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The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, a

August 7, 2019

Joint Principles of the Patient-Centered Medical Home (March 2007)

The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, a
The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, a
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http://www.medicalhomeinfo.org/downloads/pdfs/jointstatement.pdf

August 7, 2019

Primary Care Physicians Should Be Coordinators, Not Gatekeepers

Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine. However, returning to the pre–managed care model of uncoordinated open access to specialists is a poor […]
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Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine. However, returning to the pre–managed care model of uncoordinated open access to specialists is a poor solution. The primary care model should be retained, but PCPs should be transformed from gatekeepers into coordinators of care, in which the goal of the PCP is to integrate both primary and specialty care to improve quality. Changes in the PCP's daily work process, as well as the referral and payment processes, need to be implemented to reach this goal. This model would eliminate the requirement that referrals to specialists be authorized by the primary care physician or managed care organization. Financial incentives would be needed, eg, to encourage PCPs to provide management of complex cases and discourage both overreferral and underreferral to specialists. Budgeting specialists should control excess costs that might be created by the elimination of the primary care gatekeeper. Pilot projects are needed to test and refine this model of PCP as coordinator of care. KEYWORDS: gatekeepers, health service, managed care, programs, physicians' role, physicians, family, policy perspectives , primary care, physicians, referral and consultation.
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http://jama.ama-assn.org/content/281/21/2045.abstract?sid=1ae98db9-f651-4cb8-8e20-00b423514808

August 7, 2019

Implications of Reassigning Patients for the Medical Home: A Case Study

PURPOSE Improving patient-doctor continuity is one goal of the medical home, but achieving this goal may require physicians to reduce panel size. This article examines the impact on patient experience and utilization of Group Health Cooperative’s process of reassigning patients to new physicians as part of their medical home demonstration […]
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PURPOSE Improving patient-doctor continuity is one goal of the medical home, but achieving this goal may require physicians to reduce panel size. This article examines the impact on patient experience and utilization of Group Health Cooperative’s process of reassigning patients to new physicians as part of their medical home demonstration project. METHODS This work represents a subanalysis of the Group Health medical home pilot evaluation. Study participants include 8,005 adults who received primary care in 2006 and 2007 at an urban practice owned and operated by a not-for-profit integrated delivery system. Approximately one-quarter of patients were selected to be reassigned to a new physician. Primary care, emergency department, secure messaging, and telephone utilization were captured through automated sources. Patients’ experience was measured before and after implementation of the medical home for a subset of 1,098 patients. RESULTS Patients who were retained by their existing physicians were older, sicker, and had longer preexisting patient-doctor relationships. After reassignment, reassigned patients were less likely to use primary care services but equally likely to use the emergency department. They were no less satisfied with their care experience. CONCLUSIONS Informational and managerial continuity may mitigate deleterious effects of reassignment, but more must be done to actively bind reassigned patients to the medical home to improve relational continuity with younger, healthier patients. Key Words: Patient-centered medical home, primary health care, continuity of patient care, physician-patient relations, patient-centered care
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http://www.annfammed.org/cgi/content/abstract/8/6/493

August 7, 2019

Comprehensive Primary Care for Older Patients With Multiple Chronic Conditions: “Nobody Rushes You Through” (JAMA. 2010;304(17):1936-1943.)

Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based […]
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Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers’) active engagement in care, and coordination of professionals in care of the patient—all tailored to the patient's goals and preferences. Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care—the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE)—are described briefly, and steps toward their implementation are discussed.
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http://jama.ama-assn.org/cgi/content/abstract/304/17/1936

August 7, 2019

Information exchange among physicians caring for the same patient in the community (CMAJ|November 4, 2008; 179 (10). doi:10.1503/cmaj.080430)

Background: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. Methods: We conducted a […]
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Background: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. Methods: We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits. Results: A total of 3250 patients, with a total of 39 469 previous–current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.54–1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21–1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32–0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60–0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92–8.63).
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http://www.cmaj.ca/cgi/content/abstract/179/10/1013

August 7, 2019

Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions

Boutwell A, Griffin F, Hwu S, Shannon D. Institute for Healthcare Improvement. Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions. http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf. 2009 . Accessed June 30, 2012. This document is intended to provide a sampling of the range of effective programs underway to reduce hospitalizations.
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Boutwell A, Griffin F, Hwu S, Shannon D. Institute for Healthcare Improvement. Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions. http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf. 2009 . Accessed June 30, 2012. This document is intended to provide a sampling of the range of effective programs underway to reduce hospitalizations.
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http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf

August 7, 2019

Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

Jaen CR, et al.Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project. Annals of Family Medicine.2010;8(S-1):S57-S67. http://www.annfammed.org/content/8/Suppl_1/S57.abstract .Accessed 7/10/14 PURPOSE The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices’ transition to patient-centered medical homes (PCMHs).
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Jaen CR, et al.Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project. Annals of Family Medicine.2010;8(S-1):S57-S67. http://www.annfammed.org/content/8/Suppl_1/S57.abstract .Accessed 7/10/14 PURPOSE The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices’ transition to patient-centered medical homes (PCMHs).
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http://www.annfammed.org/cgi/content/abstract/8/Suppl_1/S57

August 7, 2019

Medicaring.org

Altarum Institute. Medicaring.org. [Web site]. http://medicaring.org/Updated 2013. Accessed July 30, 2014. Medicaring is the exciting idea that Americans can learn to build reliable, effective, and efficient arrangements for services to support one another when we must live with serious chronic conditions, mostly associated with older age or the last years […]
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Altarum Institute. Medicaring.org. [Web site]. http://medicaring.org/Updated 2013. Accessed July 30, 2014. Medicaring is the exciting idea that Americans can learn to build reliable, effective, and efficient arrangements for services to support one another when we must live with serious chronic conditions, mostly associated with older age or the last years of life — and that such a care system will be substantially different from what we have now. We are working on policy, economics, professional development, public education, community demonstrations and a dozen other fronts to learn what works and to forge the commitment to change.
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Palliative Care, End-of-Life

August 7, 2019

CMAG Case Management Adherence Guidelines. Version 2.0

Case Management Society of America. Case Management Adherence Guidelines. Version 2.0.http://www.cmsa.org/portals/0/pdf/CMAG2.pdf.Published June 2006. Accessed 7/9/14. Guidelines form the case Management Society of America for improving patient adherence to medication therapies
Case Management Society of America. Case Management Adherence Guidelines. Version 2.0.http://www.cmsa.org/portals/0/pdf/CMAG2.pdf.Published June 2006. Accessed 7/9/14. Guidelines form the case Management Society of America for improving patient adherence to medication therapies
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http://www.cmsa.org/portals/0/pdf/CMAG2.pdf

August 7, 2019

Comprehensive primary care for older patients with multiple chronic conditions: “Nobody rushes you through”

JAMA, 304;17:1936–43 Authors: Boult, C., Wieland, G. D. Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of […]
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JAMA, 304;17:1936–43 Authors: Boult, C., Wieland, G. D. Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient--all tailored to the patient's goals and preferences. Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care--the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE)--are described briefly, and steps toward their implementation are discussed.
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http://jama.ama-assn.org/content/304/17/1936.abstract