Home, sweet medical home
Transforming a doctor’s office into a ‘medical home’
A professor from the UT Health Science Center is exploring how to offer patient-centered, team-based care, better use of technology and a more personal experience for patients that may ultimately improve health.
Carlos R. Jaén, M.D., Ph.D., chairman of Family & Community Medicine, led the first large-scale national demonstration project on patient-centered medical homes, launched in June 2006 by the TransforMED subsidiary of the American Academy of Family Physicians.
A supplement of Annals of Family Medicine released June 7 has eight articles authored or coauthored by Dr. Jaén explaining the process, outcomes and lessons of the project. Robert L. Ferrer, M.D., M.P.H., and Raymond C. Palmer, Ph.D., associate professors of family and community medicine, also worked on the project.
There is no single description of a patient-centered medical home – also called “advanced primary care” – although there are some generally accepted principles:
Access to medical staff: A patient can get an appointment the same day, reach someone in the practice in the middle of the night or e-mail the doctor with questions or concerns. Medical practices have extended evening and weekend hours. Patients have a relationship with doctors and medical staff who know them by name.
Better use of technology: This might mean having lab results quickly integrated into a patient’s electronic medical record, or it could be the ability to instantly generate “disease registries,” or lists of patients with common conditions and needs, that can be used to remind patients about medications, tests or preventive procedures. It might be as simple as giving a patient online access to laboratory and imaging studies or the ability to e-mail a doctor or schedule an appointment online.
Team approach to care: Each patient has a personal doctor who coordinates care. But patients interact with a number of medical staffers, depending on who is best suited to a given situation. A practice might have any combination of doctors, nurses and nurse practitioners, physician assistants, pharmacists, psychologists or other medical personnel who work together to provide integrated care.
Community-oriented care: A patient-centered medical home responds to the needs of its community. Patients with the same condition might be able to see their doctor together, addressing common concerns as a group. For example, smokers might be seen together for group coaching on how to quit smoking. Those patients can be seen individually as needed. Group visits also allow patients to share experiences and support each other. This also can be valuable in prenatal, weight loss and diabetes management and other cases. In some instances, practices have outreach to local sports teams for sports physicals and other community needs.
After studying 36 diverse U.S. primary care practices, Dr. Jaén and his co-investigators found that a highly motivated practice can put into place many elements of a patient-centered medical home.
The authors conclude that “both practice and system reforms are needed to make it easier to integrate, personalize and prioritize care for whole people, communities and populations.”