Patient-centered Medical Home Model Research Articles

Aboriginal and Torres Strait Islander community members’ experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home

Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members’ health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members’ narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.

Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study.

The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care.

Policy Evaluation of Primary Care Doctor Practice Based on PCMH in Shenzhen

This work is to conduct a comprehensive policy evaluation of the Patient-Centered Medical Home (PCMH) in Shenzhen since the year of 2009. Main stakeholders of the primary care policy are community residents, government, general hospitals, health agencies, community service providers and medical insurance institutions, drug suppliers. Equity is improved through better community service coverage condition, increase of outpatients in community health service centers, decrease in medical expenditure and the implementation of zero price addition policy of drugs. Better performance in terms of public health cost saving upon primary care doctor policy based on PCMH in Shenzhen are reflected in the reduced proportion of government grant by 7.1%. Each community health service center provided medical services are increased from an average of 97.1 to 156.1 person-times per day, and every doctor servicing with an average of 27.1 to 53.2 person-times per day from 2009 to 2013. Every 1 million from government found brings 2.2 million in operational revenue in 2013, with ratio 1:2.2 compared to 1:1.6 in 2008. Based on the findings from this policy evaluations, it appears that the introduction of PCMH model in public health may improve health care equity, efficiency of community service utilization and cost saving in Shenzhen. However, the extent in which PCMH might be useful also depends on the stakeholders’ effort, as well as the validity of the data used in this evaluation report.

Impact of Evidence-Based Quality Improvement on Tailoring VA's Patient-Centered Medical Home Model to Women Veterans' Needs.

Women Veterans' numerical minority, high rates of military sexual trauma, and gender-specific healthcare needs have complicated implementation of comprehensive primary care (PC) under VA's patient-centered medical home model, Patient Aligned Care Teams (PACT). We deployed an evidence-based quality improvement (EBQI) approach to tailor PACT to meet women Veterans' needs and studied its effects on women's health (WH) care readiness, team-based care, and burnout. We evaluated EBQI effectiveness in a cluster randomized trial with unbalanced random allocation of 12 VAMCs (8 EBQI vs. 4 control). Clinicians/staff completed web-based surveys at baseline (2014) and 24 months (2016). We adjusted for individual-level covariates (e.g., years at VA) and weighted for non-response in difference-in-difference analyses for readiness and team-based care overall and by teamlet type (mixed-gender PC-PACTs vs. women-only WH-PACTs), as well as post-only burnout comparisons. We surveyed all clinicians/staff in general PC and WH clinics. EBQI involved structured engagement of multilevel, multidisciplinary stakeholders at network, VAMC, and clinic levels toward network-specific QI roadmaps. The research team provided QI training, formative feedback, and external practice facilitation, and support for cross-site collaboration calls to VAMC-level QI teams, which developed roadmap-linked projects adapted to local contexts. WH care readiness (confidence providing WH care, self-efficacy implementing PACT for women, barriers to providing care for women, gender sensitivity); team-based care (change-readiness, communication, decision-making, PACT-related QI, functioning); burnout. Overall, EBQI had mixed effects which varied substantively by type of PACT. In PC-PACTs, EBQI increased self-efficacy implementing PACT for women and gender sensitivity, even as it lowered confidence. In contrast, in WH-PACTs, EBQI improved change-readiness, team-based communication, and functioning, and was associated with lower burnout. EBQI effectiveness varied, with WH-PACTs experiencing broader benefits and PC-PACTs improving basic WH care readiness. Lower confidence delivering WH care by PC-PACT members warrants further study. The data in this paper represent results from a cluster randomized controlled trial registered in ClinicalTrials.gov (NCT02039856).

Impact of the PCMH model on post-stroke healthcare utilization

The patient-centered medical home (PCMH) model has aimed to enhance chronic care in a primary care setting where providers are expected to provide timely post-discharge follow-up and decrease potentially preventable hospital readmissions through coordinated disease management. The study examined PCMH and other (risk) factors associated with 30-day unplanned readmission as well as 7- and 28-day follow-up visit with primary care providers (PCPs). We identified 8424 New York State Medicaid patients having initial stroke discharges during 2016–2018 from the Medicaid claims database and Statewide Planning and Research Cooperative System. A patient was in the PCMH group if the attributed provider had a valid National Committee for Quality Assurance PCMH recognition upon patient’s discharge. Cox regression and competing risk analyses were used to estimate the hazard ratios of readmissions and follow-up visits between PCMH and non-PCMH groups. The PCMH group had slightly but not statistically significant lower all-cause and recurrent stroke unplanned readmission rates. While the general follow-up rates between the two groups are similar, the PCMH group had significantly higher rates of stroke-specific 7-day (HR = 1.27, P < 0.01) and 28-day follow-up visits (HR = 1.22, P < 0.01). PCPs play an essential role in post stroke care. Our findings show a significantly higher rate of stroke-specific follow-up visits and a trend towards lower readmissions among patients in the PCMH group. The intervals between stroke discharge and follow-up visit time in our study population were generally greater than the recommended timeframe. We recommend the PCMH care model to improve patients’ primary care follow-up and prevent potential readmissions.

Racial and Ethnic Disparities in Blood Pressure and Glycemic Control in the US Community Health Center Patient Population.

To describe blood pressure and glycemic control by racial/ethnic group in the US Community Health Center (CHC) patient population, and whether center characteristics, proxying for higher resource levels and better quality of care, were associated with greater rates of controlled cardiometabolic conditions. Data came from the Uniform Data System, representing aggregate patient clinical data for individual health centers in 2019. Descriptive analyses were conducted weighting by health center patient populations to produce race-specific national rates of blood pressure and glycemic control, and linear regression is used to test whether cardiometabolic control rates varied by center characteristics. Hypertension was controlled for 67.2% of non-Hispanic White, 66.9% of Hispanic, and 56.7% of non-Hispanic Black patients. Diabetes was controlled for 70.7% of non-Hispanic White, 65.7% of Hispanic, and 66.1% of non-Hispanic Black patients. The rate of blood pressure control was 2.54 to 3.99 percentage points higher across racial/ethnic groups in health centers that adopted a patient-centered medical home (PCMH) model of care relative to non-PCMH centers, while glycemic control was 1.08 to 2.27 pp. higher as a function of PCMH certification. Results for other center characteristics did not show consistent patterns across racial groups or outcomes. This study documented racial and ethnic health disparities in the CHC patient population after major expansion of the CHC program. CHCs with PCMH certification have improved clinical outcomes among patients with hypertension and diabetes across racial/ethnic groups relative to centers without this certification.

Impact of the patient-centered medical home on consistently high-cost patients.

To evaluate the effect of a statewide multipayer patient-centered medical home (PCMH) demonstration on patients consistently within the highest ranks of health services expenditure across Maryland. Post hoc longitudinal analyses of administrative data on privately insured patients of medical homes that participated in the Maryland Multi-Payer PCMH Program (MMPP), matched for comparison to medical homes in a single-payer PCMH program and to non-PCMH practices. Consistently high-cost patients (CHPs) were defined as being in the top statewide quintile of payer expenditure over a 2-year baseline period. Using population-averaged generalized linear regression models, we evaluated the odds of CHPs remaining in the highest-cost quintile during the 2-year MMPP implementation period and assessed changes in their utilization patterns. Six percent of included patients were CHPs and accounted for one-third of total expenditure. For CHPs in multipayer PCMHs, estimated odds of remaining in this status after 2 years were lower by 34% (adjusted OR [AOR], 0.66; 95% CI, 0.41-0.90; P = .03) relative to CHPs in non-PCMH practices and higher by 41% (AOR, 1.41; 95% CI, 1.08-1.75; P = .004) compared with CHPs in single-payer PCMHs. Relative to CHPs in non-PCMH practices, CHPs in multipayer PCMHs had inpatient admissions decline by 40% (incidence rate ratio [IRR], 0.60; 95% CI, 0.36-1.00; P = .049) and visits to the attributed primary care provider increase by 21% (IRR, 1.21; 95% CI, 1.05-1.39; P = .01). Relative to routine primary care, the PCMH model significantly reduces the probability that CHPs remain in this expensive category and enhances continuity of care.

Integrating Serious Illness Care into Primary Care Delivery for persons with dementia: CARIÑOS En Su Casa – Care for you at home

AbstractBackgroundThe patient‐centered medical home (PCMH) as a model of primary care transformation has the potential to improve the quality, safety, and efficiency of care and reduce costs, particularly during the COVID‐19 pandemic for persons with dementia. However, the effects of adopting the PCMH are lack of clinical and economic support, let alone the challenge of applying it in ethnically and culturally diverse patient populations.MethodTo address the limitations of the traditional PCMH model, the CARIÑOS approach, a patient‐driven, comprehensive, coordinated, and multi‐site care model, was developed by the University of Texas (UT) Health San Antonio Geriatrics and Supportive Care Practice to meet the healthcare needs of patients in an underserved, primarily Hispanic community, who are often frail and have complex medical and care needs between various healthcare settings. Early outcomes on costs were collected to demonstrate its economic effects.ResultOverall, the implementation of the CARIÑOS approach reduced total costs per patient per year by comparing six practices affiliated to the UT Health San Antonio Accountable Care Organization (ACO) – Regional Physicians Network. They serve similar underserved areas in the first and second Quarters of 2021. After adopting the CARIÑOS approach ($45,705), the costs were lower than 4 out of the 6 ACOs practices. In comparison, the Hierarchical Condition Category (HCC) score of the patients seen at the Geriatrics and Supportive Care Practice (HCC = 1.45) was higher than those seen at the other six practices (average = 1.15) during the same period of 2021.ConclusionThe CARIÑOS approach provides an innovative and comprehensive perspective delivering culturally congruent care for persons with dementia and support for their families.The main learning objectives of the session will be1. To enlist the elements of the CARINOS Approach for person centered care.2. To describe strategies that can be used to implement this approach in dementia care of underserved and Hispanic families.3. List the ways to engage promotores or community health workers as a bridge between the healthcare team and patient and family to improve patient experience.Key words – person centered, dementia care

Teaching module for obesity bias education: incorporating comprehensive competencies and innovative techniques

BackgroundThe majority of the United States population is overweight or obese, and obesity bias is frequently reported by patients. Obesity bias is associated with adverse health outcomes, even independent of body weight. Primary care residents are often sources of obesity bias towards patients with weight, yet education regarding obesity bias is significantly lacking in most family medicine residency teaching curricula. The aim of this study is to describe an innovative web-based module on obesity bias and discuss its impact in family medicine residents.MethodsThe e-module was developed by an interprofessional team of health care students and faculty. It consisted of a 15-minute video containing five clinical vignettes that depicted instances of explicit and implicit obesity bias in a patient-centered medical home (PCMH) model. Family medicine residents viewed the e-module as part of a dedicated one-hour didactic on obesity bias. Surveys were administered prior to and following the viewing of the e-module. They assessed previous education on obesity care, comfort in working with patients with obesity, residents’ understanding of their own biases in working with this population, and the anticipated impact of the module on future patient care.ResultsA total of 83 residents from three family medicine residency programs viewed the e-module and 56 completed both the pre and post survey. There was a significant improvement in residents’ comfort in working with patients with obesity as well as their understanding of their own biases.ConclusionThis teaching e-module is a short, interactive, web-based educational intervention that is free and open-sourced. The first-person patient perspective allows learners to better understand the patient’s point of view and its PCMH setting illustrates interactions with a variety of healthcare professionals. It was engaging and well received by family medicine residents. This module can begin the conversation around obesity bias, leading to improved patient care.

Child health equity and primary care.

Child health disparities in terms of access to high-quality physical and behavioral health services and social needs supports are rampant and pernicious in the United States. These disparities reflect larger societal health inequities (social injustice in health) and lead to preventable population-specific differences in wellness outcomes with marginalized children facing substantial and systematically disproportionate health burdens. Primary care, and specifically the pediatric patient-centered medical home (P-PCMH) model, is a theoretically well-positioned platform to address whole-child health and wellness needs, yet often does so in a way that is inequitable for marginalized populations. This article delineates how the integration of psychologists within the P-PCMH can advance child health equity. This discussion emphasizes roles (i.e., clinician, consultant, trainer, administrator, researcher, and advocate) that psychologists can undertake with explicit intentionality toward promoting equity. These roles consider structural and ecological drivers of inequities and emphasize interprofessional collaboration within and across child-serving systems of care using community-partnered shared decision-making approaches. Owing to the multiple intersecting drivers implicated in health inequities-ecological (e.g., environmental and social determinants of health), biological (e.g., chronic illness, intergenerational morbidity), and developmental (e.g., developmental screening, support, and early intervention)-the ecobiodevelopmental model is used as an organizing framework for psychologists' roles in promoting health equity. This article aims to advance the platform of the P-PCMH to address and promote policy, practice, prevention, and research in child health equity and the important role of psychologists within this model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting

BackgroundPeople with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. ObjectivesExplore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. MethodsConvenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. ResultsEmergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. ConclusionThe perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.

Designing an Interprofessional, Student-Led Clinic with the Patient-Centered Medical Home (PCMH) Model

Students and faculty at the University of Texas Medical Branch (UTMB) embarked on the novel undertaking of establishing a comprehensive, interprofessional clinic treating underserved, uninsured residents of Galveston County, Texas, and the surrounding area, modeled after the patient-centered medical home (PCMH). The need for such a community clinic is evident in relevant literature and patients’ suggestions, in addition to local demographic data. The comprehensive nature of this approach to clinic design is apparent in the intricate planning and documents produced by the steering committee, which outline a unique operational structure that optimizes clinic flow. This paper describes the planning, implementation, and future directions of an interprofessional, student-led free clinic operating under the PCMH model that offers a framework for other clinics.

Using a theoretical framework to inform implementation of the patient-centred medical home (PCMH) model in primary care: protocol for a mixed-methods systematic review

BackgroundThe patient-centred medical home (PCMH) was conceived to address problems that primary care practices around the world are facing, particularly in managing the increasing numbers of patients with multiple chronic diseases. The problems include fragmentation, lack of access and poor coordination. The PCMH is a complex intervention combining high-quality primary care with evidence-based disease management. Becoming a PCMH takes time and resources, and there is a lack of empirically informed guidance for practices. Previous reviews of PCMH implementation have identified barriers and enablers but failed to analyse the complex relationships between factors involved in implementation. Using a theoretical framework can help with this, giving a better understanding of how and why interventions work or do not work. This review will aim to refine an existing theoretical framework for implementing organisational change — the Consolidated Framework for Implementation Research (CFIR) — to apply to the implementation of the PCMH in primary care.MethodsWe will use the ‘best-fit’ framework approach to synthesise evidence for implementing the PCMH in primary care. We will analyse evidence from empirical studies against CFIR constructs. Where studies have identified barriers and enablers to implementing the PCMH not represented in the CFIR constructs, we will use thematic analysis to develop additional constructs to refine the CFIR. Searches will be undertaken in MEDLINE (Ovid), Embase (Ovid), Web of Science Core Collection (including Science Citation Index and Social Science Citation Index) and CINAHL. Gaps arising from the database search will be addressed through snowballing, citation tracking and review of reference lists of systematic reviews of the PCMH. We will accept qualitative, quantitative and mixed methods primary research studies published in peer-reviewed publications. A stakeholder group will provide input to the review.DiscussionThe review will result in a refined theoretical framework that can be used by primary care practices to guide implementation of the PCMH. Narrative accompanying the refined framework will explain how the constructs (existing and added) work together to successfully implement the PCMH in primary care. The unpopulated CFIR constructs will be used to identify where further primary research may be needed.Systematic review registrationPROSPERO CRD42021235960

The ‘Service Transformation Outline’ toolkit to assist in the design, comparison and replication of integrated care programmes

PurposeThe author is introducing a toolkit that can assist stakeholders to design, compare and replicate integrated care programmes, by making explicit their view on the transformations of care and cure services, according to a structured template. The purpose of this paper is to address this issue.Design/methodology/approachThe toolkit is made of two elements: a classification and a template. The author adopted a step-wise approach of semantic modelling to work out three layers of a classification in the domain of integration needs related to care and cure services. The third layer consists of 23 non-overlapping classes that fully cover that semantic domain. The classes are used to build a template to elicit the stakeholder's standpoint about the transformations involved in the deployment of a programme. The result is the «Outline» of the programme.FindingsSo far, in eight years the author applied the toolkit to 100+ programmes either to design, simulate or evaluate them, either to compare them to similar ones in the same or in different jurisdictions, and we refined the description of the classes according to that experience.Research limitations/implicationsThe objective of the toolkit is not to provide solutions, but to stimulate reflections on the transformations involved in a programme and their practical consequences in a precise context. In fact, the Outlines cannot be generalized: they are conceived to reflect the perspective of the stakeholders and thus are intrinsically subjective; in addition, they must be contingent, as they must depend on the local context in the particular timeframe. In case of similar initiatives in other localities, the Outlines must be filled in again by the local stakeholders; however, a subsequent comparison could help to explore similarities and motivated differences.Practical implicationsIdeally the stakeholders should use the Outline of the actual transformations in a programme as a reference to mediate between the principles and the methodologies provided by the «Models» and «Conceptual Frameworks» in the literature (e.g. Chronic Care Model, Rainbow Model, Development Model of Integrated Care Patient-Centered Medical Home and Maturity Models) and the deeper studies using the specific tools developed in their disciplines (e.g. on information modelling, process modelling, cost–benefit analysis and health technology assessment). The toolkit could have its role also in a multi-annual roadmap made of a sequence of programmes to cope with the urgent challenges on ageing, social changes and technological evolution, in synergy with regulations, budget, context maturity, critical success factors and local priorities.Originality/valueThe author argues that the approach of the structured Outline is unique, as the scoring mechanism to assess the relevance of the transformation within each class on the overall change brought by the whole programme into the health systems.

A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient's Care Experience.

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient–provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.

High-Risk Encounters: Primary Care Experiences of Women Living with Intimate Partner Violence, and Implications for the Patient Centered Medical Home

ABSTRACT Women experiencing intimate partner violence (IPV) often face stigma, uncertainty, and complex emotions when deciding to disclose IPV to primary care providers. As the Patient Centered Medical Home (PCMH) model’s general assumptions and value have been more widely accepted, interest has grown in understanding how well it serves different populations. We interviewed 50 women who had experienced prior-year IPV and received care from 2 Veterans Health Administration (VA) facilities, to explore their health care needs Disclosure of IPV status was revealed as a high-risk moment in medical care for many participants, yet nearly all supported clinical screening and described or envisioned patient-centered screening practices. The PCMH’s interprofessional team-based care model offers strengths for connecting women to services and support. However, if women do not experience trust, genuine care, and respect for their autonomy, they are unlikely to disclose IPV or access extended services. The PCMH model holds intrinsic promise but may fall short in delivering on relational aspects of patient-centered care desired by women experiencing IPV (and possibly others facing similar complex, stigmatized challenges). IPV screening practices should aim to empower the entire care team to be able to build the trusting relationships that open the door to discussions of IPV.

Increasing Breastfeeding Rates Through Continuity of Care

BackgroundContinuity of care is important in many aspects of medicine, as evidenced by the patient-centered medical home model. The newborn period is an especially important time for continuity of care, as this time sets the stage for lifelong health. Breastfeeding, which is known for its positive health benefits for both mother and child, is the gold standard for infant feeding. While inpatient lactation support is a common amenity available during hospital admission, support can be more difficult to obtain once a patient is discharged. To help eliminate this barrier, a process was put in place within an Eastern Pennsylvania health network’s seven office locations to standardize outreach to the mother-infant dyad.MethodsA quality improvement retrospective chart review comparing pre- and post-intervention rates of exclusive and non-exclusive breastfeeding was completed using one health system’s Electronic Health Record (EHR). A referral process was established to capture dyads born within the health network’s hospital who were going to be followed at one of the seven pediatric offices outpatient. Mothers were called and followed to see how they were progressing with their breastfeeding goals. Any problems were addressed by the health network’s International Board-Certified Lactation Consultants (IBCLCs) and Certified Lactation Counselor (CLC).ResultsLactation rates at the pediatric practice were observed to have increased at both 6 months and 12 months post-intervention compared to pre-intervention.ConclusionProactively scheduling and providing outreach immediately following birth may promote increased breastfeeding rates.

Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research.

Background:The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components.Methods:The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination.Results:There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care.Conclusions:It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.

What Primary Care Innovation Teaches Us About Oral Health Integration.

Integrating primary and oral health care is critical to improving population health and addressing health inequity exacerbated by the COVID-19 pandemic. Leaders of the patient-centered medical home (PCMH) movement focused on building consensus for the PCMH model among diverse stakeholders in order to enhance infrastructure investment, care innovation, and payment reforms that support access and equity. This article offers 5 lessons from the PCMH movement to inform primary and oral health care integration.

A parent-led, patient-centered medical home model instruction for interprofessional undergraduate and graduate learning opportunities

ABSTRACT Introduction Despite national efforts to establish patient-centered medical homes (PCMH), 57.3% of children with special health care needs are receiving care that does not meet medical home criteria. Project DOCC, a national curriculum designed by parents of children with disabilities or chronic disease, has shown documented strengths in medical resident learner education of children with special health care needs from the parent perspectives for over a decade. Because of the importance of PCMH and the need to provide compassionate care, our team adapted the curriculum to incorporate team-based learning in the rural setting. Materials and Methods Reading materials were distributed to learners prior to an in-person workshop at which time, learners reviewed a video and discussed PCMH materials to identify elements of the PCMH. Learners then engaged with parent mentors across three breakout sessions. A final group reflection was completed to review and discuss efforts providers would take to establish and maintain the PCMH in their own practice. Baseline and post-workshop PCMH perceptions and parent mentor reflections were collected and compared using t-test comparisons. Results Learner knowledge, perceptions, and comfort significantly increased after the workshop. Parent mentor comments also highlighted an increased understanding for the provider. Discussion: The adapted PCMH curriculum significantly impacted learner outcomes using a feasible approach that fit nicely within health professional curricula and limited resources of the rural setting. Parents enjoyed the opportunity to serve as mentors and valued the instruction format.