The Patient-Centered Healthcare Home

What is the Medical Home Concept? While the medical home concept has its origins in pediatric care, the concept has expanded as the general healthcare system has contemplated the shift from a focus on episodic acute care to a focus on managing the health of defined populations, especially those living with chronic health conditions. Several seminal commentaries influenced thinking about how team-based care might improve clinical care and achieve optimal population health, establishing the foundation for a more detailed conceptualization of the medical home: > The Chronic Care Model, a structured approach for clinical improvement through team based care supported by an organizational and information technology infrastructure, which is the basis for the Bureau of Primary Health Care's (BP) Health Disparities Collaborative. > The Institute of Medicine's (IOM) first Quality Chasm report which articulated Six Aims and Ten Rules to guide the redesign of healthcare, including the importance of team-based care. This roadmap for improving quality in the healthcare system stated that healthcare should be safe, effective, patient-centered, timely, efficient, and equitable. The Chronic Care Model, Health Disparities Collaborative and Quality Chasm Aims and Rules are described in Appendices A and B. Building on this foundation, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association released their Joint Principles of the Patient-Centered Medical Home in 2007. > Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care. > Physician directed medical practice - the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. > Whole person orientation - the personal physician is responsible for providing for all the patient's healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life: acute care, chronic care, preventive services, and end of life care. > Care is coordinated and/or integrated across all elements of the complex healthcare system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient's community (e.g., family, public and private community based services). Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. > Quality and safety are hallmarks of the medical home. > Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physician, and practice staff. > Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. Barr recently summarized the rationale for the patient-centered medical home, pointing to the unwarranted variation in our nation's delivery of healthcare and the lack of relationship between what is spent and the quality of the services that are delivered. He also notes that, while research suggests a robust primary care system is a major characteristic of an efficient and high-quality healthcare system, the U.S. primary care system is uncertain, perhaps close to collapse.