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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, August 05, 2009

The NHHRC and the Concept of the Patient Centered Medical Home.

In the last few years there has been a lot of discussion in the US about the concept of the Patient-Centred Medical Home (PCMH).

The definition of what is being talked about is here (from their main proponents).

http://www.aafp.org/online/en/home/policy/policies/p/patientcenteredmedhome.html

Patient-Centered Medical Home,

A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence and appropriate technology. These relationships offer patients comfort, convenience, and optimal health throughout their lifetimes.

In a little more detail what is envisaged is spelt out here:

“American Academy of Pediatrics President Jay Berkelhamer, M.D., agreed. “By its very definition, a medical home is a quality improvement approach that promotes a partnership between the child, the family and the physician care team,” he said in a March 5 news release accompanying the announcement of the principles. “This partnership not only optimizes quality care, but also minimizes patient risk because the medical home forges a safe bond and quality connection between the care delivered and the specific needs of the child and the family.”

According to the principles, key to the personal medical home are

  • a physician who has an ongoing relationship with patients, arranges care with other qualified professionals, and leads a team of professionals who take responsibility for the ongoing care of patients;
  • implementation of evidence-based medicine, continuous quality improvement, information technology, patient participation in care decisions and patient feedback;
  • improved access, such as open scheduling, expanded hours and new options for communication with patients; and
  • a payment system that recognizes the medical expertise, administrative requirements and time demands that come with providing a personal medical home.”

See here for more:

http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20070306medhomeprinciples.html

The four principles of the PCMC are endorsed by 330,000 doctors in the US. Bold italics highlights the important bit.

Principles

Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

More here:

http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home

There are many links and discussions of the concept, as envisaged in the US, to be found here:

http://en.wikipedia.org/wiki/Medical_home

From the NHHRC Final Report – Numbered Page 6 o the Executive Summary we have:

Connect and integrate health and aged care services

.....

To do this, we argue strongly that strengthened primary health care services in the community should be the ‘first contact’ for providing care for most health needs of Australian people. This builds upon the vital role of general practice. We want to create a platform for comprehensive care that brings together health promotion, early detection and intervention, and the management of people with ac ute and ongoing conditions. Our key recommendations to support this are:

bringing together and integrating multidisciplinary primary health care services, with the Commonwealth Government having responsibility for the policy and government funding of primary health care services that are currently funded or managed by state, territory and local governments;

improving access to a more comprehensive and multidisciplinary range of primary health care and specialist services in the community, through the establishment of Comprehensive Primary Health Care Centres and Services, which would be available for extended hours;

encouraging better continuity and coordinated care for people with more complex health problems – including people with chronic diseases and disabilities, families with young children, and Aboriginal and Torres Strait Islander people – under voluntary enrolment with a ‘health care home’ that can help coordinate, guide and navigate access to the right range of multidisciplinary health service providers;

establishing Primary Health Care Organisations to support better service coordination and population health planning, by evolving from or replacing the current system of Divisions of General Practice; and

promoting better use of specialists in the community, recognising the central role of specialists to the shared management of care for patients with complex and chronic health needs

The point of going through all this is to highlight a couple of points – other than simply pointing out how similar the approaches are.

First there does seem to be agreement around the world that a healthcare system built on a strong primary care base and an emphasis on continuity of care and prevention works pretty well and it as cost effective as can be achieved.

Second, there is a very important role for information technology in having such a model work optimally.

If the NHHRC is to achieve its stated goals it will need, in the first instance, to focus on ensuring there are appropriate levels of health IT implemented in the wider health provider community. Only with that executed properly will be broader goals be possible.

David.

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