Medicine
In my last post, I discussed the high hopes many have for improving health care through the medical home and the sobering results of the AAFP's National Demonstration Project, which fell short of fulfilling those hopes. The "PC" in PCMH stands for "patient-centered," which means changing primary care practice to better meet the needs of patients rather than allowing patients access to care only when convenient for the practice (which I'd call a "practice-centered" approach). Some ways that the AAFP's demonstration practices did this were to offer same-day scheduling and phone or electronic mail consultations in lieu of face-to-face visits.
The potential of primary care teams will not be achieved if medical homes are too "physician-centered." This point requires some clarification. Physicians have the most education and training of any person in the practice, and they should be doing primary care tasks commensurate with their training and ability, and no more. But the primary care team that succeeds will expect the same from all of its members, including the nurse practitioner, the physician assistant, the health educator, the medical assistant, etc. and just as importantly, be responsive to their input about improving inefficient or inadequate processes of care.
Reflecting in the Annals of Family Medicine on the lessons from the AAFP's attempt at creating a sustainable patient-centered medical home model, my friend and colleague Dr. Larry Green from the University of Colorado, Denver makes several valuable observations:
The PCMH is useful, even galvanizing, but limited, as a political construct and is best understood as the rallying point for robust, modernized primary care that now necessitates a new mind model from all of medicine, policy makers, and especially those wonderful clinicians and staff members taking care of most of the folks in the US today. PCMH is really not a thing, a collection of techniques; it is presently a journey toward a destination not yet crystal clear. ...
I am not at all concerned about all the "hoopla" around patient experience getting worse during a 26 month period and small effect sizes. ... What would one expect from a traffic survey of travelers on a road under repair if asked, "Does this ride delight you? Are you getting exactly what you want from this road the way you want it when you want it?" And to lament small effect sizes is akin to lamenting less than gorgeous blossoms on roses planted in a desert, with the gardener having only a cup of water each day.
Well said, Larry.
- Reinventing Primary Care: Themes And Challenges
. My May 27 entry, Universal Coverage and Primary Care: The US needs both, focused on one article from the May 2010 issue of the journal Health Affairs. That article, by Barbara Starfield, (“Reinventing Primary Care: Lessons from Canada for the United...
- How Care Teams Can Support Shared Decision Making In Primary Care (2 Of 2)
Yesterday, I delivered the keynote speech at the Team Care Challenge, sponsored by the Patient-Centered Primary Care Collaborative, Medstro, and the American Resident Project. This is the second of two posts containing the text of my talk. Part 1 is posted...
- Your Primary Care Team Will See You Now
In a previous post about how health reform will change your doctor's visits, I mentioned that you're likely to see your future primary care delivered by a "team" of health professionals rather than your doctor. You might be surprised to hear that...
- Patient-centered Primary Care: Easier Said Than Done
Two months ago, surgeon and New York Times columnist Pauline Chen observed that primary care demonstration projects have spent most of their efforts building components of the "medical home" - such as proactive, team-based care and health information...
- Can Primary Care Practices Be "dream Teams"?
The greatest U.S. Olympic basketball team ever assembled, dubbed the "Dream Team," dominated the rest of the world at the 1992 Summer Olympics. This team, which beat opponents by an average of 44 points en route to a gold medal, included 10 eventual NBA...
Medicine
Medical homes and the meaning of "P.C." - Part 2 of 2
In my last post, I discussed the high hopes many have for improving health care through the medical home and the sobering results of the AAFP's National Demonstration Project, which fell short of fulfilling those hopes. The "PC" in PCMH stands for "patient-centered," which means changing primary care practice to better meet the needs of patients rather than allowing patients access to care only when convenient for the practice (which I'd call a "practice-centered" approach). Some ways that the AAFP's demonstration practices did this were to offer same-day scheduling and phone or electronic mail consultations in lieu of face-to-face visits.
The potential of primary care teams will not be achieved if medical homes are too "physician-centered." This point requires some clarification. Physicians have the most education and training of any person in the practice, and they should be doing primary care tasks commensurate with their training and ability, and no more. But the primary care team that succeeds will expect the same from all of its members, including the nurse practitioner, the physician assistant, the health educator, the medical assistant, etc. and just as importantly, be responsive to their input about improving inefficient or inadequate processes of care.
Reflecting in the Annals of Family Medicine on the lessons from the AAFP's attempt at creating a sustainable patient-centered medical home model, my friend and colleague Dr. Larry Green from the University of Colorado, Denver makes several valuable observations:
The PCMH is useful, even galvanizing, but limited, as a political construct and is best understood as the rallying point for robust, modernized primary care that now necessitates a new mind model from all of medicine, policy makers, and especially those wonderful clinicians and staff members taking care of most of the folks in the US today. PCMH is really not a thing, a collection of techniques; it is presently a journey toward a destination not yet crystal clear. ...
I am not at all concerned about all the "hoopla" around patient experience getting worse during a 26 month period and small effect sizes. ... What would one expect from a traffic survey of travelers on a road under repair if asked, "Does this ride delight you? Are you getting exactly what you want from this road the way you want it when you want it?" And to lament small effect sizes is akin to lamenting less than gorgeous blossoms on roses planted in a desert, with the gardener having only a cup of water each day.
Well said, Larry.
- Reinventing Primary Care: Themes And Challenges
. My May 27 entry, Universal Coverage and Primary Care: The US needs both, focused on one article from the May 2010 issue of the journal Health Affairs. That article, by Barbara Starfield, (“Reinventing Primary Care: Lessons from Canada for the United...
- How Care Teams Can Support Shared Decision Making In Primary Care (2 Of 2)
Yesterday, I delivered the keynote speech at the Team Care Challenge, sponsored by the Patient-Centered Primary Care Collaborative, Medstro, and the American Resident Project. This is the second of two posts containing the text of my talk. Part 1 is posted...
- Your Primary Care Team Will See You Now
In a previous post about how health reform will change your doctor's visits, I mentioned that you're likely to see your future primary care delivered by a "team" of health professionals rather than your doctor. You might be surprised to hear that...
- Patient-centered Primary Care: Easier Said Than Done
Two months ago, surgeon and New York Times columnist Pauline Chen observed that primary care demonstration projects have spent most of their efforts building components of the "medical home" - such as proactive, team-based care and health information...
- Can Primary Care Practices Be "dream Teams"?
The greatest U.S. Olympic basketball team ever assembled, dubbed the "Dream Team," dominated the rest of the world at the 1992 Summer Olympics. This team, which beat opponents by an average of 44 points en route to a gold medal, included 10 eventual NBA...