Literature Collection

361

Not all (medical) homes are built alike: some work better than others

Type: Journal Article

Authors: Richard J. Baron

Year: 2014

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362

Off the Hamster Wheel? Qualitative Evaluation of a Payment-Linked Patient-Centered Medical Home (PCMH) Pilot

Type: Journal Article

Authors: Asaf Bitton, Gregory R. Schwartz, Elizabeth E. Stewart, Daniel E. Henderson, Carol A. Keohane, David W. Bates, Gordon D. Schiff

Year: 2012

Publication Place: United States

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363

Offering Patients a Medical Home – Not a Hallway – and a Stronger Health System

Type: Journal Article

Authors: Leanne Clarke, Kavita Mehta

Year: 2019

Publication Place: Toronto

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364

Open access in the patient-centered medical home: lessons from the Veterans Health Administration

Type: Journal Article

Authors: G. True, A. E. Butler, B. G. Lamparska, M. L. Lempa, J. A. Shea, D. A. Asch, R. M. Werner

Year: 2013

Publication Place: United States

Abstract: BACKGROUND: The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. OBJECTIVE: We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. DESIGN: A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. PARTICIPANTS: Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. APPROACH: We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. KEY RESULTS: Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. CONCLUSIONS: Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

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365

Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home

Type: Journal Article

Authors: C. L. Hunter, J. L. Goodie

Year: 2010

Publication Place: United States

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366

Opioid Management in Older Adults: Lessons Learned From a Geriatric Patient-Centered Medical Home

Type: Journal Article

Authors: N. Azubike, M. Moseley, J. S. Powers

Year: 2021

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367

Opportunities for Social Workers in the Patient Centered Medical Home

Type: Journal Article

Authors: M. Hawk, E. Ricci, G. Huber, M. Myers

Year: 2014

Abstract: The Patient Centered Medical Home (PCMH) has been hailed as one method of improving chronic care outcomes in the United States. A number of studies have underscored the importance of the social work role within the PCMH, yet little existing research explores the social worker as a driver of improved patient care. The Pennsylvania Chronic Care Initiative was created with a primary goal of increasing the number of practices that were recognized as PCMH by the National Committee for Quality Assurance. This article describes findings from in-depth qualitative interviews with representatives from seven primary care practices, in which the authors examined barriers and facilitators to implementation of the initiative. Barriers to implementation included small practice size, payer-driven care, not having a strong physician champion, variability within patient populations, and high implementation costs. Facilitators included having a social worker coordinate behavioral health services, clinical nurse case managers, preexisting models of outcomes-driven care, and being part of an integrated health delivery and financing system. Recommendations strengthening the role of medical social workers in primary care practices are discussed.

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368

Optimizing pain management through collaborations with behavioral and addiction medicine in primary care

Type: Journal Article

Authors: M. Brensilver, S. Tariq, S. Shoptaw

Year: 2012

Publication Place: United States

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369

Orchestrating Large Organizational Change in Primary Care: The Veterans' Health Administration Experience Implementing a Patient-Centered Medical Home

Type: Journal Article

Year: 2014

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370

Organization of care and diagnosed depression among women veterans

Type: Journal Article

Authors: U. Sambamoorthi, B. Bean-Mayberry, P. A. Findley, E. M. Yano, R. Banerjea

Year: 2010

Publication Place: United States

Abstract: OBJECTIVE: To analyze the association between the organizational features of integration of physical and mental healthcare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension). STUDY DESIGN: Retrospective and observational secondary data analyses. METHODS: We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged Medicare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices. The dependent variable was a binary indicator for diagnosed depression during FY2001 at the individual level. We used a multilevel logistic regression model to control for clustering of women veterans within facilities. Individual-level independent variables included demographics, socioeconomic characteristics, and chronic physical conditions. RESULTS: Overall, 27% of women veterans using the VHA were diagnosed as having depression in FY2001. Across facilities, rates of diagnosed depression varied from 13% to 41%. After controlling for individual-level and facility-level independent variables, women veterans who were served in separate women's health clinics with integrated physical and mental healthcare were more likely to have diagnosed depression. The adjusted odds ratio was 1.12 (95% confidence interval, 1.01-1.25). CONCLUSIONS: Existing women-specific VHA organizational features with integration of primary care and mental health seem effective in diagnosing depression. Emerging patient-centered medical home models may facilitate diagnosis and treatment of mental health issues among women with complex chronic conditions.

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371

Organizational correlates of implementation of colocation of mental health and primary care in the Veterans Health Administration

Type: Journal Article

Authors: E. G. Guerrero, K. C. Heslin, E. Chang, K. Fenwick, E. Yano

Year: 2015

Publication Place: United States

Abstract: This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders' perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics' flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work.

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372

Outreach to high-need, high-cost individuals: Best practices for New York health homes

Type: Report

Authors: A. Hamblin, R. Davis, K. Hunt

Year: 2014

Publication Place: New York, NY

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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373

Partial and incremental PCMH practice transformation: Implications for quality and costs.

Type: Journal Article

Authors: Michael L. Paustian, Jeffrey A. Alexander, Darline K. El Reda, Chris G. Wise, Lee A. Green, Michael D. Fetters

Year: 2014

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374

Participatory (re)design of a sociotechnical healthcare delivery system: The Group Health Patient-Centered Medical Home

Type: Journal Article

Authors: J. T. Tufano, J. D. Ralston, P. Tarczy-Hornoch, R. J. Reid

Year: 2010

Publication Place: Netherlands

Abstract: This paper describes one organization's interpretation of the Patient-Centered Medical Home concept and the healthcare delivery system that has emerged from their participatory redesign initiative. Group Health, a large integrated healthcare system based in Seattle, Washington, USA initiated a Patient-Centered Medical Home care delivery system transformation in January 2007. Current theories and evidence about the Patient-Centered Medical Home (PCMH), the Chronic Care Model, and effective primary care were interpreted via a facilitated group process and translated into a core set of 5 system design principles. These design principles guided all subsequent system transformation activities. The central organizing principle is supporting and sustaining the patient-primary care physician relationship. The emergent PCMH healthcare delivery system comprises both opportunistic point-of-care and outreach components, many of which leverage and enhance the organization's health information and communication technologies.

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375

Partnering with a payer to develop a value-based medical home pilot: a West Coast practice's experience

Type: Journal Article

Authors: L. D. Bosserman, D. Verrilli, W. McNatt

Year: 2012

Publication Place: United States

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376

Patient Centered Medical Home Resource Center

Type: Web Resource

Authors: Agency for Healthcare Research and Quality

Year: 2016

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,

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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377

Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project

Type: Journal Article

Authors: C. R. Jaen, R. L. Ferrer, W. L. Miller, R. F. Palmer, R. Wood, M. Davila, E. E. Stewart, B. F. Crabtree, P. A. Nutting, K. C. Stange

Year: 2010

Publication Place: United States

Abstract: PURPOSE: The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices' transition to patient-centered medical homes (PCMHs). METHODS: In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of how many of 39 predominantly technological NDP model components the practices adopted. We evaluated 2 types of patient outcomes with repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months: patient-rated outcomes and condition-specific quality of care outcomes. Patient-rated outcomes included core primary care attributes, patient empowerment, general health status, and satisfaction with the service relationship. Condition-specific outcomes were measures of the quality of care from the Ambulatory Care Quality Alliance (ACQA) Starter Set and measures of delivery of clinical preventive services and chronic disease care. RESULTS: Practices adopted substantial numbers of NDP components over 26 months. Facilitated practices adopted more new components on average than self-directed practices (10.7 components vs 7.7 components, P=.005). ACQA scores improved over time in both groups (by 8.3% in the facilitated group and by 9.1% in the self-directed group, P <.0001) as did chronic care scores (by 5.2% in the facilitated group and by 5.0% in the self-directed group, P=.002), with no significant differences between groups. There were no improvements in patient-rated outcomes. Adoption of PCMH components was associated with improved access (standardized beta [Sbeta]=0.32, P = .04) and better prevention scores (Sbeta=0.42, P=.001), ACQA scores (Sbeta=0.45, P = .007), and chronic care scores (Sbeta=0.25, P =.08). CONCLUSIONS: After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience. PCMH models that call for practice change without altering the broader delivery system may not achieve their intended results, at least in the short term.

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378

Patient predictors and utilization of health services within a medical home for homeless persons

Type: Journal Article

Authors: A. L. Jones, R. Thomas, D. O. Hedayati, S. K. Saba, J. Conley, A. J. Gordon

Year: 2018

Publication Place: United States

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379

Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems

Type: Journal Article

Authors: Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee

Year: 2014

Publication Place: United States

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380

Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of "Consultant" for Psychiatric-Mental Health Nurse Practitioner

Type: Journal Article

Authors: V. Soltis-Jarrett

Year: 2016

Publication Place: England

Abstract: The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the "navigator" for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.

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