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https://www.readbyqxmd.com/read/27909251/-in-principle-we-have-agreement-but-in-practice-it-is-a-bit-more-difficult-obtaining-organizational-buy-in-to-patient-centered-medical-home-transformation
#1
Janelle Applequist, Michelle Miller-Day, Peter F Cronholm, Robert A Gabbay, Deborah S Bowen
The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state...
November 30, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27893520/impact-of-a-patient-centered-medical-home-pilot-on-utilization-quality-and-costs-and-variation-in-medical-homeness
#2
Signe Peterson Flieger
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. Data included the New Hampshire Comprehensive Healthcare Information System and Medical Home Index (MHI) scores for 9 pilot sites. A quasi-experimental, difference-in-difference model with propensity score-matched comparison group was employed. MHI scores were collected in late 2011. There were no statistically significant findings for utilization, cost, or quality in the expected direction...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893519/effects-of-hospital-systems-on-medical-home-transformation-in-primary-care-residency-training-practices
#3
Kyle Knierim, Tristen Hall, Douglas Fernald, Thomas J Staff, Emilie Buscaj, Jessica Cornett Allen, Mary Onysko, W Perry Dickinson
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27887032/provider-perception-of-pharmacy-services-in-the-patient-centered-medical-home
#4
Nicole P Albanese, Alyssa M Pignato, Scott V Monte
BACKGROUND: Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. OBJECTIVE: To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. METHODS: A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group...
November 24, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27876686/encouraging-patient-portal-use-in-the-patient-centered-medical-home-three-stakeholder-perspectives
#5
Gemmae M Fix, Timothy P Hogan, Daniel J Amante, D Keith McInnes, Kim M Nazi, Steven R Simon
BACKGROUND: Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. OBJECTIVE: We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. METHODS: Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system...
November 22, 2016: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/27875602/practice-facilitation-for-pcmh-implementation-in-residency-practices
#6
Emilie Buscaj, Tristen Hall, Linda Montgomery, Douglas H Fernald, Jaclyn King, Nicole Deaner, W Perry Dickinson
BACKGROUND AND OBJECTIVES: Primary care residency programs continue to adapt and change to become high-performing training sites for advanced primary care. Practice facilitation is a key method to assist practices in implementing organizational changes. This evaluation described the unique nature and essential roles and qualities of practice facilitation for residency program patient-centered medical home (PCMH) transformation. METHODS: Evaluation of the Colorado Residency PCMH Project from 2009 through 2014 included template and immersion-crystallization approaches to qualitative analysis of field notes, key informant interviews, and meeting documentation to identify themes related to external facilitation for practice transformation in 11 Colorado primary care residency practices...
November 2016: Family Medicine
https://www.readbyqxmd.com/read/27875601/association-between-patient-centered-medical-home-features-and-satisfaction-with-family-medicine-residency-training-in-the-us
#7
Patricia A Carney, Elaine Waller, Eve Dexter, Miguel Marino, Stephanie E Rosener, Larry A Green, Geoffrey Jones, J Drew M Keister, Julie A Dostal, Samuel M Jones, M Patrice Eiff
BACKGROUND AND OBJECTIVES: Primary care residencies are undergoing dramatic changes because of changing health care systems and evolving demands for updated training models. We examined the relationships between residents' exposures to patient-centered medical home (PCMH) features in their assigned continuity clinics and their satisfaction with training. METHODS: Longitudinal surveys were collected annually from residents evaluating satisfaction with training using a 5-point Likert-type scale (1=very unsatisfied to 5=very satisfied) from 2007 through 2011, and the presence or absence of PCMH features were collected from 24 continuity clinics during the same time period...
November 2016: Family Medicine
https://www.readbyqxmd.com/read/27870544/referrals-and-the-pcmh-how-well-do-we-know-our-neighborhood
#8
Andrew Schreiner, Patrick Mauldin, Jingwen Zhang, Justin Marsden, William Moran
OBJECTIVES: Characterize patterns of referral from a patient-centered medical home (PCMH) and observe the association of provider experience, patient chronic disease burden, and risk of utilization on referral placement. STUDY DESIGN: Descriptive analysis of referral patterns in an academic, internal medicine PCMH. METHODS: We examined referrals (eg, specialist visit, testing, ancillary services) placed between July and December of 2014 in an academic PCMH caring for a total of 12,000 patients...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27852789/patient-centered-medical-home-capacity-and-ambulatory-care-utilization
#9
Larry R Hearld, Kristine R Hearld, Claudia Guerrazzi
The patient-centered medical home (PCMH) has increasingly received attention as a model of care to potentially remedy the cost and quality problems that confront the US health care system, including and especially ambulatory care-related issues. This study examined the association between physician practices' PCMH capacity and 3 indicators of ambulatory care utilization: (1) emergency department utilization, (2) ambulatory care sensitive hospitalization rate, and (3) 30-day all-cause readmission rate. Results show that overall PCMH capacity is associated with lower rates, and technical aspects of the PCMH in particular were associated with lower utilization rates while interpersonal capabilities were not...
November 15, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/27849352/medical-home-transformation-and-breast-cancer-screening
#10
Amy W Baughman, Phyllis Brawarsky, Tracy Onega, Tor D Tosteson, Qianfei Wang, Anna N A Tosteson, Jennifer S Haas
OBJECTIVES: The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service. STUDY DESIGN: Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts. METHODS: Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27836506/evaluating-community-health-centers-adoption-of-a-new-global-capitation-payment-echange-study-protocol
#11
H Angier, J P O'Malley, M Marino, K J McConnell, E Cottrell, R L Jacob, S Likumahuwa-Ackman, J Heintzman, N Huguet, S R Bailey, J E DeVoe
Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon's Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment...
November 9, 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27833396/strengthening-the-coordination-of-pediatric-mental-health-and-medical-care-piloting-a-collaborative-model-for-freestanding-practices
#12
Carolyn A Greene, Julian D Ford, Barbara Ward-Zimmerman, Lisa Honigfeld, Anne E Pidano
BACKGROUND: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model...
October 2016: Child & Youth Care Forum
https://www.readbyqxmd.com/read/27818428/implementation-of-the-patient-centered-medical-home-model-in-facilities-providing-comprehensive-care-to-medically-underserved-populations
#13
Rachel Mosher Henke, Jayne Johann, Mahil Senathirajah, Maren Crandell, Lisa Parker, Lynn Riley, Grafton Adams, Fred Echoles, Michelle Mack, Jennifer Donovan, Robert Fleming, William Tulloch
During the three-year Centers for Medicare & Medicaid Services Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration, 393 FQHCs (78.6% of the original 500 and 90.6% of the 434 continually-enrolled FQHCs) achieved patient-centered medical home (PCMH) recognition. Facilitators included survey fee coverage and technical assistance.
2016: Journal of Health Care for the Poor and Underserved
https://www.readbyqxmd.com/read/27783702/who-treats-patients-with-diabetes-and-compensated-cirrhosis
#14
Tsai-Ling Liu, A Sidney Barritt Iv, Morris Weinberger, John E Paul, Bruce Fried, Justin G Trogdon
BACKGROUND: Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. OBJECTIVE: We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. DESIGN: Retrospective cross-sectional study using 2000-2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases...
2016: PloS One
https://www.readbyqxmd.com/read/27783547/the-impact-of-patient-centered-medical-homes-on-quality-of-care-and-medication-adherence-in-patients-with-diabetes-mellitus
#15
JaeJin An
BACKGROUND: Current evidence suggests that patient-centered medical homes (PCMHs) potentially increase overall quality of disease management, including preventive care. However, there are mixed findings regarding quality of diabetes care, and little evidence exists with respect to the effect of PCMHs on medication adherence in patients with diabetes. OBJECTIVE: To investigate associations between PCMHs and process measures of diabetes care, as well as adherence to oral hypoglycemic agents (OHAs) in patients with diabetes in a nationally representative U...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27769897/evaluating-a-novel-health-system-intervention-for-chronic-kidney-disease-care-using-the-re-aim-framework-insights-after-two-years
#16
Denise M Hynes, Michael J Fischer, Linda A Schiffer, Rani Gallardo, Ifeanyi Beverly Chukwudozie, Anna Porter, Michael Berbaum, Jennifer Earheart, Marian L Fitzgibbon
INTRODUCTION: Using a quasi-experimental design, we implemented the Patient-Centered Medical Home for Kidney Disease (PCMH-KD), a comprehensive, multidisciplinary care team to improve quality of life and healthcare coordination for adult chronic hemodialysis (CHD) patients. This paper highlights our experience in the first two years of the study. We focus on the process dimensions of Reach, Adoption, and Implementation within the context of the RE-AIM framework. MATERIALS AND METHODS: We established a new PCMH-KD model at two outpatient dialysis centers...
October 18, 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27740673/patient-centered-medical-home-exposure-and-its-impact-on-pa-career-intentions
#17
Gerald Kayingo, Owais Gilani, Vasco Deon Kidd, Mary L Warner
BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs...
October 2016: Family Medicine
https://www.readbyqxmd.com/read/27692504/association-of-healthy-home-environments-and-use-of-patient-centered-medical-homes-by-children-of-low-income-families
#18
Xin Hu, Victoria L Phillips, Laura M Gaydos, Peter Joski
INTRODUCTION: Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH. METHOD: We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs...
September 27, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/27681310/pediatric-informed-facilitation-of-patient-centered-medical-home-transformation
#19
Valerie S Harder, Webb E Long, Susan E Varni, Jenney Samuelson, Judith S Shaw
Patient-centered medical home (PCMH) transformation has been challenging for pediatric practices, in part because of the National Committee for Quality Assurance (NCQA) PCMH focus on conditions and processes specific to adult patients. Realizing the potential challenges faced by pediatric practices, Vermont supported pediatric-informed facilitators to help practices during PCMH transformation. This study characterizes the impact of pediatric-informed facilitators; provides benchmark data on NCQA scores, number of facilitation meetings, and the time between facilitation start and end; and compares pediatric- and adult-serving practices...
September 27, 2016: Clinical Pediatrics
https://www.readbyqxmd.com/read/27659297/medical-home-characteristics-and-quality-of-diabetes-care-in-safety-net-clinics
#20
Kathryn E Gunter, Robert S Nocon, Yue Gao, Lawrence P Casalino, Marshall H Chin
We examined associations between patient-centered medical home (PCMH) characteristics and quality of diabetes care in 15 safety net clinics in five states. Surveys among clinic directors assessed PCMH characteristics using the Safety Net Medical Home Scale. Chart audits among 864 patients assessed diabetes process and outcome measures. We modeled the odds of the patient receiving performance measures as a function of total PCMH score and of PCMH subscales and covariates. PCMH characteristics had mixed, inconsistent associations with the quality of diabetes care...
September 22, 2016: Journal of Community Health
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