Medical home

The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the 'Joint Principles' (see below) as 'an approach to providing comprehensive primary care for children, youth and adults.' The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the 'Joint Principles' (see below) as 'an approach to providing comprehensive primary care for children, youth and adults.' The provision of medical homes is intended to allow better access to health care, increase satisfaction with care, and improve health. The 'Joint Principles' that popularly define a PCMH were established through the efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA) in 2007. Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology and appropriately-trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their functions devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage further coordination. The concept of the 'medical home' has evolved since the first introduction of the term by the American Academy of Pediatrics in 1967. At the time, it was envisioned as a central source for all the medical information about a child, especially those with special needs. Efforts by Calvin C.J. Sia, MD, a Honolulu-based pediatrician, in pursuit of new approaches to improve early childhood development in Hawaii in the 1980s laid the groundwork for an Academy policy statement in 1992 that defined a medical home largely the way Sia conceived it: a strategy for delivering the family-centered, comprehensive, continuous, and coordinated care that all infants and children deserve. In 2002, the organization expanded and operationalized the definition. In 2002, seven U.S. national family medicine organizations created the Future of Family Medicine project to 'transform and renew the specialty of family medicine.' Among the recommendations of the project was that every American should have a 'personal medical home' through which they could receive acute, chronic, and preventive health services. These services should be 'accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians.' As of 2004, one study estimated that if the Future of Family Medicine recommendations were followed (including implementation of personal medical homes), 'health care costs would likely decrease by 5.6 percent, resulting in national savings of 67 billion dollars per year, with an improvement in the quality of the health care provided.' A review of this assertion, published later the same year, determined that medical homes are 'associated with better health,... with lower overall costs of care and with reductions in disparities in health.' By 2005, the American College of Physicians had developed an 'advanced medical home' model. This model involved the use of evidence-based medicine, clinical decision support tools, the Chronic Care Model, medical care plans, 'enhanced and convenient' access to care, quantitative indicators of quality, health information technology, and feedback on performance. Payment reform was also recognized as important to the implementation of the model. IBM and other organizations started the Patient-Centered Primary Care Collaborative in 2006 to promote the medical home model. As of 2009, its membership included 'some 500 large employers, insurers, consumer groups, and doctors'. In 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association—the largest primary care physician organizations in the United States—released the Joint Principles of the Patient-Centered Medical Home. Defining principles included: