the nurse and the patient's primary caregiver, (b) education and referral to community resources, © ongoing “coaching,” (d) a six-session group Caregiver Workshop, and € monthly Support Group meetings, all facilitated by the patient's GC nurse. Results A cluster-randomized controlled trial of GC is underway in 14 primary care physician teams. Of 904 consented patients, 450 (49.8%) identified a primary caregiver; 308 caregivers met eligibility criteria, consented to participate, and completed a baseline interview. At 6-month follow-up, intervention group caregivers’ mean Center for Epidemiological Studies Depression (CESD) and Caregiver Strain Index (CSI) scores were respectively 0.97 points (p = .14) and 1.14 points (p = .06) lower than control group caregivers’. Among caregivers who provided more than 14 hours of weekly assistance at baseline, intervention group caregivers’ mean CESD and CSI scores were respectively 1.23 points (p = .20) and 1.83 points (p = .04) lower than control group caregivers’. Conclusions The GCPFF may benefit family caregivers of chronically ill older adults. Outcomes will continue to be monitored at 18-months follow-up. BACKGROUND: The Guided Care Program for Families and Friends (GCPFF) is one component of “Guided Care” (GC), a model of primary care for chronically ill older adults that is facilitated by a registered nurse who has completed a supplemental educational curriculum. METHODS: The GCPFF melds support for family caregivers with the delivery of coordinated and comprehensive chronic care and seeks to improve the health and well-being of both patients and their family caregivers. The GCPFF encompasses (a) an initial meeting between the nurse and the patient's primary caregiver, (b) education and referral to community resources, (c) ongoing “coaching,” (d) a six-session group Caregiver Workshop, and (e) monthly Support Group meetings, all facilitated by the patient's GC nurse. RESULTS: A cluster-randomized controlled trial of GC is underway in 14 primary care physician teams. Of 904 consented patients, 450 (49.8%) identified a primary caregiver; 308 caregivers met eligibility criteria, consented to participate, and completed a baseline interview. At 6-month follow-up, intervention group caregivers’ mean Center for Epidemiological Studies Depression (CESD) and Caregiver Strain Index (CSI) scores were respectively 0.97 points (p = .14) and 1.14 points (p = .06) lower than control group caregivers’. Among caregivers who provided more than 14 hours of weekly assistance at baseline, intervention group caregivers’ mean CESD and CSI scores were respectively 1.23 points (p = .20) and 1.83 points (p = .04) lower than control group caregivers’. CONCLUSIONS: The GCPFF may benefit family caregivers of chronically ill older adults. Outcomes will continue to be monitored at 18-months follow-up.
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http://biomedgerontology.oxfordjournals.org/content/64A/7/785.abstract

August 8, 2019

Institute for Healthcare Improvement

The Institute for Healthcare Improvement. http://www.ihi.org/Pages/default.aspx. Updated 2014. Accessed 7/8/14. The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization helping to lead the improvement of health care throughout the world. Founded in 1991 and based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for […]
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The Institute for Healthcare Improvement. http://www.ihi.org/Pages/default.aspx. Updated 2014. Accessed 7/8/14. The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization helping to lead the improvement of health care throughout the world. Founded in 1991 and based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.
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http://www.ihi.org

August 8, 2019

Community Collaborative Improves Accuracy of Medication Lists for Elderly Patients in Outpatient Clinic Setting. Aurora Healthcare, Milwaukee Wisconsin

Agency for Healthcare Research and Quality. Aurora Health Care. http://www.innovations.ahrq.gov/content.aspx?id=1766. Accessed 4/16/13. Community Collaborative Improves Accuracy of Medication Lists for Elderly Patients in Outpatient Clinic Setting. A community-wide medication reconciliation collaborative, involving health care consumers, providers, pharmacists, and community stakeholders, gave elderly patients and their providers the tools and education […]
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Agency for Healthcare Research and Quality. Aurora Health Care. http://www.innovations.ahrq.gov/content.aspx?id=1766. Accessed 4/16/13. Community Collaborative Improves Accuracy of Medication Lists for Elderly Patients in Outpatient Clinic Setting. A community-wide medication reconciliation collaborative, involving health care consumers, providers, pharmacists, and community stakeholders, gave elderly patients and their providers the tools and education needed to assemble and verify accurate medication lists and communicate effectively to prevent medication errors. As a result, the rate of accurate medication lists among targeted patients improved from 55 percent to 72 percent. Evidence Rating Moderate: The evidence consists primarily of before and after comparisons of the accuracy of medication lists and comparison with controls, which included Aurora practices in which there was no intervention and post-implementation surveys eliciting patient and provider views. Although the project provided extensive education and support and employed controls, a direct causal link between the program and the improved accuracy rates cannot be confirmed, as confounding variables may have influenced the results, including recent emphasis and education by professional organizations.
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http://www.innovations.ahrq.gov/content.aspx?id=1766

August 7, 2019

Strengthening primary care with better transfer of information CMAJ November 4, 2008 179:987-988

The reality of modern health care is that patients commonly receive care from multiple providers, both physicians and nonphysicians, who often work in disconnected offices and facilities. This makes it a tremendous challenge to connect and integrate a patient’s care into a coherent whole. Widespread lack of information continuity is […]
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The reality of modern health care is that patients commonly receive care from multiple providers, both physicians and nonphysicians, who often work in disconnected offices and facilities. This makes it a tremendous challenge to connect and integrate a patient's care into a coherent whole. Widespread lack of information continuity is troublesome because of the unnecessary tests, medical errors and inconsistent treatment plans that can result.1 The transition from hospital to community care is a particularly vulnerable time when coordination lapses can result in serious adverse events.2
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http://www.cmaj.ca/cgi/content/full/179/10/987