The patient-centered medical home as an intervention strategy for diabetes mellitus: A systematic review of the literature

2020 ◽  
Vol 16 ◽  
Author(s):  
Lisa S. McManus ◽  
Karen A. Dominguez-Cancino ◽  
Michele K. Stanek ◽  
Juan. M. LeyvaMoral ◽  
Carola E. Bravo-Tare ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Care Coordination ◽  
Medical Home ◽  
Health Care Expenditures ◽  
The United States ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Team Based Care ◽  
The Impact

Background: Poorly managed diabetes mellitus increases health care expenditures and negatively impact health outcomes. There are 34 million people living with diabetes in the United States with a direct annual medical cost of $237 billion. The patient-centered medical home (PCMH) was introduced to transform primary care by offering teambased care that is accessible, coordinated, and comprehensive. Although the PCMH is believed to address multiple gaps in delivering care to people living with chronic diseases, the research has not yet reported clear benefits for managing diabetes. Objective: To review the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understand the impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and health related outcomes. Method: The systematic review was performed according to the Cochrane method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight databases were systematically searched for articles. The Oxford Centre for Evidence-based Medicine levels of evidence and the Critical Appraisal Skills Programme systematic review checklist were used to evaluate the studies. Results: The search resulted in 596 articles, of which 24 met all the inclusion criteria. Care management resulted in more screenings and better preventive care. Pharmacy-led interventions and technology were associated with positive clinical outcomes, decreased utilization, and cost savings. Most studies reported decreased emergency room visits and less inpatient admissions. Conclusion : The quality and strength of the outcomes were largely inconclusive about the overall effectiveness of the PCMH. Defining and comparing concepts across studies was difficult as universal definitions specific to the PCMH were not often applied. More research is needed to unpack the care model of the PCMH to further understand how the individual key components, such as care bundles, contribute to improved outcomes. Further evaluations are needed for team-based care, communication, and care coordination with comparisons to patient, clinical, health, and financial outcomes.

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

2015 ◽  
Vol 7 (4) ◽  
pp. 580-588 ◽  
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.

scholarly journals Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes Among Patients of HRSA-Funded Health Centers

2018 ◽  
Vol 32 (4) ◽  
pp. 418-425 ◽  
Author(s):  
Nadereh Pourat ◽  
Xiao Chen ◽  
Christopher Lee ◽  
Weihao Zhou ◽  
Marlon Daniel ◽  
...  
Keyword(s):  
Medical Home ◽  
Health Centers ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
The Impact

scholarly journals Attributes of Effective Nurse Care Managers in Patient-Centered Medical Home

2012 ◽  
Author(s):  
Susan Corner
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Medical Home ◽  
Care Management ◽  
Improve Patient Care ◽  
The United States ◽  
Small Sample ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Nurse Care

<p>The burden of chronic disease on our medical system and on society is substantial and adds to the difficulty of managing ever-increasing amounts of patient information as care becomes more complex. It has placed the quality of health care in the United States (US) under scrutiny because of medical errors, lack of coordination, patient frustration and poor outcomes. In response to the many challenges, the Patient-Centered Medical Home (PCMH) model of care was developed and is designed to increase the value of our health care and to improve the experience for the patient. The role of the Nurse Care Manager (NCM) in PCMH to help patients with chronic disease is relatively new, but results in the literature are promising.</p> <p>In this evaluation study, the literature on effective NCM interventions and attributes is reviewed and summarized. In addition, a small sample of NCMs was interviewed to determine the specific attributes and interventions used by NCMs in PCMH. NCMs are effective in assisting patients in managing chronic disease, engaging and activating the patient, transition of care management, and using electronic medical records (EMR) to track patient outcomes. Collaboration with other clinicians, evidence-based and advanced protocol interventions, advanced education and training, and understanding the social and environmental context of the patient were all found to improve patient care. The findings from the literature as well as the interviews explore the components of effective nurse care management and the challenges for the NCM as the role evolves.</p>

Care Management and Care Coordination Within a Patient-Centered Medical Home

2020 ◽  
Vol 50 (11) ◽  
pp. 565-570
Author(s):  
Bonnie J. Wakefield ◽  
Michelle A. Lampman ◽  
Monica B. Paez ◽  
Greg L. Stewart
Keyword(s):  
Care Coordination ◽  
Medical Home ◽  
Care Management ◽  
Patient Centered Medical Home ◽  
Patient Centered

scholarly journals Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians

2015 ◽  
Vol 13 (3) ◽  
pp. 250-256 ◽  
Author(s):  
S. Morton ◽  
S. C. Shih ◽  
C. H. Winther ◽  
A. Tinoco ◽  
R. S. Kessler ◽  
...  
Keyword(s):  
National Survey ◽  
Care Coordination ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Health It ◽  
Patient Centered

Patient-Centered Care in a Medical Home

2011 ◽  
Vol 16 (2) ◽  
Author(s):  
Colette Carver ◽  
Anne Jessie
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Patient Centered Medical Homes ◽  
Medical Homes ◽  
Centered Care ◽  
Medical Home Model

There is general consensus that our current healthcare delivery system will not be able to supply an adequate workforce, contain costs, and meet the ever-increasing chronic-care needs of the growing and aging population in the United States (US). Some of the major challenges to the U.S. healthcare system are faced by those on the front lines, namely the healthcare workers in primary care. Part of the emerging solution for primary care is the adoption of the Patient-Centered Medical Home Model. The intent of this model is to provide coordinated and comprehensive care rooted in a strong collaborative relationship. Carilion Clinic in Southwestern Virginia is implementing this patient-centered model in which a proactive, multidisciplinary care team collectively takes responsibility for each patient. In this article we will elaborate on the concepts of patient-centered care and patient-centered medical homes, after which we will offer an exemplar describing the process that Carilion Clinic is using to establish patient-centered medical homes throughout their primary care departments. Limitations of the Patient-Centered Medical Home Model will also be discussed.

scholarly journals Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

2017 ◽  
Vol 5 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Anaïs Tuepker ◽  
Summer Newell ◽  
Christina Nicolaidis ◽  
Marie-Elena Reyes ◽  
Maria Carolina González-Prats ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Medical Home ◽  
Care Delivery ◽  
Hybrid Approach ◽  
The United States ◽  
Patient Centered Medical Home ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Centered

Background: The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date. Objective: We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which characteristics of care mattered most to their experiences. Method: Qualitative interviews were conducted with 32 veterans receiving primary care at 1 of 8 VA clinics in the northwest United States. Interviews were analyzed using an inductive–deductive hybrid approach by an interdisciplinary team that included a veteran patient. Result: Participants noticed recent positive changes, including improved communications and shorter waits in clinic, but rarely were aware of VA’s PCMH initiative; a strong relationship with the primary care provider and feeling cared for/respected by everyone involved in care delivery were key components of quality care. The needs of the veteran community as a whole also shaped discussion of care expectations. Conclusion: The PCMH model may provide benefits even when invisible to patients. Veteran awareness of population needs suggests a promising role for veteran involvement in further PCMH transformation efforts.

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