Evidence-based medicine is the system of practicing medicine in such a way that it results in improving outcomes and reduces the overall healthcare cost.
https://www.cognibrain.com/importance-of-evidence-based-medicine-on-research-and-practice/
Evidence-based medicine is the system of practicing medicine in such a way that it results in improving outcomes and reduces the overall healthcare cost.
https://www.cognibrain.com/importance-of-evidence-based-medicine-on-research-and-practice/
PRIME Centre Wales
Long Term Conditions Consensus Meeting
Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND
http://www.primecentre.wales/ltc-consensus-meeting.php
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
Nottingham Roosevelt Travel Scholarship 2012 - Occupational Therapist travels to the USA to look at the Role of Occupational Therapists in Major Trauma Rehabilitation.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths.
Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
PRIME Centre Wales
Long Term Conditions Consensus Meeting
Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND
http://www.primecentre.wales/ltc-consensus-meeting.php
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
Nottingham Roosevelt Travel Scholarship 2012 - Occupational Therapist travels to the USA to look at the Role of Occupational Therapists in Major Trauma Rehabilitation.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths.
Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
Apresentação realizada no I Seminário Internacional de Atenção às Condições Crônicas, pela diretora do Programa da Gestão de Doenças Crônica dos Serviços Sanitários De Alberta/Canadá, Sandra Delon.
Belo Horizonte, 11 de novembro de 2014
Integration of Policy, Practice and Partnership with Julie Wood, MDsfary
From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”).
Panel will focus on the necessary partnerships to integrate tobacco prevention and tobacco cessation in community and health systems. Three perspectives will be shared: Public Health, Primary Care, and Behavioral Health.
Julie Wood, MD, is the Vice President for Health of the Public and Interprofessional Activities, American Academy of Family Physicians
Utilización de la evidencia cualitativa para mejorar la inclusión de las pref...GuíaSalud
Tercera intervención de la Mesa 1 de la Jornada científica GuíaSalud 2017: La implicación de pacientes en el desarrollo de GPC. Una estrategia necesaria para mejorar la toma de decisiones. Simon Lewin
Director of Strategy and Development, Australian Commission on Safety and Quality in Healthcare.
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Evolution of and Trends in Health Care - Lecture D
1. Introduction to Health Care and
Public Health in the U.S.
Evolution of and Trends in
Health Care in the U.S.
Lecture d
This material (Comp 1 Unit 9) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
2. Evolution of and Trends in
Health Care in the U.S.
Learning Objectives
• Describe the application of evidence-
based medicine and clinical practice
guidelines (Lecture a, b)
• Discuss quality indicators in medicine
(Lecture c)
• Describe the patient-centered medical
home and other models of care
coordination (Lecture d)
2
3. History of the
Medical Home Concept - 1
• 1967: American Academy of Pediatrics
(AAP) introduced the medical home
concept
• 2002: Expanded medical home concept to
include specific characteristics of patient
care
– Accessible
– Continuous
– Comprehensive
– Family-centered
– Coordinated
– Compassionate
– Culturally effective
3
4. History of the
Medical Home Concept - 2
• American Academy of Family Physicians
(AAFP) and American College of
Physicians (ACP) have developed their
own models for improving patient care
– AAFP: Medical home
– ACP: Advanced medical home
4
5. The Patient-Centered
Medical Home (PCMH)
• 2007 Joint principles of the patient-centered
medical home delineated by:
– American Academy of Family Physicians (AAFP)
– American Academy of Pediatrics (AAP)
– American College of Physicians (ACP)
– American Osteopathic Association (AOA)
• Approach to providing comprehensive primary
care
• Health care setting that facilitates partnerships
5
6. Personal Physician,
Directed Medical Practice
• Personal physician: Each patient has an
ongoing relationship with a personal
physician
• Physician directed medical practice
– Personal physician leads a team of individuals
at the practice level
– The team takes collective responsibility for
patient care
6
7. Whole Person Orientation
• Personal physician is responsible for
providing for all the patient’s health care
needs
• Care is provided in all stages of life
• Care is provided in multiple settings
– Acute care
– Chronic care
– End-of-life care
• Preventive services are emphasized
7
8. Coordination of Care
• Care is coordinated and/or integrated
across all elements of the health care
system and the patient’s community
• Care is facilitated by technology
• Clinicians provide care that is culturally
and linguistically appropriate
8
9. Quality and Safety - 1
• Incorporated as essential component of
care
• Patients are encouraged to achieve
patient-centered outcomes
• Clinicians use evidence based medicine
and clinical decision support tools to guide
their decision making
• Uses information technology to support
patient care
9
10. Quality and Safety - 2
• Practices agree to undergo voluntary
recognition process
• Physicians participate in continuous
quality improvement and performance
measurement
• Patients participate in decision-making
• Patients and families participate in quality
improvement activities
10
11. Enhanced Access to Care
• Improves current mode of care access and
facilitates availability of clinical services
• This may include:
– Open-access scheduling
– Expanded hours
– New options for communication
o Secure messaging and email
o Use of personal health records
11
12. Payment - 1
• Payment appropriately recognizes the
added value of a patient-centered medical
home
• Reflects the value of patient-centered care
management work
• Pays for face-to-face visits as well as
services associated with coordination of
care
12
13. Payment - 2
• Additionally, the PCMH payment model
– Recognizes case mix differences in the
practice patient population
– Allows for additional payments when quality
improvements are achieved
– Covers enhanced patient communication
access to clinicians
– Supports adoption and use of health
information technology
13
14. Evolution of Care Coordination
• Affordable Care Act introduced the concept of
Accountable Care Organizations (ACOs)
– Provide flexible financial support in exchange for
accepting accountability for overall quality and
cost, aka “shared savings” (Pham, 2015)
– Payment models usually involve “bundled”
payment to manage a patient with specific
diagnoses or perform specific procedures, with
additional payment for achieving specified quality
measures
14
15. Evolution of and Trends in
Health Care in the U.S.
Summary – Lecture d
• Described characteristics of the Patient-
Centered Medical Home (PCMH) including
personal physician, team approach to
care, whole person integrated approach,
quality and safety measures, enhanced
access, and payment
• Introduced new models of care
coordination, in particular Accountable
Care Organizations (ACOs)
15
16. Evolution of and Trends in
Health Care in the U.S.
Summary
• Described evidence-based medicine and
its applications, including clinical practice
guidelines
• Introduced health care quality
improvement
• And, described models of care
coordination, with emphasis on the
patient-centered medical home
16
17. Evolution of and Trends in
Health Care in the U.S.
References – Lecture d
References
American Academy of Pediatrics, Medical Home Initiatives for Children with Special
Needs Project Advisory Committee (2002). The medical home. Pediatrics, 110, 184-
186.
Joint Principles of the Patient Centered Medical Home. (2007). Retrieved February 1,
2017, from Patient-centered Primary Care Collaborative - American Academy of
Family Physicians (AAFP); American Academy of Pediatrics (AAP); American College
of Physicians (ACP); American Osteopathic Association (AOA) website:
https://pcpcc.org/about/medical-home.
Pediatric Records and a "Medical Home". (1967). In Standards of Child Care (pp. 77-79).
Evanston, IL: American Academy of Pediatrics.
Patient-Centered Medical Home Recognition, NCQA, Retrieved February 1, 2017.
http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-
pcmh
Pham, HH, Pilotte, J, et al. (2015). Medicare's vision for delivery-system reform - the role
of ACOs. New England Journal of Medicine. 373: 987-990.
17
18. Introduction to Health Care and
Public Health in the U.S.
Evolution of and Trends in
Health Care in the U.S.
Lecture d
This material was developed by Oregon
Health & Science University, funded by the
Department of Health and Human Services,
Office of the National Coordinator for Health
Information Technology under Award
Number 90WT0001.
18
Editor's Notes
Welcome to Introduction to Health Care and Public Health in the U.S.: Evolution of and Trends in Health Care in the U.S. This is lecture d.
The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S.
The learning objectives for this unit, the Evolution of and Trends in Health Care in the U.S., are to:
Describe the application of evidence-based medicine and clinical practice guidelines;
Discuss quality indicators in medicine;
And, describe the patient-centered medical home and other models of care coordination.
This lecture will discuss the patient-centered medical home.
The patient-centered medical home is a model of providing primary care that is comprehensive and takes into account the needs of the patient, as well as the clinician.
The concept has been around for many years. In 1967, the American Academy of Pediatrics, or AAP, initially introduced the medical home concept as a central location to archive a child’s medical records.
By 2002, the AAP expanded the medical home concept to include specific characteristics of patient care - that patient care should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.
Other organizations, such as the American Academy of Family Physicians, or AAFP, and the American College of Physicians, or ACP, have developed their own approaches for improving patient care. The AAFP calls it “the medical home model,” while the ACP calls it “the advanced medical home.”
In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, combined their efforts and drafted “The Joint Principles of the Patient-Centered Medical Home”, PCMH. They modeled the medical home as a method to provide comprehensive primary care for children, youth, and adults. They felt that the patient-centered medical home was a health care setting that would facilitate partnerships between individual patients, their physicians, and when appropriate, the patient’s family.
We are now going to look at some of the elements of the patient-centered medical home or PCMH.
The first characteristic is the concept of a personal physician. Each patient has an ongoing relationship with a personal physician. The physician is trained to provide continuous and comprehensive care and often acts as the first contact for the patient in the health care universe.
The patient-centered medical home embraces the concept of a physician-directed medical practice. The personal physician directs care for the patient by leading a team of individuals at the practice level, and while the team takes collective responsibility for patient care, the physician often coordinates the activities of the team.
Another characteristic of the patient-centered medical home is the concept of whole person orientation.
This suggests that the personal physician is responsible for providing for all of the patient’s health care needs. The physician may seek assistance through consultation from other clinicians, if appropriate, but aims to provide care for the patient in all stages of life. Care is provided even in the acute, chronic, and end-of-life settings. Preventive services are emphasized and provided by the personal physician.
The patient-centered medical home mandates coordination of care. Coordinated or integrated care is provided to the patient across all elements of the health care system and within the patient’s community.
Care is facilitated by technology so that patients get appropriate care when and where they need it. Clinicians are trained to provide care that is culturally and linguistically appropriate.
In this setting, the health care system includes subspecialty care, hospitals, home health agencies, or nursing homes. The patient’s community includes family, public, or private community-based services; and the concept of technology includes electronic health records, health information exchanges, information technology registries, and other means to provide appropriate care.
Quality and safety are important characteristics of the model. Quality and safety measures are incorporated as an essential component of patient care. Patients are encouraged to achieve patient-centered outcomes and are assisted by a care planning process and a strong partnership between the physician, the patient, and the patient’s family.
Clinicians use evidence-based medicine and clinical decision support tools to guide their decision making in order to ensure a standard of quality and safety that is acceptable.
The patient-centered medical home emphasizes quality and safety of care. The model uses information technology to support patient care and makes use of tools such as performance measurement, patient education, and enhanced communication to improve quality and safety.
Further, practices go through a voluntary recognition process by an appropriate non-governmental entity, for example, the National Committee for Quality Assurance’s Physician Practice Connection’s and Patient-Centered Medical Home recognition program, to demonstrate that they have the capabilities to provide patient-centered services consistent with the PCMH model.
Participation is an important aspect of maintaining quality and safety in the PCMH model. Physicians participate in continuous quality improvement and performance measurement.
Patients participate in decision making and are able to provide feedback if their expectations are being met, or if they are not, and both patients and their families participate in quality improvement activities.
The patient-centered medical home also enhances access to care. It specifies improvement in the current model of care access and facilitates the availability of clinical services for patients by using innovative methods of scheduling. This may be done by open access scheduling in the outpatient setting, by expanding hours for clinician/patient contact, and by offering new options for communication between the patient, their personal physician, and the practice staff.
These options may be implemented using methods such as secure online messaging between clinicians and patients, and the use of personal health records.
In the traditional model of medical care, payment for health care services typically reflects face-to-face services provided by the clinician to the patient. In patient-centered medical home, the payment model is enlarged to appropriately recognize the added value provided to patients who select the patient-centered medical home. It also reflects the value of physician and non-physician staff, and patient-centered care management work that falls outside of the face-to-face encounter.
Payment for coordination of care includes care provided within a given practice, as well as care provided between consultants, ancillary providers, and community resources. These options include payments for face-to-face visits, and also for services associated with coordination of care.
So, the payment model associated with the patient-centered medical home recognizes the value of physician work that is not necessarily delivered in a face-to-face environment with the patient. For example, if the physician remotely assesses patient clinical data, then there is a methodology of payment for these services.
There is also a methodology for payment reimbursement for enhanced patient communication access to clinicians, including secure email, telephone consultations, and consultations between an interdisciplinary team that provides care.
Additionally, the model also recognizes case mix differences in the practice’s patient population. A practice that has a larger number of more complex patients has payment options that are weighted to reflect the complexity of their population.
The model also allows for additional payments when measurable and continuous quality improvements are achieved and surpassed. It also covers enhanced patient communication, access to clinicians, and supports the adoption and use of health information technology for quality improvement.
The Affordable Care Act introduced another type of care coordination called Accountable Care Organizations, or ACOs.
ACOs provide flexible financial support in exchange for accepting accountability for overall quality and cost, which is sometimes called shared savings. Payment models usually involve bundled payment to manage a patient with specific diagnoses or perform specific procedures, with additional payment for achieving specific quality measures.
This concludes lecture d of The Evolution of and Trends in Health Care in the U.S.
In summary, this lecture described features of the patient-centered medical home including having a relationship with a personal physician; a team approach to care; a whole person, integrated approach to care; care that includes quality and safety measures; enhanced access to care for patients; and payment that recognizes the added value of the patient-centered medical home.
This lecture also introduced new models of care coordination, in particular, Accountable Care Organizations- ACOs.
This also concludes the unit: The Evolution of and Trends in Health Care in the U.S.
In summary, this unit described evidence-based medicine and its applications, including clinical practice guidelines. It discussed the importance of health care quality improvement and introduced quality indicators and quality improvement methodology. Finally, it described coordinated care models, including the patient-centered medical home.