Medical home
Sia, MD, a Honolulu-based pediatrician, in pursuit of new approaches to improve early childhood development in Hawaii in the 1980s[14] laid the groundwork for an academy policy statement in 1992 that defined a medical home largely the way Sia conceived it: a strategy for delivering the family-centered, comprehensive, continuous, and coordinated care that all infants and children deserve.
[18] These services should be "accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians.
[5] Defining principles included: A survey of 3,535 U.S. adults released in 2007 found that 27 percent of the respondents reported having "four indicators of a medical home.
The onsite survey is conducted by surveyors who are qualified professionals – physicians, registered nurses, administrators and others – who have first-hand experience with ambulatory health care organizations.
The AAAHC Accreditation Handbook for Ambulatory Health Care includes a chapter specifically devoted to medical home standards, including assessment of the following characteristics: In addition, electronic data management must be continually assessed as a tool for facilitating the Accreditation Association medical home.
AAAHC Medical Home Accreditation also requires that core standards required of all ambulatory organizations seeking AAAHC Accreditation be met, including: Standards for rights of patients; governance; administration; quality of care; quality management and improvement; clinical records and health information; infection prevention and control, and safety; and facilities and environment.
[40] The National Committee for Quality Assurance's (NCQA) "Physician Practice Connections and Patient Centered Medical Home" (PPC-PCMH) Recognition Program emphasizes the systematic use of patient-centered, coordinated care management processes.
It is an extension of the Physician Practice Connections Recognition Program, which was initiated in 2003 with support from organizations such as The Robert Wood Johnson Foundation, The Commonwealth Fund and Bridges to Excellence.
[42] With the guidance from the ACP, the AAFP, the AAP and the AOA the NCQA launched PPC-PCMH and based the program on the medical home joint principles developed by these organizations.
[43] If practices achieve NCQA's PCMH Recognition they can take advantage of financial incentives that health plans, employers, federal and state-sponsored pilot programs offer and they may qualify for additional bonuses or payments.
"[48] Nevertheless, the seven-country study of Schoen et al. found that the prevalence of medical homes was highest in New Zealand (61%) and lowest in Germany (45%).
[59] More recent analyses show that the program improved the quality of care for asthma and diabetes patients significantly, reducing emergency department and hospital use that produced savings of $150 million in 2007 alone.
The CSI-RI Medical Home demonstration officially launched in October 2008 with 5 primary care practices and was expanded in April 2010 to include an additional 8 sites.
[62][63] Thirteen primary care sites, 66 providers, 39 Family Medicine residents, 68,000 patients (46,000 covered lives), and all Rhode Island payers are participating in the demonstration.
Since the start of the demonstration, CSI-RI sites have implemented a series of delivery system reforms in their practices, aimed at becoming patient-centered medical homes, and in turn receive a supplemental per-member-per-month payment from all of Rhode Island's insurers.
[64] The Agency for Healthcare Research and Quality offers grants to primary care practices in order for them to become patient-centered medical homes.
More specifically, the project served as a learning lab to gain better insight into the kinds of hands-on technical support family physicians want and need to implement the PCMH model of care.
Learn more about National Demonstration Project Between 2002 and 2006, Group Health Cooperative made reforms to increase efficiency and access at 20 primary care clinics in western Washington.
These four core functions consist of providing "accessible, comprehensive, longitudinal, and coordinated care in the context of families and community".
