Friday, November 18, 2011

The Medical Home Seems to Be A Pretty Good Idea for Patient Care. Again the PCEHR is The Wrong Shape!

The following very interesting report turned up just a few days ago.

Medical homes prove worth, in U.S. and abroad

November 09, 2011 | Mike Miliard, Managing Editor
NEW YORK – A new Commonwealth Fund international survey finds that chronically and seriously ill adults who received care from a medical home were less likely to report medical errors, test duplication and other care coordination failures.
The survey, which polled patient experiences in the U.S. and 10 other high-income countries, also found that patients connected with medical homes – accessible primary care practices that help coordinate care – had better relationships with their doctors and rated their care more highly.
The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States included people who reported they were in "fair" or "poor health," had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year.
The report identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers.
.....
Across the diverse healthcare systems included in the study, patients who were connected to a medical home in general had more positive care experiences, including better support for managing chronic conditions, better communication, and better care coordination. Patients with medical homes were also less likely to report medical mistakes and far more likely to rate their care highly.
.....
Schoen says the study highlights the critical importance of patient-centered primary care as a foundation for a high-performing health system.
.....
The survey found wide variations in access, coordination, and patient-reported medical errors.
  • Despite having very different health care systems, the U.K. and Switzerland were leaders in having rapid access to primary care, easy access to after-hours care and comparatively low rates of coordination gaps and patient-reported medical errors.
  • More than seven of 10 patients in the U.K., Switzerland, France, New Zealand and the Netherlands were able to get same- or next-day appointments when they were sick. In contrast, only half of patients in Sweden and Canada reported such rapid access to care.
  • One-third or more of sicker adults in all 11 countries had visited an emergency department in the past two years. Emergency department use was highest in Canada, Sweden, the U.S., Australia and New Zealand.
  • More than half of German (56 percent) and French (53 percent) patients and more than two of five Norwegian (43 percent) and U.S. (42 percent) patients reported gaps in care coordination, including duplicate tests being ordered, medical records or test results not being available during a medical appointment, or providers not sharing important information with each other. In contrast, only 20 percent of U.K. patients and 23 percent of Swiss patients reported such care gaps.
  • The proportion of patients reporting medical errors (including prescription and lab test errors) ranged from a low of 8 percent to 9 percent in the U.K. and Switzerland to 22 percent or more in New Zealand, Norway, and the U.S.
Overall, the survey found that countries are facing similar challenges in providing effective treatment to sicker adults. Evident in every country surveyed were gaps in care coordination, gaps in transitions between hospitals and other community-based care settings, lapses in communication between specialists and primary care physicians, failure to review medications and delays in receiving test results.
.....
 “All the other study countries already spend far less than the United States, yet provide more comprehensive, protective benefits,” the study’s authors note. “Comparative research finds the higher costs in the United States are largely due to paying higher prices and not related to the generosity of insurance.”
The full article is here:
Again it is primary care provider being information enabled that provides the best chance for provision of a ‘Medical Home’ and the benefits that flow from having one. The PCEHR seems to just make provision of that outcome more difficult!
Oh Well!
David.

No comments: