By Lorin T. SmithJanuary 19, 2010
The goal is simple: consult with a primary care provider-nurse team for all your medical needs.
This team will coordinate your specialty care, double-check your medications to make sure the prescriptions don't interfere with one another and most importantly, provide better clinical outcomes.
The concept was endorsed in a 2007 joint statement of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association on the "Patient-centered Medical Home."
Madigan Healthcare System, in conjunction with the Washington state Department of Health and Washington state Academy of Family Physicians, has embraced the concept of the "patient-centered medical home" to provide primary care to the Joint Base Lewis-McChord community.
The Washington state Patient-Centered Medical Home Collaborative is a two-year test project that strives to deliver primary health care through a "team partnership" between the primary care provider and the Family, to ensure health care services are provided in a high-quality, cost effective and comprehensive manner. Thirty-two primary care practices throughout the state participate in the program, including Madigan's Family Medicine Clinic.
The project is designed to improve health outcomes for patients, improve the patient and Family's experience of care, improve primary care team satisfaction and examine the overall health care costs impacted by the medical home implementation, according to the state's Web site. Col. (Dr.) Diane Flynn, the Department of Family Medicine chief, has devoted a great deal of effort applying these recommendations to its clinics.
Advancing a patient-centered focus to health care means a change from the rigid clinic-driven system to more flexible options that benefit dual-working Families, as part of the commitment made by the Army Family Covenant signed last year at Madigan.
Family Medicine has expanded evening appointments to accommodate parents who can't take their children out of school early; simplified clinic rules; strived to achieve a one-call resolution so patients get their appointments and implemented changes to make prescription renewals more hassle-free for the patient - all components of patient-centered care, Flynn added. "Our goal is to improve each patient's experience of care and to deliver the highest quality of care possible," she said.
Providers, nurses and administrative staff have been hired to bring enrollment, panel sizes, access to care and provider-to-support ratios in line with U.S. Army Medical Command standards. Doctors and nurses have "teamed" up to share responsibility of attending to patients.
Providers like it because they receive scheduled "desk-top medicine" time to allow for telephone and e-mail communication with patients. Flynn believes it is creating a positive impact on nurse morale within the department too. "A year ago, our nurses' role was focused on taking vital signs and rooming patients, but now, nurses are teamed up with a primary care provider, and the two of them share responsibility for the health, well-being and satisfaction of their panel of patients" Flynn said. "The nurses love the medical home idea because they see the positive impact on the health and satisfaction of our patients."
Billed as a possible solution to the health care debate that has dominated the airwaves during the past year, the medical home pilot may show that it can produce better medical outcomes at a lower cost, Flynn said.
A primary care provider that knows his or her patients and can coordinate the myriad of specialty and inpatient/outpatient care available will reduce the fragmentation of care and keep an eye on the prescriptions that could interact with medications the patient is already taking.
Technology is a key component of the medical home; patients are encouraged to enroll in MiCare, which provides online access to their personal electronic health record free of charge.
One of the biggest benefits of implementing a medical home is developing a process for preventive health care screening.
The state requires each hospital in the collaborative to report certain data, including the number of children who are up-to-date on their well-baby and well-child care; tobacco screening assessments - how many are using tobacco, and if so, how many have been counseled on quitting; how many patients have been screened for breast, cervical and colon cancer; how many diabetes patients are up-to-date and at goal on accepted standards; and how many patients aged 65 years or older are taking 15 or more medications.
Several other Military Treatment Facilities across the Army have implemented principles of the patient-centered medical home, and Flynn said the U.S. Army Surgeon General has expressed interest in expanding this concept across MEDCOM.
"If we improve outcomes, have happier staff and patients at lower cost, then we can spread that word across the Military Health System and help other clinics do this as well," Flynn said.
For more information about the Washington state Patient-Centered Medical Home Collaborative, visit the Web site at www.doh.wa.gov/cfh/WSC/Med-Home/What-is-MH.htm.