Patient Vs. Soldier-Centered Medical Home: Comparing Access, Continuity, and Communication in the U.S. Army

ABSTRACT Introduction Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army’s most vital asset—the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. Materials and Methods This was a retrospective, cross-sectional, and correlational study. We used a subset of data from the Military Data Repository collected between January 1, 2018, and December 31, 2018. The sample included 266 medical home teams providing care for active duty soldiers. Only active duty soldiers were included in the sample. We reviewed current U.S. Army Medical Department policies to describe the structures and operational functioning of PCMHs and SCMHs. General linear mixed regressions were used to evaluate the associations between medical home type and outcome measures. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. Results There was no significant difference in access to 24-hour and future appointments or soldiers’ perception of access between PCMHs and SCMHs. There was no significant difference in primary care manager continuity. There was a significant difference in medical home team continuity (P < .001), with SCMHs performing better. There was no significant difference in patient-centered communication scores. Our analysis showed that while the PCMH and SCMH models were designed to improve primary care manager continuity, access to care, and communication, medical home teams within the U.S. Army are not consistently meeting the Military Health System standard of care benchmarks for these care processes. Conclusions Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness.

Download Full-text

Soldier-Centered Care: A Concept Analysis

Military Medicine ◽

10.1093/milmed/usz448 ◽

2020 ◽

Vol 185 (3-4) ◽

pp. e422-e430

Author(s):

Tanekkia M Taylor-Clark ◽

Patricia A Patrician

Keyword(s):

Primary Care ◽

Physical Performance ◽

Patient Centered Care ◽

Concept Analysis ◽

Medical Department ◽

Patient Centered ◽

Medical Needs ◽

Leadership Support ◽

Centered Care ◽

The U.S

Abstract Introduction It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. Methods Rodgers’ evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. Results The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier’s unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. Conclusions The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.

Download Full-text

Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics

Healthcare ◽

10.1016/j.hjdsi.2014.09.008 ◽

2014 ◽

Vol 2 (4) ◽

pp. 238-244 ◽

Cited By ~ 8

Author(s):

Christian D. Helfrich ◽

Emily D. Dolan ◽

Stephan D. Fihn ◽

Hector P. Rodriguez ◽

Lisa S. Meredith ◽

...

Keyword(s):

Primary Care ◽

Medical Home ◽

Patient Centered Care ◽

Patient Centered ◽

Home Team ◽

Primary Care Clinics ◽

Centered Care ◽

Team Based Care

Download Full-text

Faculty Opinions recommendation of Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1157385.617540 ◽

2009 ◽

Author(s):

Stewart Babbott

Keyword(s):

Primary Care ◽

Medical Home ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Care Practices ◽

Primary Care Practices

Download Full-text

Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00597.1 ◽

2015 ◽

Vol 7 (4) ◽

pp. 580-588 ◽

Cited By ~ 4

Author(s):

Fadya El Rayess ◽

Roberta Goldman ◽

Christopher Furey ◽

Rabin Chandran ◽

Arnold R. Goldberg ◽

...

Keyword(s):

Primary Care ◽

Situated Learning ◽

Medical Home ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Individual Interviews ◽

Knowledge And Attitudes ◽

Positive Attitudes ◽

Level 3 ◽

The Impact

ABSTRACT Background The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Brown University achieved Level 3 PCMH accreditation in 2010, with training relying primarily on situated learning through immersion in PCMH practice, supplemented by didactics and a few focused clinical activities. Objective To assess PCMH knowledge and attitudes after Level 3 PCMH accreditation and to identify additional educational needs. Methods We used a qualitative approach, with semistructured, individual interviews with 12 of the program's 13 postgraduate year 3 residents and 17 of 19 core faculty. Questions assessed PCMH knowledge, attitudes, and preparedness for practicing, teaching, and leading within a PCMH. Interviews were analyzed using the immersion/crystallization method. Results Residents and faculty generally had positive attitudes toward PCMH. However, many expressed concerns that they lacked specific PCMH knowledge, and felt inadequately prepared to implement PCMH principles into their future practice or teaching. Some exceptions were faculty and resident leaders who were actively involved in the PCMH transformation. Barriers included lack of time and central roles in PCMH activities. Conclusions Practicing in a certified PCMH training program, with passive PCMH roles and supplemental didactics, appears inadequate in preparing residents and faculty for practice or teaching in a PCMH. Purposeful curricular design and evaluation, with faculty development, may be needed to prepare the future leaders of primary care.

Download Full-text