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Thursday, January 26, 2012

Combining the past with the present to invent the future: your medical home

Can you reach your physician, or an informed and responsive surrogate, any time you have a question?  And if you need a same day visit, can you count on getting one?  Are you treated like a mature adult who is in charge of your own healthcare decisions?  If you are seeing one or more specialists, does your primary care physician coordinate your plan of care and help you understand it? Can you access your own records online?

Despite islands of excellence, contemporary healthcare falls short in providing the kind of patient-centered, coordinated, efficient and accurate care that our nation deserves and that is within our reach.  Not only do the current deficiencies frustrate patients and care givers alike, but our fractured system adds enormously to the cost of care. Ours is a high-cost, low-value system that many have criticized as being not a system at all.

Enter the "Patient-Centered Medical Home".

Arising from concepts first articulated by the American Academy of Pediatrics, PCMH is a model of care that describes a role for the primary care physician and his team that goes far beyond the "gatekeeper" economic model of the 1990s.  To be a PCMH, a primary care practice must provide comprehensive, team-based care that meets the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care provided by a cohesive team. 


This care must be coordinated across all elements of the complex health care system and connect patients to both medical and social resources in the community. It must include superb access to care that meets patients’ needs, including care provided after hours and by e-mail and telephone.  Finally, it must encourage self-care and empower patients and families to be active decision-makers to ensure that the healthcare provided is consistent with the needs, values and preferences of the patient.  


Why did this model originate in Pediatrics, when so many more adults than children have chronic diseases and the desperate need for this kind of care?  First, I think pediatricians have historically been oriented toward health maintenance, education and empowering families.  Second, and this is just my personal conjecture, when it comes to coordinating the care of patients under the care of one or more specialists, we pediatricians have been better able to practice to the "gold standard" if only because such a small fraction of our total population requires this intensive (and uncompensated) work.   


However it started, the PCMH concept is getting serious attention by thought leaders in Washington and across the healthcare scene.  At the risk of sounding like a pediatrician, it sure seems like a good idea to me.  Look for more details on the Patient Centered Medical Home at www.ahrq.gov.







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