scholarly journals The Patient-Centered Medical Home for Refugee Children in Rhode Island

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Tecla Mtui Temu ◽  
Lisa Ratanaprasatporn ◽  
Linda Ratanaprasatporn ◽  
Delma-Jean Watts ◽  
Carol Lewis
Keyword(s):  
Rhode Island ◽  
Medical Home ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Refugee Children ◽  
Background Information ◽  
Missed Appointments ◽  
Patient Centered ◽  
Medical Interpreters

Purpose. To describe a “medical home” for pediatric refugees and its ability to provide culturally competent care, to partner with and train medical interpreters, and to improve health screening and follow-up adherence rates of pediatric refugees immigrating to Rhode Island. Methods. A retrospective chart review of refugees was performed. Background information, initial laboratory data, whether patients completed the recommended follow-ups scheduled at 1, 3, 6, and 12 months, and completion of tuberculosis treatment were recorded. Results. Since its initiation, 104 refugee children have attended the clinic ranging in age from 5 months to 18 years. Since the initiation of the medical home for refugee children in 2007, initial screening rates have gone up to 99-100% compared to a low of 41% in 2003–2006 prior to the establishment of the medical home. There was a 43% reduction in missed appointments in 15-month follow-up. Conclusion. The refugee “medical home” allows refugees to benefit from a comprehensive system for disease detection and ongoing primary health care.

scholarly journals Facilitators and Barriers to Implementing a Patient-Centered Oncology Care Model

2020 ◽  
Vol 16 (12) ◽  
pp. e1441-e1450
Author(s):  
Manasi A. Tirodkar ◽  
Lindsey Roth ◽  
Shelley Fuld Nasso ◽  
Mark W. Friedberg ◽  
Sarah H. Scholle
Keyword(s):  
Care Coordination ◽  
Medical Home ◽  
Financial Incentives ◽  
Technical Assistance ◽  
Patient Centered Care ◽  
Self Report ◽  
Patient Centered ◽  
Leadership Support ◽  
Centered Care

PURPOSE: Oncology practices often serve as the “medical home” for patients but may not have systems to support all aspects of patient-centered care. We piloted a new set of oncology medical home standards that call for accessible, continuous, coordinated, and team-based care. We examined how adoption of the standards varies across a variety of practices and compared practice self-report with external evaluation of implementation. METHODS: Five medical oncology practices in southeastern Pennsylvania implemented the standards from 2014 into 2016. Implementation support included training webinars and technical assistance. External reviewers evaluated practices’ implementation of the standards. We conducted site visits to interview providers and patients. RESULTS: Between baseline and follow-up, practice self-assessments and independent audits showed practices increased implementation of the patient-centered oncology standards. The largest improvement was seen in continuous quality improvement (QI). Practices were less successful in implementing care coordination: achievement on two standards (access and evidence-based decision support) declined from baseline to follow-up. Qualitative analyses revealed that practices focused QI in five areas: goals of care, engaging patients in QI, financial counseling, symptom management, and care coordination. Interviewees talked about facilitators, such as leadership support and physician buy-in, and barriers to transformation, including inadequate resources and staffing. Health information technology both supported and limited implementation. CONCLUSION: Oncology practices showed some progress in their implementation of patient-centered care processes over the course of the pilot program. Systems for tracking and documenting improvement, training for staff and clinicians, leadership support, and alignment of financial incentives are critical to transformation.

The Adolescent Patient Centered Medical Home Initiative of Rhode Island

2016 ◽  
Vol 58 (2) ◽  
pp. S23
Author(s):  
Joanna Brown ◽  
Patricia Stebbins ◽  
Victoria Adewale ◽  
Lauren Chan ◽  
Annie Gjelsvik ◽  
...  
Keyword(s):  
Rhode Island ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Adolescent Patient ◽  
Patient Centered

Retention: Building a Patient-Centered Medical Home in HIV Primary Care through PUFF (Patients Unable to Follow-up Found)

2012 ◽  
Vol 23 (3A) ◽  
pp. 81-95 ◽  
Author(s):  
Amy M. Sitapati ◽  
Jan Limneos ◽  
Militza Bonet-Vázquez ◽  
Moira Mar-Tang ◽  
Huifang Qin ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Hiv Primary Care

scholarly journals Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter?

2018 ◽  
Vol 66 (8) ◽  
pp. 1118-1123 ◽  
Author(s):  
Andrew D Schreiner ◽  
William P Moran ◽  
Jingwen Zhang ◽  
Elizabeth B Kirkland ◽  
Marc E Heincelman ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Repeat Testing ◽  
Liver Test ◽  
Clinical Patterns ◽  
Multiple Abnormalities ◽  
Liver Tests

Abnormal liver tests are extremely common in clinical practice, present with varying patterns and degrees of elevation, and can signal liver injury from a variety of causes. Responding to these abnormalities requires complex medical decision-making and merits investigation in primary care. This retrospective study investigates the association of patterns of liver test abnormality with follow-up in primary care. Using administrative data, this study includes patients with abnormal liver tests seen between 2007 and 2016 in a patient-centered medical home. Liver tests examined include serum bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Patients entered the cohort on the first liver test elevation. The outcome examined was completion of repeat testing, and the proportions of patients without follow-up were compared by patterns of index abnormality. 9545 patients met the inclusion criteria. Of these, 6155 (64.5%) possessed one liver test abnormality and 3390 (35.5%) possessed multiple abnormalities on index testing. Overall 1119 (11.7%) patients did not have repeat testing performed during the study period. A greater proportion of patients with lone abnormalities lacked repeat testing compared with those patients with multiple abnormalities. Differences in repeat testing appeared when comparing clinical patterns of abnormality, with higher proportions of follow-up in patients with testing suggestive of cholestasis. Over 11% of patients with abnormal liver tests did not undergo repeat testing during the study period. Repeat testing occurred more often in patients with multiple abnormalities and in clinical patterns suggestive of cholestasis. This study highlights a potential opportunity to improve quality of care.

scholarly journals Motivating residents to change communication: the role of a brief motivational interviewing didactic

2019 ◽  
Vol 20 ◽  
Author(s):  
Lisa Renee Miller-Matero ◽  
Erin T. Tobin ◽  
Elizabeth Fleagle ◽  
Joseph P. Coleman ◽  
Anupama Nair
Keyword(s):  
Motivational Interviewing ◽  
Medical Home ◽  
Training Programs ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Residency Programs ◽  
Change Communication ◽  
Post Test

Abstract Introduction: Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents’ knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. Methods: Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. Results: The residents’ knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. Conclusion: The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.

Accountable Care in Transitions (ACTion): A Team-Based Approach to Reducing Hospital Utilization in a Patient-Centered Medical Home

2017 ◽  
Vol 31 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Emily M. Hawes ◽  
Jennifer N. Smith ◽  
Nicole R. Pinelli ◽  
Rayhaan Adams ◽  
Gretchen Tong ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Medical Provider ◽  
Care Needs ◽  
Patient Centered ◽  
Access To Primary Care ◽  
Transition Points ◽  
The Impact

Background: There is limited data describing the role of the patient-centered medical home (PCMH) in successful transitions programs and more information is needed to determine the transition points where pharmacist involvement is most impactful. Methods: A family medicine center developed a multidisciplinary outpatient-based transitions program focused on reducing emergency department (ED) and hospital use in medically complex patients. Key team members were a medical provider, clinical pharmacist practitioner (CPP), and care manager. The objective was to evaluate the impact of the program by comparing utilization before and after the intervention and to identify patient and process characteristic predictors of 30-day rehospitalizations. Results: Of the 268 patients included, the mean time to follow-up appointment attended was 11.6 (11.8) days after discharge. The majority of patients (72%) saw their primary care provider at follow-up. Patients experiencing the multidisciplinary intervention had lower 30-day rehospitalizations at 7, 14, and 30 days postdischarge with significance achieved at 14 and 30 days. Compared to before the intervention, reductions in both ED visits and hospitalizations as well as increases in clinic visits were seen at 1, 3, and 6 months. CPP involvement was associated with lower rehospitalizations (7.7% vs 18.8%; P = .04). Conclusion: A multidisciplinary outpatient-based transitions program embedded in the PCMH increased access to primary care and reduced hospital and ED utilization. Face-to-face CPP involvement significantly lowered rehospitalizations. This program describes a standardized approach to complex care needs with defined roles, a model that may be generalizable and reproduced in other medical homes.

Statin Adherence Rates in Patients Utilizing a Patient-Centered Medical Home-Based Pharmacy

2016 ◽  
Vol 30 (5) ◽  
pp. 516-520 ◽  
Author(s):  
Erin M. Slazak ◽  
Jessica T. Kozakiewicz ◽  
Natalie S. Winters ◽  
Jason R. Smith ◽  
Scott V. Monte
Keyword(s):  
Statin Therapy ◽  
Medical Home ◽  
Retrospective Chart Review ◽  
Third Party ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Home Based ◽  
Gender And Age ◽  
Costs Of Treatment ◽  
Statin Adherence

Background: Medication nonadherence contributes to approximately US$290 billion per year in avoidable health-care spending. Statins are of particular interest because of their importance to patient outcomes, costs of treatment failure, and categorization as a Medicare star measure linked to financial reimbursement. Objective: To evaluate statin adherence as defined by the proportion of days covered (PDC) among patients who use an embedded dispensing pharmacy in a patient-centered medical home (PCMH). Methods: This study is a retrospective chart review of Lifetime Health Medical Group’s electronic health record and third-party prescription claims data of statin therapy. Statin adherence is reported using PDC, with 0.8 or greater considered adherent for statin therapy. Statistics used include 2-sample unpaired t test to compare PDC between gender and age, and analysis of variance was used to determine differences in PDC among different insurance types. Results: One hundred ninety-three patients were included, and 917 statin prescriptions were filled. PDC for statin medications in the population was 0.92 ± 0.20. Eighty-six percent of patients were considered adherent, with a PDC ≥80%. The average insurance and patient costs for brand prescriptions (n = 106) were US$233 ± US$143 and US$31 ± US$27, respectively, and costs for generic prescriptions (n = 811) were US$8 ± US$13 and US$7 ± US$6, respectively. Conclusion: Statin adherence rates for patients utilizing a dispensing pharmacy embedded in a large PCMH exceed the national average of 40% to 50% adherence.

scholarly journals What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

2018 ◽  
Vol 6 ◽  
pp. 205031211878193
Author(s):  
Roberta E Goldman ◽  
Joanna Brown ◽  
Patricia Stebbins ◽  
Donna R Parker ◽  
Victoria Adewale ◽  
...  
Keyword(s):  
Primary Care ◽  
Rhode Island ◽  
Medical Home ◽  
Teaching Practice ◽  
The United States ◽  
Personal Accomplishment ◽  
System Evaluation ◽  
Patient Centered Medical Home ◽  
Implementation Barriers ◽  
Patient Centered

Objectives: Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at eight primary care teaching practice sites in Rhode Island. It provides a picture of system changes from the perspective of providers, staff, and patients in these practices. Methods: Quantitative/qualitative evaluation methods include patient, provider, and staff surveys and qualitative interviews; practice observations; and focus groups with the intervention facilitation team. Results: Patient satisfaction in the practices was high. Patients could describe observable elements of patient-centered medical home functioning, but they lacked explicit awareness of the patient-centered medical home model, and their activation decreased over time. Providers’ and staff’s emotional exhaustion and depersonalization increased slightly over the course of the intervention from baseline to follow-up, and personal accomplishment decreased slightly. Providers and staff expressed appreciation for the patient-centered medical home as an ideal model, variously implemented some important patient-centered medical home components, increased their understanding of patient-centered medical home as more than specific isolated parts, and recognized their evolving work roles in the medical home. However, frustration with implementation barriers and the added work burden they associated with patient-centered medical home persisted. Conclusion: Patient-centered medical home transformation is disruptive to practices, requiring enduring commitment of leadership and personnel at every level, yet the model continues to hold out promise for improved delivery of patient-centered primary care.

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