Medical Home Research Articles

Visualisation technology for physical exercise

Art and science are separate yet interrelated. In order to feel something, an artist relies on their body’s sense organs. Using a chair as an example, one is conscious of the sensation of the skin in contact with the chair but cannot feel blood vessels being crushed, the lungs being compressed or an uneven load on the spine. Indeed, designing a chair requires scientific methodology. This line of thinking underpins the work of Professor Yoshihiro Shimomura, Humanomics Lab, Design Research Institute, Chiba University, Japan. He is conducting joint research with more than 120 institutions in the fields of medical devices, automobiles, home appliances, and environment design and lifestyle related to energy. He is working on several projects developing visualisation technology for physical exercise. In his design work he places emphasis on physiological functions in order to examine the nature of health, fatigue and comfort, and create designs that go beyond appearance and aesthetic appeal, boasting real meaning. A key project the team is currently working on concerns the development of an alternative method to surface electromyography (EMG) to measure muscle vibrations called mechanomyography (MMG). The researchers are developing a technology that allows users to observe the spatial distribution between muscles and can be applied in different ways. Patients can use the technology to monitor their muscle activity and work on their rehabilitation.

Improving Access to Early Developmental Evaluation in Academic Primary Care Centers.

Developmental disorders (DDs) affect approximately 1 in 6 children in the United States. Early identification and treatment improve developmental outcomes and child and family functioning. Disparities exist in the diagnosis of DD that leads to inequitable access to developmental services during important periods of neuroplasticity. Improve access to the developmental and behavioral pediatrics (DBP) clinic for developmental evaluation when developmental delays occur among children 3-5 years of age by increasing the percentage of children scheduled for and completing an initial visit in 90 days from 20% to 40%. We used the Institute of Health Improvement model, executed mapping failure modes, created a key driver diagram and conducted plan-do-study-act cycles. We plotted data over time in a statistical control chart. The key intervention was an expedited, collaborative referral and scheduling process developed, tested, and implemented by the general pediatric clinic and DBP stakeholders. Additional interventions included reminder notifications and calls to patients who missed appointments. The percentage of patients referred to DBP who scheduled and completed their initial visit in DBP within 90 days increased from 20% to 40%. DBP clinicians suspecting that patients had global developmental delay and/or autism spectrum disorder at the initial DBP visit referred them for more extensive developmental testing with psychology and speech-language providers. Access to developmental evaluation for preschool-aged children at risk for delayed diagnosis and treatment was improved using quality improvement methodology focused on flexible and creative priority scheduling practices from within the medical home.

An Evaluation of the Impact of Genetic Counseling on Adherence to the 2011 American Academy of Pediatrics Health Supervision Guidelines for Children With Down Syndrome.

The American Academy of Pediatrics (AAP) health supervision guidelines for children with Down syndrome are important for preventative and symptom-based care. Studies, however, have shown low overall adherence to these care recommendations due to a lack of provider familiarity, inaccessibility of a medical home, and caregiver burden. In a population of children with Down syndrome, using a retrospective chart review, we evaluated overall patient adherence to the medical components of the 2011 AAP guidelines, along with potential influencing factors, to determine if there was a difference in adherence between those who had genetic counseling and those who had not. Among 106 subjects meeting our study criteria, adherence rates were higher on average in six domains of health supervision (62% vs. 45%) in those that had genetic counseling compared with those that had not. Although adherence to supervision recommendations is likely impacted by numerous factors, genetic counseling may be one factor associated with increased adherence to medical recommendations for a pediatric population with Down syndrome. Encouraging caregivers of individuals with Down syndrome to undergo genetic counseling may lead to improved adherence to the health supervision guidelines.

Impact of an Independent Patient Centered Medical Home Clinic Experience during Residency Training on Post-Residency Confidence

Description of the problem: While previous studies have described the impact of incorporating a postgraduate year two (PGY2) Ambulatory Care resident on clinical outcomes and revenue, the impact of an independent Patient Centered Medical Home (PCMH) experience from the resident perspective has not been reported on. The purpose of this study was to determine the impact of an independent PCMH rotation on resident confidence. Description of the innovation: A longitudinal independent PCMH rotation has been part of our PGY2 Ambulatory Care residency since program inception. To determine the impact of this experience on resident confidence, a 23-item survey was developed and distributed electronically to all previous PGY2 Ambulatory Care residents who completed this experience. Critical Analysis: All invited residents (n=15) responded. Following PGY2 completion, 46.7% of respondents worked as a clinical pharmacist specialist at an academic medical center. The majority (86.7%) practiced in primary care and/or population health. Identified strengths of the experience included increased resident confidence in the following areas: independent practice model (100% indicated positive impact), having their own Collaborative Practice Agreement (86.7%), and building rapport with patients (80%) and providers (73.3%). Implications: An independent PCMH rotation during PGY2 Ambulatory Care training has a positive impact on post-residency clinical confidence.

Evaluation of a Telemonitoring System Using Electronic National Early Warning Scores for Patients Receiving Medical Home Care: Pilot Implementation Study.

Telehealth programs and wearable sensors that enable patients to monitor their vital signs have expanded due to the COVID-19 pandemic. The electronic National Early Warning Score (e-NEWS) system helps identify and respond to acute illness. This study aimed to implement and evaluate a comprehensive telehealth system to monitor vital signs using e-NEWS for patients receiving integrated home-based medical care (iHBMC). The goal was to improve the early detection of patient deterioration and enhance care delivery in home settings. The system was deployed to optimize remote monitoring in iHBMC and reduce emergency visits and hospitalizations. The study was conducted at a medical center and its affiliated home health agency in central Taiwan from November 1, 2022, to October 31, 2023. Patients eligible for iHBMC were enrolled, and sensor data from devices such as blood pressure monitors, thermometers, and pulse oximeters were transmitted to a cloud-based server for e-NEWS calculations at least twice per day over a 2-week period. Patients with e-NEWSs up to 4 received nursing or physician recommendations and interventions based on abnormal physiological data, with reassessment occurring after 2 hours. A total of 28 participants were enrolled, with a median age of 84.5 (IQR 79.3-90.8) years, and 32% (n=9) were male. All participants had caregivers, with only 5 out of 28 (18%) able to make decisions independently. The system was implemented across one medical center and its affiliated home health agency. Of the 28 participants, 27 completed the study, while 1 exited early due to low blood pressure and shortness of breath. The median e-NEWS value was 4 (IQR 3-6), with 397 abnormal readings recorded. Of the remaining 27 participants, 8 participants had earlier home visits due to abnormal readings, 6 required hypertension medication adjustments, and 9 received advice on oxygen supplementation. Overall, 24 out of 28 (86%) participants reported being satisfied with the system. This study demonstrated the feasibility of implementing a telehealth system integrated with e-NEWS in iHBMC settings, potentially aiding in the early detection of clinical deterioration. Although caregivers receive training and resources for their tasks, the system may increase their workload, which could lead to higher stress levels. The small sample size, short monitoring duration, and regional focus in central Taiwan may further limit the applicability of the findings to areas with differing countries, regions, and health care infrastructures. Further research is required to confirm its impact.

Continuity and sustainability of care in family medicine: Assessing its association with quality of life and health outcomes in older populations—A systematic review

Background Continuity of care is a core principle of family medicine associated with improved outcomes. However, fragmentation challenges sustaining continuous relationships. This review aimed to provide timely and critical insights into the benefits of continuity and sustainability of care for older adults. Methods PubMed, EMBASE, CINAHL, Cochrane Library were systematically searched for studies on continuity/sustainability models in family medicine and effects on older adults. 14 studies met inclusion criteria for final synthesis. Quality was assessed using ROBINS-I. Outcomes were narratively and thematically synthesized. Results Greater continuity of care was consistently associated with reduced healthcare utilization including lower emergency department visits and hospitalizations. Continuity also correlated with improved chronic disease management, care coordination, patient-reported experiences, and quality of life. Patient-centered medical homes and care coordination models showed potential to strengthen continuity and sustainability. Thoughtful telehealth integration and technology tools augmented continuity. Conclusion Continuous healing relationships are vital for patient-centered care of older adults. While current fragmentation challenges sustainability, innovations in primary care teaming, coordination, telehealth, and health information technology can extend continuity’s benefits. Realizing improvements requires system-wide reorientation toward relationships and whole-person care.

Critical Analysis of Healthcare Delivery Models: Addressing Gaps in Accessibility, Quality, and Efficiency

Healthcare delivery systems have determinative implications for the availability, cost, effectiveness, and patient experiences of society’s medical care system. More recent developments, including value-based care and integrated models, are nevertheless characterized by such disparities, most especially for the rural and economically less privileged citizens, thus underlining the role of drastic change. They suggest that the conventional model, such as fee-for-service and managed care, is not effective enough to transform systematic problems, while new models like patient-centered medical homes and Accountable Care Organizations could develop more effective frameworks. However, these innovations have drawbacks like poor scalability, non-uniform take-updates, and erratic policy intervention, which makes them insufficient to fill the gaps in accessibility and efficiency in one go. The ten barriers discussed here are geographical location, shortage of these specialists, and cost to patients, which imply the need to maintain equity in dispensing healthcare services. Additionally, established indicators of quality demonstrate that there is considerable instability in the results associated with patient satisfaction, clinical results, and organizational effectiveness; this underscores the need for the further application of ICTs such as telehealth, artificial intelligence and analytics to underpin successful processes and support decision-making. This work examines the existing models of the specified problem in detail, categorizes the problem into critical areas of improvement, and synthesizes the problem using literature reviews, quantitative assessment, and presentation of the problem graphically. It is supposed to offer a set of recommendations on how to achieve this goal and incentivizing innovative care networks, building out digital health, and advancing policy changes that support population-health approaches to delivering care. Filling these gaps is crucial for getting a healthcare system that is fair, cheap and capable of producing quality health for all population types as they need.

Transformation to a Patient Centred Medical Home in an Urban Aboriginal Community Controlled Health Service: A Qualitative Study Using Normalisation Process Theory.

The Patient-Centred Medical Home (PCMH) is a model of team-based care that is patient centred, coordinated, accessible, and focused on quality and safety. To learn how this model of healthcare works in an Indigenous primary health care setting in Australia, we explored the experiences of health staff in an urban Aboriginal Community Controlled Health Service (ACCHS) transitioning to an adapted model of a PCMH. Normalisation Process Theory (NPT) was applied to better understand factors enabling and inhibiting implementation of the PCMH, and the work required to deliver it. Applying NPT, we aimed to examine enablers and barriers to implementing a PCMH in an ACCHS setting and identify practical strategies to strengthen its implementation and delivery. We employed semi-structured interviews with 19 health staff in an urban ACCHS to explore mechanisms that inhibit and promote the implementation and delivery of a PCMH in their setting. Interview data were analysed using thematic analysis that mapped codes against NPT constructs (Coherence, Cognitive Participation, Collective Action and Reflexive Appraisal) to generate themes. Five key themes and 14 sub-themes related to NPT constructs were identified. Broadly, health staff found the model of the PCMH to be coherent, engaged with others to adapt their roles, and worked collectively to embed new practices. Characteristics and practice norms of the clinic already aligned with the PCMH model were key enablers. Barriers were related to inadequate resourcing and ill-defined roles. Stronger leadership and support, practical learning resources for staff, workforce mapping to better define staff roles, and training to address gaps in staff skills were strategies identified for strengthening implementation of a PCMH and sustaining its delivery in the ACCHS setting. Applying NPT revealed the characteristics and practice norms of Indigenous community controlled health care as key enablers of implementing a PCMH in an urban ACCHS. Less than optimal resourcing and workforce development emerged as barriers needing to be resolved to strengthen implementation and delivery of a PCMH in this setting.

Transforming community-based primary health care delivery through comprehensive performance measurement and reporting: examining the influence of context

BackgroundCommunity-based primary health care represents various community-based health care (CBPHC) models that incorporate health promotion and community development to deliver first-contact health services. Learning health systems (LHSs) are essential for improving CBPHC in which feedback from relevant stakeholders is used to continuously improve health systems with the goal of achieving population health and health equity. Performance reporting is one way to present data to clinicians and decision makers to facilitate a process of reflection, participation, and collaboration among partners to improve CBPHC.MethodsOur objective was to obtain feedback on a regional CBPHC performance portrait through key informant interviews. We used purposive convenience sampling to recruit participants who were clinicians in primary care and/or decision-makers in primary care at a regional level. The performance portrait summarized results of survey questions asked of patients, providers, and primary care organizations. The portrait was organized by the 10 pillars of the Patient’s Medical Home (PMH) model. Interview questions specifically asked about portrait content, formatting, interpretability, utility, and dissemination strategies. Content analysis was used to analyze interview data.ResultsWe completed 19 interviews with key informants from the Canadian provinces of Nova Scotia (n = 8), Ontario (n = 6) and British Columbia (n = 5). We coded transcripts into four content areas: (1) Usability as influenced by content and interpretability, (2) Formatting, (3) Utility, and (4) Dissemination. Using data and reporting back to clinicians and decision-makers about how their practices and jurisdictions are performing in primary care in meaningful ways is important. Our results suggest having available methodology notes, including the analysis used to develop any scoring, sampling and sample sizes, and interpretation of the statistics is necessary.ConclusionsThis research was the first to create a comprehensive performance portrait using data driven by factors that are important to primary care partners. We obtained important feedback on the portrait in the context of usability, formatting, utility, and dissemination. This data needs to be used to provide feedback in continuous cycles to evaluate and improve CBPHC models as part of a LHS.

A Compelling Health Promoting Primary Care Clinic Using a Settings-Based Approach: A Demonstration Project.

The Ottawa Charter for Health Promotion, issued by the World Health Organization in 1986, called for several strategies to promote the public's health. One of the strategies was to create health-promoting health services. Over 35 years have passed since the Ottawa Charter was released, since then, efforts to improve health care have been implemented such as the Patient-Centered Medical Home, the Triple Aim, and the Affordable Care Act, yet little has been done to reorient the cultural and physical environment of health care services to one focused on health promotion. In this perspective, the author offers a compelling description of how one primary care clinic, serving an ethnically and economically diverse population, utilized a settings-based approach to design and implement several health-promoting policies, systems, and environmental strategies. This reorientation of a primary care clinic to one that is health-promoting leveraged the clinical specialty of lifestyle medicine as a cornerstone of the settings-based approach.

Perspectives of Physicians in Taipei on the Home Healthcare Programs

<p>目的：高齡社會時代的來臨，居家醫療照護服務需求增加，然而目前醫師參與居家醫療照護比例仍偏低，因此本研究希望能透過問卷調查，協助瞭解台北市醫師對於推動居家照護相關計畫的實務運作與障礙。</p> <p>方法：本研究為無記名結構式問卷調查，於2022年8月至2022年10月之間進行，針對執業登記會籍為臺北市醫師之意見調查，內容包括：基本資料、參加居家醫療照護整合計畫與居家失能個案家庭醫師照護方案現況與障礙誘因等，問卷經專家效度檢視修正後以電子式表單請醫師回答。針對醫師參與居家照護相關計畫（居家醫療照護整合計畫、居家失能個案家庭醫師照護方案）進行單變量分析與多元邏輯斯迴歸分析。</p> <p>結果：本研究共計回收410份，發現到門診數較少的醫師，較願意參與居家醫療照護整合計畫，女性醫師較願意參與居家失能個案家庭醫師照護方案；而越瞭解計畫/方案內容的醫師，越願意參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案。醫師對於推動居家醫療照護整合計畫之障礙前三名依序為提供24小時電話諮詢服務有困難(76%)、往返案家交通耗時(75%)、給付不足(74%)；而居家失能個案家庭醫師照護方案前三名影響的因素為往返案家交通耗時(71%)、給付不足(69%)、個管師人力不易安排(69%)。</p> <p>結論：對台北市醫師參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案之政策建議，包括給付需考量向上調整並納入交通成本與提供24小時緊急電話諮詢服務，以及建立更有效率之個案媒合溝通機制。</p> <p> </p><p>Purpose: With the advent of an aging society, the demand for home medical care services in Taiwan has increased. However, the current participation rate of physicians in home medical care remains low. The study accordingly conducted a questionnaire survey to help understand the operational challenges and barriers facing physicians in Taipei regarding the promotion of home healthcare programs. </p> <p> Methods: This study as an anonymous structured questionnaire survey was conducted between August 2022 and October 2022 to solicit the opinions of physicians registered for practice in Taipei City. The questionnaire covers basic information, participation in home medical care integration programs, the current status, and challenges and incentives of home care for disabled cases by family physicians. After expert validity review and revisions, the questionnaire was administered to physicians through in an electronic form. Univariate and linear regression analyses were performed on the results obtained from physicians participating in home healthcare programs (home medical care integration program, home care for disabled cases by family doctors). </p> <p> Results: According to the 410 responses collected, physicians with less clinic sessions are more willing to participate in home medical care integration programs, and female physicians tend to be more willing to participate in home care for disabled cases by family physicians. Physicians equipped with a better understanding of the programs are also more willing to participate. The top three obstacles for physicians to promote home medical care integration programs were respectively difficulty in providing 24-hour telephone consultation services, time-consuming transportation, and insufficient reimbursement. For home care for disabled cases by family physicians, the top three challenges were time-consuming travel to patients at home, insufficient reimbursement, and difficulty in arranging case managers. </p> <p>Conclusion: To promote the participation of Taipei physicians in home medical care integration program and home care for disabled cases by family physicians, the study recommends the following three measures: increasing the reimbursement considering transportation costs, providing 24-hour emergency telephone consultation services, and establishing a more efficient communication mechanism for case matching.</p> <p> </p>

Exploring Healthcare Preferences of Senior High School Students

This study investigates the healthcare preferences of senior high school students at Mindanao Mission Academy (MMA) in the Philippines, focused on exploring healthcare preference within an urban setting. Such studies overlook healthcare behaviors among adolescents in semi-rural, mission-based settings. The primary objective of this research is to examine students' preferences for medical checkups versus home remedies and to assess how demographic factors such as age, sex, and socioeconomic status may influence these choices. This study utilizes a descriptive correlational design, with a sample of 266 students who completed structured survey questionnaires. The data were analyzed using SPSS software, employing statistical tests including correlation and linear regression. The findings reveal that students exhibit a moderate preference for both medical checkups and home remedies, with age emerging as a significant factor influencing healthcare preferences. However, sex and socioeconomic status were not found to significantly impact healthcare decisions. Specifically, socioeconomic status did not serve as a significant predictor, suggesting socioeconomic status as a single demographic do not predict healthcare preferences. The study highlights the importance of age-specific health education programs, as demographic indicators like sex and socioeconomic status may not reliably predict healthcare preferences. The results suggest that schools, healthcare providers, and policymakers should prioritize creating health education programs modified to the unique healthcare decision-making needs of adolescents, focusing on buiding independent decision-making skills. These programs should address the importance of recognizing symptoms and understanding when to seek professional care or utilize home remedies. Future research could explore how healthcare preferences evolve over time, considering a broader age range or different socio-cultural settings.

Establishing a Gynecology Student-Run Free Clinic: A Joint Medical Student and Resident Physician Initiative

Dedicated women’s health services are rarely mentioned in the student-run free clinic literature. As society grappled with repeated waves of coronavirus-2019, the number of healthcare professionals decreased across the country and impacted all healthcare settings, including student-run free clinics. In response, a collaboration between medical students and Obstetrics & Gynecology resident physicians at Oakland University William Beaumont School of Medicine and the Gary Burnstein Community Health Clinic established a new gynecology free clinic. This program, under the joint oversight of medical students and resident physicians in addition to attending physician support, provided uninsured women across Southeast Michigan with critical access to healthcare services at a time demand for services was similarly rising. Our clinic emphasized excellence in screening, contraception, and vaccination and, in doing so, provided our patients with evidence-based care and a medical home. Our experience demonstrates student-run free clinics are uniquely positioned to critically expand access to women’s health services. Additionally, the establishment of a joint medical student and resident physician endeavor can further enrich both the educational and patient-care experience.

Machine Learning Algorithms Exceed Comorbidity Indices in Prediction of Short-Term Complications After Hip Fracture Surgery.

Hip fractures are among the most morbid acute orthopaedic injuries often due to accompanying patient frailty. The purpose of this study was to determine the reliability of assessing surgical risk after hip fracture through machine learning (ML) algorithms. The American College of Surgeons National Surgical Quality Improvement Program was queried from 2011 to 2018 and the American College of Surgeons National Surgical Quality Improvement Program hip fracture-targeted data set was queried from 2016 to 2018 for all patients undergoing surgical fixation for a diagnosis of an acute primary hip fracture. The data set was randomly split into training (80%) and testing (20%) sets. 3 ML algorithms were used to train models in the prediction of extended hospital length of stay (LOS) >13 days, death, readmissions, home discharge, transfusion, and any medical complication. Testing sets were assessed by receiver operating characteristic, positive predictive value (PPV), and negative predictive value (NPV) and were compared with models constructed from legacy comorbidity indices such as American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index, frailty index, and Nottingham Hip Fracture Score. Following inclusion/exclusion criteria, 95,745 cases were available in the overall data set and 22,344 in the targeted data set. ML models outperformed comorbidity indices for each complication by area under the curve (AUC) analysis (P < 0.01 for each): medical complications (AUC=0.65, PPV=67.5, NPV=71.7), death (AUC=0.80, PPV=46.7, NPV=94.9), extended LOS (AUC=0.69, PPV=71.4, NPV=94.1), transfusion (AUC=0.79, PPV=64.2, NPV=77.4), readmissions (AUC=0.63, PPV=0, NPV=96.8), and home discharge (AUC=0.74, PPV=65.9, NPV=76.7). In comparison, the best performing legacy index for each complication was medical complication (ASA: AUC=0.60), death (NHFS: AUC=0.70), extended LOS (ASA: AUC=0.62), transfusion (ASA: AUC=0.57), readmissions (CCI: AUC=0.58), and home discharge (ASA: AUC=0.61). ML algorithms offer an improved method to holistically calculate preoperative risk of patient morbidity, mortality, and discharge destination. Through continued validation, risk calculators using these algorithms may inform medical decision making to providers and payers.

Impact of an Ambulatory Clinical Pharmacy Population Health Initiative on HbA1c Reduction and Value-Based Measures: A Retrospective, Single-Center Cohort Study

Background: Studies of pharmacists’ clinical programs have demonstrated improvements in controlling chronic diseases. However, significantly less data are available regarding pharmacist impact in a value-based Patient-Centered Medical Home (PCMH). The present study assessed a population health initiative to incorporate pharmacists for the management of type 2 diabetes (T2D), hypertension, and hyperlipidemia in a PCMH. Methods: This was a single-center retrospective cohort study of patients with T2D and baseline glycated hemoglobin (HbA1c) greater than 9%. Patients were excluded if they received care from an endocrinology provider or were lost to follow-up during the observation window of 1 January 2023 through 31 July 2023. Patients were analyzed in two cohorts: (1) patients who received any outpatient care from a clinical pharmacist (pharmacist cohort) and (2) patients who did not receive any outpatient care from a clinical pharmacist (usual care cohort). The primary outcome was the proportion of patients achieving an HbA1c of less than 8%. Secondary outcomes included blood pressure control and receipt of guideline-directed statin therapy. Results: Ninety-one patients were identified, twenty-nine in the pharmacist cohort and sixty-two in the usual care cohort. The overall population was older (mean age ~66 years), 59% female, and racially diverse (&lt;50% Caucasian). HbA1c less than 8% was achieved in 34% of patients in the pharmacist cohort and 29% of patients in the usual care cohort (p = 0.001). A blood pressure goal of less than 140/90 mmHg was achieved more frequently in the pharmacist cohort (90% vs. 61%, p = 0.006), but guideline-directed statin therapy was similar between groups (90% vs. 79%, p = 0.215). Conclusions: Pharmacists can play an integral role within a PCMH to improve value-based measures for HbA1c and blood pressure control. Further research is needed to assess the impact of pharmacist care on statin use and economic outcomes.

Patient-centered medical homes and vision care for children: a cross-sectional analysis with data from the national survey of children’s health 2018–2019

BackgroundVision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor’s office (‘primary care’).MethodPopulation-based data for US children aged 3 to 6 years was derived from the National Survey of Children’s Health (2018–2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH (‘PCMH care’), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care.ResultsAmong 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care.ConclusionsCaregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications.

Implementation of Immunization Services Through a Pediatric Urgent Care Clinic.

Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

Patient-Centered Care Models in Primary Healthcare: A Systematic Review of Implementation and Outcomes

This systematic review evaluates the implementation and outcomes of patient-centered care (PCC) models in primary healthcare settings. Patient-centered care is a foundational approach in primary healthcare, emphasizing patient preferences, needs, and values to improve the quality of care and health outcomes. A comprehensive literature search was conducted across PubMed, Cochrane, and MEDLINE databases, focusing on studies that assessed the impact of PCC models such as the Patient-Centered Medical Home (PCMH) and shared decision-making. Forty studies met the inclusion criteria, covering a range of patient populations and healthcare settings. Findings indicate that PCC models enhance patient satisfaction, improve health outcomes, and increase patient engagement in care. Additionally, these models positively impact provider satisfaction and may reduce healthcare costs by lowering emergency visits and hospitalizations. However, challenges in implementation, including provider workload and resource needs, were commonly reported. This review underscores the effectiveness of PCC models in primary care and highlights the need for structured, resource-supported implementation strategies. Further research is recommended to optimize PCC approaches across diverse populations and healthcare systems.

Integrating Nursing and Family Medicine: A Comprehensive Review of Interdisciplinary Approaches in Patient-Centered Care

This review explores the integration of nursing and family medicine in promoting patient-centered care through interdisciplinary approaches. Family medicine and nursing play complementary roles in primary healthcare, with nurses increasingly involved in collaborative efforts to address complex patient needs. This article examines current models of interdisciplinary collaboration, including team-based care and the Patient-Centered Medical Home (PCMH), and their impact on patient outcomes, cost-efficiency, and holistic care delivery. Additionally, the review highlights barriers to integration, such as role ambiguity, communication challenges, and institutional constraints, and offers strategies for overcoming these obstacles, including interdisciplinary training, supportive policies, and integrated health IT systems. Case studies of successful integration are presented, underscoring the practical benefits of collaborative care. The review concludes with implications for practice, suggesting that integrating nursing into family medicine enhances patient-centered care, especially in managing chronic conditions and preventive care. Further research is encouraged to establish best practices and policies that support effective interdisciplinary collaboration in primary care

Health Center Characteristics Associated With Hospital Care Among Medicare-Medicaid Dual Enrollees.

Using 2012-2018 Medicare claims and health center data, we identified factors associated with variation in rates of hospital care among Medicare-Medicaid dual enrollees receiving primary care at health centers. In our sample ( n =5961 health center-years), we found no evidence that patient-centered medical home designation or other modifiable health center characteristics were associated with reductions in hospital care use, which depends more on health center patient mix. Thus, policymakers should target efforts to health centers serving the most disadvantaged and marginalized communities.