In their September / October issue Health Affairs have provided some very interesting articles on the concept of the Medical Home and the place of Health IT is assisting the quality, safety and efficiency of chronic care delivery.
The Washington Post provides some useful coverage here:
Patient-Centered 'Medical Home' Models Lag in Key Areas
Wednesday, September 10, 2008; 12:00 AM
WEDNESDAY, Sept. 10 (HealthDay News) -- Many large physician groups in the United States lack the essential elements needed to create patient-centered "medical homes" designed to put primary-care doctors in charge of coordinating care, says a new study.
The medical home model is seen by many health-care providers, businesses and patients as a promising way to address problems with the country's health-care delivery system. It's believed that comprehensive primary care can ensure the best outcomes for patients.
But this study of large medical groups with at least 20 physicians found that the practices are lagging in key areas needed to created a medical home.
Between March 2006 and March 2007, researchers at the University of California, San Francisco, the University of California at Berkley, and the University of Chicago surveyed all large physician practices across the United States that treat patients with asthma, diabetes, congestive heart failure and depression.
The researchers focused vital elements of the medical home model: whether physicians work closely with other health-care providers in patient care teams; how well care is coordinated and integrated; whether care is delivered in ways that maximize quality and safety; and whether patients can reach physicians by e-mail or other nontraditional ways.
The use of electronic medical records, disease registries, patient reminders, performance feedback and distribution of educational materials to patients was also examined in the study.
…..
Overall, the largest medical groups in the study (those with more than 140 physicians) and those owned by a hospital or health maintenance organization (HMO) scored highest on the four critical areas of a medical home model. This may be because they have more resources to invest, the study authors said.
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More information
The Patient-Centered Primary Care Collaborative has more about the patient-centered medical home model.
More here:
http://www.washingtonpost.com/wp-dyn/content/article/2008/09/10/AR2008091001482.html
Coverage of another article is found here:
Report: Potential of Health IT Depends on Technical Standards and Policy Objectives
Focusing solely on the technical aspects of health information technology without also developing policy standards will not transform the nation’s health care system, according to an online report published this month in Health Affairs.
The report cites “serious structural barriers to the use of IT that have nothing to do with technology.” Obstacles include financial and legal incentives currently in place that don’t encourage information sharing across institutions, it said. In addition, many physicians and hospitals wonder how to shoulder the financial burden of implementing health IT, while consumers are concerned about privacy and security issues surrounding use of their medical information, the report said.
Initially adopting a minimal set of standards could pave the way to using health IT to overhaul the health care system, said the report’s authors, Carol Diamond, managing director of the Health Program at the Markle Foundation, and Clay Shirky, an adjunct professor at New York University. The authors suggests that information policy decisions should be made openly and not backed into through technology choices; that incremental changes have a greater chance of success; and that standards alone can’t compensate for the lack of a business case for sharing health information.
More here:
http://www.cqpolitics.com/wmspage.cfm?docID=hbnews-000002947413
For those who can access the full text the following look to be the most important articles.
Health Affairs Table of Contents
A new issue of Health Affairs is available online:
Overhauling The Delivery System:
September/October 2008; Vol. 27, No. 5
The below Table of Contents is available online at:
http://content.healthaffairs.org/content/vol27/issue5/
From the Editor
Innovations: ‘Medical Home’ Or Medical Motel ?
Susan Dentzer
Health Affairs 27(5): 1216-1217
http://content.healthaffairs.org/cgi/content/full/27/5/1216
Medical Home
The Medical Home
Health Affairs 27(5): 1218
http://content.healthaffairs.org/cgi/content/full/27/5/1218
A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign
Robert A. Berenson, Terry Hammons, David N. Gans, Stephen Zuckerman, Katie Merrell, William S. Underwood, and Aimee F. Williams
Health Affairs 27(5): 1219-1230
http://content.healthaffairs.org/cgi/content/abstract/27/5/1219
Continuous Innovation In Health Care: Implications Of The Geisinger Experience
Ronald A. Paulus, Karen Davis, and Glenn D. Steele
Health Affairs 27(5): 1235-1245
http://content.healthaffairs.org/cgi/content/abstract/27/5/1235
Measuring The Medical Home Infrastructure In Large Medical Groups
Diane R. Rittenhouse, Lawrence P. Casalino, Robin R. Gillies, Stephen M. Shortell, and Bernard Lau
Health Affairs 27(5): 1246-1258
http://content.healthaffairs.org/cgi/content/abstract/27/5/1246
Perspective
The Patient-Centered Medical Home For Chronic Illness: Is It Ready For Prime Time?
Jaan E. Sidorov
Health Affairs 27(5): 1231-1234
http://content.healthaffairs.org/cgi/content/abstract/27/5/1231
Web Exclusives
Health Information Technology: A Few Years Of Magical Thinking?
Carol C. Diamond and Clay Shirky
Health Affairs 27(5): w383-w390
http://content.healthaffairs.org/cgi/content/abstract/27/5/w383
Health Information Technology: Strategic Initiatives, Real Progress
Robert M. Kolodner, Simon P. Cohn, and Charles P. Friedman
Health Affairs 27(5): w391-w395
http://content.healthaffairs.org/cgi/content/abstract/27/5/w391
The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology
David C. Kibbe and Curtis P. McLaughlin
Health Affairs 27(5): w396-w398
http://content.healthaffairs.org/cgi/content/abstract/27/5/w396
There seems little doubt that the concept of a ‘Medical Home’ is gaining traction in the USA. I believe Dr Oliver Frank of Adelaide University is seeking similar outcomes. See the following:
Big step to improving patient care
10-Sep-2008
By Dr Oliver Frank
I BELIEVE patient enrolment is the biggest single step we can take towards improving our ability to provide all appropriate care for our patients.
We would know, for instance, that our practice is the only one responsible for providing all routine care for the patient. This includes preventive care and all routine consulting. Hospitals will no longer have to wonder who the patient’s usual GP is. They will be able to look it up.
If we want to send recall notices to the patient for some aspect of care, we will know that no other practice is likely to be doing so.
And we would know we would be paid for performing the various care plan items for the patient rather than finding out its been done by someone else.
More here (subscription required):
I think he is right and that any steps on the part of Ms Roxon to fracture the single responsible doctor as care co-ordinator for individual patients would be a very, very bad thing. We need more, not less co-ordination to improve health outcomes.
David.
3 comments:
Well said Oliver, you are absolutely right. Let's hope that the review of Primary Care comes to the same conclusion. Patient enrolment is at the core of a Primary Care strategy which is fundamental to creating a more efficient and effective health system.
Oliver's model looks much like the UK capitation system. Patients enrol with the medical practice of their choice (within their geographic area) and the practice receives a capitation fee per patient on their books. I think that's how it works.
No,
Oliver's model is registration - not capitation where payment is linked to registration. Payment in Oliver's model remains unchanged as the usual fee for service as I understand it.
David.
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