patient-centered medical home (PCMH)

Introduction

Concept introduced in 1967 by the American Academy of Pediatrics.

Initially, a central location of a patient medical record

Concept expanded to incorporate accessible, continuous, comprehensive, family-centered, coordinated, compassionate & culturally effective care.

Components:

• having a usual source of care
• having a personal physician or nurse
• receiving needed referrals for specialty care
• receiving needed help coordinating care
• receiving family-centered care

Attributes & functions

• comprehensive care
• patient centered
• coordinated care
• accessible services
• quality & safety

Participating practices usually need to make structural & organizational changes

Physicians work in healthcare teams with emphasis on patient self management

Capitated payment is not essential

A patient-centered medical home should include:

• access & connection
• patient tracking & registry (disease registry)
• case management
• patient self-management support
• electronic prescribing
  • interoperable electronic health records not essential
• test tracking
  • onsite basic laboratory & imaging not essential
• referral tracking
• continuous quality improvement
• electronic communications

Notes

• may provide higher quality of patient care at the cost of increased expense
• no benefit for primary care practices
  • editorialist suggests benefit may be restricted to patients with high utilization of medical care

More general terms

• medical organizational structure