Saturday, July 10, 2010

Medical homes and the meaning of "P.C." - Part 1 of 2

In this week's issue of Annals of Internal Medicine, Dr. Adam Goldstein writes about a disabled elderly man who died from a metastatic colorectal cancer that may have been prevented had one of his physicians referred him for a screening test at one of several preceding office visits. Dr. Goldstein blames this omission on breakdowns in communication and coordination of care between multiple clinicians. He feels that a primary care team (which I discussed in a recent blog post) would have served this patient far more effectively:

With a team approach to care, 1 or more members of the team is more likely to notice when something seems amiss rather than relying on 1 team member alone. ... In addition to traditional concepts, the new medical home also focuses on integrating health care technology, quality measures, and feedback on performance - all critical aspects of a care planning process that can lead to improved systems of care for severely disabled patients.

The term "medical home" was first used by the American Academy of Pediatrics in 1967 to refer to a physician-led practice that integrated and coordinated the health care of children with chronic medical conditions. All of the primary care physician organizations, as well as the American Medical Association, now seem to agree that the PCMH is the answer to many of the ills of our fragmented, specialist-oriented health care system. But what does the "PC" in this acronym stand for? Primary care? Politically correct? And does it really improve the experience and health of patients?

A recent review of state and federal legislation related to the medical home found "a lack of a clear operational definition," and widely varying ideas about its key components. The failure of the American Academy of Family Physicians' 2-year National Demonstration Project to yield better patient satisfaction or health outcomes in practices that attempted to transform themselves into medical homes has elicited doubt among many observers that the PCMH idea will ever be successful in more than a handful of highly motivated practices.

In my next post, I'll share a more optimistic view of the implications of the AAFP's report for the PCMH, and why being a "patient-centered medical home" is about more than simply technological innovations.