PatientCentered Medical Home (PCMH)Building a Better ：以病人为中心的医疗之家（PCMH）建立一个更好的.pptVIP

thepatient-centeredmedicalhome(pcmh):buildingabetterhealthcaremodel,objectives,identifycurrentprioritiestoenacthealthcarereform.describethepatient-centeredmedicalhome(pcmh)modelofcare.understandhowthepcmhmodelisanappropriatemethodtoaddresspriorityhealthreformissues.understandfamilymedicinesroleinthedevelopmentandadoptionofthepatient-centeredmedicalhome.,patientstodayaresavvyconsumersofhealthcareandhavehigherexpectations.,communicationaccessconveniencecoordinationresponsivenesssource:medfusion,anaafpaffinitypartner,2008,patientexpectations,75%wanttheabilitytointeractwiththeirphysicianonline(appointments,prescriptions,testresults).77%wanttoaskquestionswithoutavisit.75%wantemailaccessaspartoftheiroverallcare.62%ofpatientssayaccesstotheseserviceswouldinfluencetheirchoiceofphysicians.source:medfusion,anaafpaffinitypartner,2008,familymedicineisleadingthewaytomakehealthcaremorepatient-centered.,“willfamilymedicineteacherspreparetheirstudentsandresidentstohelppracticestransformandmeettheinfrastructureprinciples?ibelievethatwewill,notsimplybecausedoingsowilllikelyincreaseourfinancialsituationbutbecausebuildingpcmhsthatmeetthecareandinfrastructureprincipleswillimprovethecareweprovidetomeetourpatientsandourcommunitiesneeds.wewillbuildourpcmhpractices,becauseitistherightthingtodoanditreflectsourcorevalues.”johnc.rogers,md,mph,medpast-president,societyofteachersoffamilymedicinefammed2008;40(1):11-2.),healthcarereform,prioritiesforushealthcarereformquality-who(worldhealthorganization)identifiestheushealthcaresystemasthe“mostindividuallyresponsive”whoranksushealthcare37thoverall(among191countries)efficiencypeoplewithacuteandchronicmedicalconditionsreceiveonlyabouttwo-thirdsofthehealthcarethattheyneed.between20and30%oftestsandproceduresprovidedtopatientsareneitherneedednorbeneficial.*leathermanandmccarthy,qualityofhealthcareintheunitedstates:achartbook,2002.thecommonwealthfund*schuster,mcglynn,andbrook.,healthcarereform,prioritiesforushealthcarereformcosttheu.s.spendsmoreonhealthcarepercapitathananyothernation.theu.s.spendsmoreonhealthcareasaproportionofgdp(grossdomesticproduct)thananyothernation.patient-friendlypublicconfidenceinhospitalsandpersonaldoctorsremainsrelativelyhigh.whileindividualsreportgenerallypositiveexperiencewithmedicalcare,publicconfidenceandtrustinthesystematlargeiseroding.*leathermanandmccarthy,qualityofhealthcareintheunitedstates:achartbook,2002.thecommonwealth,healthcarereform,prioritiesforushealthcarereformaccesslackofinsuranceisamajorreasonfornotobtainingaccesstoneededcare.the40millionamericanswithoutinsurancecoveragearelesslikelytoobtainneededmedicalcareandpreventivetestsevenwithinsurance,barrierstocarestillexist:lackofanestablishedrelationshipwithadoctorlanguageandculturalbarrierssocialdeterminantsofhealthtransportationissuesgeographyhighout-of-pocketscostsevenforthosewithinsuranceie:highdeductibles,underinsured,etc.,healthcarereform,prioritiesforushealthcarereformautomationinfrastructureforhealthcaredeliveryhasnotkeptpacewiththeelectronicinnovationsofotherindustries.manyinstitutionsstillrelyonsystemsthatarenotautomatedandallowopportunitiesforhumanerror,eventhoughtechnologyexiststominimizeerrorsandimproveefficiency.,aneffectiveandefficienthealthcaresystemisaprimarycare-basedhealthcaresystem,providesaccesstobasichealthcareservicesmanageshealthdisparitiescoordinatescarecontrolscosto/valueoffamilymedicine,briefhistoryofthepcmh,1960s,2000s,2010s,future,1990s,innovativesolution:historyofthepcmhconcept,introducedbyamericanacademyofpediatrics(aap)in1967initiallyreferredtoacentrallocationformedicalrecordsthemedicalhomeconceptwasexpandedin2002toinclude:accessiblecontinuouscomprehensivefamily-centeredcoordinatedcompassionateculturallysensitivecarein2007,theaap,theamericanacademyoffamilyphysicians(aafp),theamericanosteopathicassociation(aoa),andtheamericancollegeofphysicians(acp)adoptedasetofjointprinciplestodescribeanewlevelofprimarycare.,“jointprinciples”ofthepatient-centeredmedicalhome,apersonalphysicianwhocoordinatesallcareforpatientsandleadstheteam.physician-directedmedicalpracticeacoordinatedteamofprofessionalswhoworktogethertocareforpatients.wholepersonorientationthisapproachiskeytoprovidingcomprehensivecare.coordinatedcarethatincorporatesallcomponentsofthecomplexhealthcaresystem.qualityandsafetymedicalpracticesvoluntarilyengageinqualityimprovementactivitiestoensurepatientsafetyisalwaysbeingmet.enhancedaccesstocaresuchasthroughopen-accessschedulingandcommunicationmechanisms.paymentasystemofreimbursementreflectiveofthetruevalueofcoordinatedcareandinnovation.,growingsupportforthepatient-centeredmedicalhome,partnershipsaredevelopingasmoreandmorestakeholdersseevalueinthejointprinciples.thepatientcenteredprimarycarecollaborative(pcpcc)*isacoalitionofmajoremployers,consumergroups,patientqualityorganizations,healthplans,laborunions,hospitals,physiciansandotherstodevelopandadvancepcmh.thepcpcchaswellover1,000members.*,patient-centered|physician-directed,thepatientcenteredmedicalhome,thefamilymedicinemodel,familymedicinefoundation,healthit,patientexperience,healthit,heathinformationtechnology,patient-centeredcare,understandwaystoidentifypatientsriskstatusplanoutcareforchronicconditionsandpreventivecareidentify“high-risk”patientsusetoolstotrackpopulationsbyriskcategory,establishbaselineperformancemeasurescollectandanalyzedatadiscussbestpracticesandimprovementconductregularclinicalteammeetings,managecaretransitionsandbuildlinkagetocommunityresourcescoordinatecarewithspecialistsandoutsidefacilitiesevaluatecaretransitionprocess,shareddecisionmaking,convenientaccess,patientexperience,same-dayappointmentsandextendedhourse-mailcommunicationwithpatients(e-visits)webportalsforrxrefillandappointmentstranslationandculturallyappropriateservices,understandingthepatientssocialbarriers,goalsandprioritiescreatecareplansincollaborationwithpatient/caregivermonitorprogressbetweenvisits,conductpatientsatisfactionsurveysonaregularbasisestablishpatientadvisorypanelandqiactivitiesconductpatientfocusgroups,patient-centeredcare,labtestingprescriptionsregistries,cultureofchange,practiceenvironment,establishapcmhleadershipteamengageallmembersofthepracticeinasharedvisionprovidestaffeducationandtrainingtosupportpatient-centeredcare,staffingmodelsupportsteam-basecaredefinerolesforteammembersincludehealthcoachandcarecoordinationfunctions,financialmanagement,allstaffareawareofthemostefficientwaystodelivercarenationalpoliciessupporttheinvestmentofresourcesintoprimarycarepracticesthatareeffectiveandefficient,patient-centeredcare,technologyinfrastructure,familymedicinefoundation,digitallyconnected,evidence-basedmedicine,ehrreportingtools,patientreminderspatientnotificationfornewinformationremindersforrecommendedcareorhealthmaintenancemakespatientregistriespossible,canquicklypullclinicaldataforqualityanalysiscanenhancebusinessprocessespopulationhealthmanagementthroughpatientregistries,enhancescarecoordinationbyimprovinginformationflowwithotherphysicians,practices,andprovidersimprovespatient-physiciancommunication,point-of-carelearning,alertsandremindersclinicaldecisionsupport(e.g.,epocrates),patientcenteredcare,healthinformationtechnology,familymedicinefoundation,greatoutcomes,goodforpatientspatientsenjoybetterhealth.patientsshareinhealthcaredecisions.goodforphysiciansphysiciansfocusondeliveringexcellentmedicalcare.goodforpracticesteamworkseffectivelytogether.resourcessupportthedeliveryofexcellentpatientcare.goodforpayorsandemployersensuresqualityandefficiency.avoidsunnecessarycosts.,patient-centeredcare,healthinformationtechnology,doespcmhwork?,fullyimplementedthepcmhhitsthetripleaim,betterhealth,bettercare,lowercostsimprovespracticeorganization,workenvironmentandjobsatisfactionnolongerapilotnowaprogramwithprovenresults,21,thepcmhmodelinfamilymedicineresidencytraining,“preparingthepersonalphysicianforpractice”(p4)thep4initiativewasdesignedtoinspireandexamineinnovationinfamilymedicineresidencytraining.sponsorsaretheamericanboardoffamilymedicine,theassociationoffamilymedicineresidencydirectors,andtransformed.differentapproachesrangefrommovingthecontinuityclinicintoanewcommunitysetting,toexpandingtoafour-yearprogram,toprovidingtheopportunityfortrackingandobtainingadditionaldegreeswhileintraining,andmore.theaimofp4istospurinnovationinallfamilymedicineresidenciestobestpreparefamilyphysiciansbetheexcellentpersonalphysiciansoftomorrow.initially,84familymedicineresidenciesappliedtoparticipateinthep4initiative.the14p4residencieswereselectedasparticipantsformoreintensiveevaluationofoutcomestodeterminewhatworksbest.,pcmhmodelandhealthcarereform,attemptstofixpartoftheproblemwithoutaddressingitcomprehensivelywillnotleadtoviablesolutions.advocacybyallstakeholdersisnecessary.communityprojectsthroughlocalhospitalsandresourcenetworksstateprojectsforregionalpayorsandstatemedicaidprogramsnationalsupportforchanginghowcareisdeliveredandforensuringapreparedworkforcetodelivercare,familyphysiciansandthepcmh,pcmhisaplace,notaperson.patient-centered,physician-directed.familyphysiciansprovidecomprehensivecarecareforallpatientscoordinatecareprovidecarethatiseffectiveandefficient*futureoffamilymedicine*starfielddata,healthinformationtechnology,familyphysicianshowweprovidecare:,acuteinjuriesandillnesseshealthpromotionandbehaviorchangehospitalcarechronicdiseasemanagementmaternitycarewell-childcareandchilddevelopmentprimarymentalhealthcaresupportiveandend-of-lifecare,familyphysicianshowweviewpatients:,consideralloftheinfluencesonapersonshealth.knowandunderstandpeopleslimitations,problems,andpersonalbeliefswhendecidingonatreatment.areappropriateandefficientinproposingtherapiesandinterventions.developrewardingrelationshipswithpatients.provideacontinuoushealingrelationshipovertime.,individualsandfamilieswomenandmenregardlessofageordiseaseinfants,children,andadolescentsregardlessofdiseasecommunitiesandpublichealthglobalhealth,familyphysicianswhowecarefor:,primarycaredeliversbetterhealthoutcomes,mortalitymorbiditymedicationusepercapitaexpenditurespatientsatisfactiongreaterequityinhealthcaresource:b.starfield,etal.,“theeffectsofspecialistsupplyonpopulationshealth,”healthaffairs(march2005);w5-97,thepatient-centeredmedicalhomeasapreferredmodelofcare,changeishere!patientswantmorefromthehealthcaresystemandfromtheirphysician.pur