Patient Centered Medical Home Chapter
2 || With Complete Solutions and
Explanations (Expert Rated A+)
The intuitive mind is a sacred gift, and the rational mind
is a faithful servant. We have created a society in which
we honor the servant and have forgotten the gift.
ALBERT EINSTEIN
History
The concept of the "medical home" was first described in
Standards of Child Care by the American Academy of
Pediatrics (AAP) Council on Pediatrics Practice in 1967. It
defined "ideal care" for children with disabilities as a practice
that provided care that was accessible, coordinated,
family-centered, and culturally effective.
The American Academy of Family Physicians (AAFP)
used this concept to expand the characteristics based on
discussions defining the future of family medicine. These
characteristics described the "personal" medical home,
which focused on bringing attention to the importance of
continuous, relationship-centered, whole-system, comprehensive
care for communities (Martin et al., 2004). In
2007, the AAP, AAFP, Am - ANSWER - collaborated to define further the foundational principles
of the patient-centered medical home (PCMH; Table 2-1).
The goal of the medical home is to emphasize the importance
of primary care in maximizing quality of care, health
outcomes, and the patient experience, with improved cost
efficiency, called "the "triple aim" by the Institute for
Healthcare Improvement (IHI, 2014).
However, the ingredients of the medical home (or "health
home") continue to be defined and modified based on the
needs of the clinicians and communities that implement
them. These ingredients and how they are delivered are key
to the achievement of the lofty goals of the medical home
and family medicine in general. This chapter discusses the
most important ingredients for the medical home and the
actions that the family physician can take to create one.
Healing, Curing, and the Goals
of the Medical Home
Medicine in general and primary care in particular involve
constant tension between the diagnosis and elimination of disease (cure) on one hand and the alleviation of suffering
(healing) on the other. In this context, healing means - ANSWER - Principles of a Patient-Centered Medical Home
1. Access to care based on an ongoing relationship with a personal
physician who is able to provide first-contact, continuous, and
comprehensive care
2. Care provided by a physician-led team of individuals within the
practice who collectively take responsibility for the ongoing needs
of patients
3. Care based on a whole-person (holistic) orientation in which the
practice team takes responsibility for either providing care that
encompasses all patient needs or arranges for the care to be done
by other qualified professionals
4. Care coordinated and integrated across all elements of the
complex health care system and the patient's community
5. Care facilitated by the use of office practice systems (e.g.,
registries, information technology, health information exchange)
to ensure that patients receive the indicated care when and where
they need and want it in a culturally and linguistically appropriate
manner
6. Reimbursement structure that supports and encourages this
model of care
optimizing patients' responses to treatments and helping
them cope emotionally and practically with whatever condition
they face, even when cure is not possible.
In The Nature of Suffering and the Goals of Medicine, Cassell
(2004) elegantly describes this tension and the continual
erosion of healing practices under the pressure to apply
more specific, technologic cures. In A Time to Heal, Ludmerer
(1999) documents how, despite decades of efforts in curriculum
change, these core values of healing in medical
education have failed to gain significant traction under the
forces driving the payment for cure-seeking behaviors.
Thus, physicians seeking to create a medical home that
balances cure and healing face considerable challenges,
especially in the delivery of healing. What are the essential
components of such a health care home? How can they be
delivered in the current medical context? What actions
must a family physi - ANSWER - BALANCING TREATMENT OF DISEASE AND
PROMOTION OF HEALTH AND HEALING
Health is largely a result of positive lifestyle behaviors that
are often challenging to implement. Addressing issues
such as smoking, obesity, substance abuse, and inactivity
can reduce premature death by 40% (McGinnis et al.,
2002; Schroeder, 2007). Positive lifestyle behaviors not
2 || With Complete Solutions and
Explanations (Expert Rated A+)
The intuitive mind is a sacred gift, and the rational mind
is a faithful servant. We have created a society in which
we honor the servant and have forgotten the gift.
ALBERT EINSTEIN
History
The concept of the "medical home" was first described in
Standards of Child Care by the American Academy of
Pediatrics (AAP) Council on Pediatrics Practice in 1967. It
defined "ideal care" for children with disabilities as a practice
that provided care that was accessible, coordinated,
family-centered, and culturally effective.
The American Academy of Family Physicians (AAFP)
used this concept to expand the characteristics based on
discussions defining the future of family medicine. These
characteristics described the "personal" medical home,
which focused on bringing attention to the importance of
continuous, relationship-centered, whole-system, comprehensive
care for communities (Martin et al., 2004). In
2007, the AAP, AAFP, Am - ANSWER - collaborated to define further the foundational principles
of the patient-centered medical home (PCMH; Table 2-1).
The goal of the medical home is to emphasize the importance
of primary care in maximizing quality of care, health
outcomes, and the patient experience, with improved cost
efficiency, called "the "triple aim" by the Institute for
Healthcare Improvement (IHI, 2014).
However, the ingredients of the medical home (or "health
home") continue to be defined and modified based on the
needs of the clinicians and communities that implement
them. These ingredients and how they are delivered are key
to the achievement of the lofty goals of the medical home
and family medicine in general. This chapter discusses the
most important ingredients for the medical home and the
actions that the family physician can take to create one.
Healing, Curing, and the Goals
of the Medical Home
Medicine in general and primary care in particular involve
constant tension between the diagnosis and elimination of disease (cure) on one hand and the alleviation of suffering
(healing) on the other. In this context, healing means - ANSWER - Principles of a Patient-Centered Medical Home
1. Access to care based on an ongoing relationship with a personal
physician who is able to provide first-contact, continuous, and
comprehensive care
2. Care provided by a physician-led team of individuals within the
practice who collectively take responsibility for the ongoing needs
of patients
3. Care based on a whole-person (holistic) orientation in which the
practice team takes responsibility for either providing care that
encompasses all patient needs or arranges for the care to be done
by other qualified professionals
4. Care coordinated and integrated across all elements of the
complex health care system and the patient's community
5. Care facilitated by the use of office practice systems (e.g.,
registries, information technology, health information exchange)
to ensure that patients receive the indicated care when and where
they need and want it in a culturally and linguistically appropriate
manner
6. Reimbursement structure that supports and encourages this
model of care
optimizing patients' responses to treatments and helping
them cope emotionally and practically with whatever condition
they face, even when cure is not possible.
In The Nature of Suffering and the Goals of Medicine, Cassell
(2004) elegantly describes this tension and the continual
erosion of healing practices under the pressure to apply
more specific, technologic cures. In A Time to Heal, Ludmerer
(1999) documents how, despite decades of efforts in curriculum
change, these core values of healing in medical
education have failed to gain significant traction under the
forces driving the payment for cure-seeking behaviors.
Thus, physicians seeking to create a medical home that
balances cure and healing face considerable challenges,
especially in the delivery of healing. What are the essential
components of such a health care home? How can they be
delivered in the current medical context? What actions
must a family physi - ANSWER - BALANCING TREATMENT OF DISEASE AND
PROMOTION OF HEALTH AND HEALING
Health is largely a result of positive lifestyle behaviors that
are often challenging to implement. Addressing issues
such as smoking, obesity, substance abuse, and inactivity
can reduce premature death by 40% (McGinnis et al.,
2002; Schroeder, 2007). Positive lifestyle behaviors not
