Turning a doctor’s office into a “medical home”
UT Health Science Center professor leads national research on new breed of primary care practice; findings published today in special edition of Annals of Family Medicine
SAN ANTONIO (June 7, 2010) — A professor from The University of Texas Health Science Center at San Antonio is exploring how to transform a doctor’s office into a “patient-centered medical home” that offers team-based care, better use of technology and a more personal experience for the patient that may ultimately improve health.
Carlos R. Jaén, M.D., Ph.D., chairman of Family & Community Medicine at the UT Health Science Center, is principal investigator for the first large-scale national demonstration project on patient-centered medical homes, launched in June 2006 by the TransforMED subsidiary of the American Academy of Family Physicians.
A special supplement of Annals of Family Medicine released Monday, June 7, contains eight articles authored or coauthored by Dr. Jaén explaining the process, outcomes and lessons of the project.
There is no single description of a patient-centered medical home – also called “advanced primary care” – although there are some generally accepted principles. These are broad and wide-ranging, calling for a team approach, elimination of barriers to access, electronic health records, redesigned offices, care within a community context and better financial practices.
“It’s proactive care,” Dr. Jaén said. “It’s a place where you get what you need when you need it and how you need it in terms of medical care.”
Depending on the practice, a patient might see some of the following signs of a patient-centered medical home:
• Access to medical staff: A patient can get an appointment the same day, reach someone in the practice in the middle of the night or e-mail the doctor with questions or concerns. Medical practices have extended evening and weekend hours. Patients have a relationship with doctors and medical staff who know them by name.
• Better use of technology: This might mean having lab results quickly integrated into a patient’s electronic medical record, or it could be the ability to instantly generate “disease registries,” or lists of patients with common conditions and needs, that can be used to remind patients about medications, tests or preventative procedures. It might be as simple as giving a patient online access to laboratory and imaging studies or the ability to e-mail a doctor or schedule an appointment online.
• Team approach to care: Each patient has a personal doctor who coordinates care. But patients interact with a number of medical staffers, depending on who is best suited to a given situation. A practice might have any combination of doctors, nurses and nurse practitioners, physician assistants, pharmacists, psychologists or other medical personnel who work together to provide integrated care. Dr. Jaén calls it “a partnership for the benefit of the patients.”
• Community-oriented care: A patient-centered medical home responds to the needs of its community. Patients with the same condition might be able to see their doctor together, addressing common concerns as a group. For example, smokers might be seen together for group coaching on how to quit smoking. Those patients can be seen individually as needed. Group visits also allow patients to share experiences and support each other. This also can be valuable in prenatal visits, weight loss, diabetes management and other cases. In some instances, practices have outreach to local sports teams for sports physicals and other community needs.
Dr. Jaén and his faculty have brought some of these changes to the family medicine clinic at the Medical Arts & Research Center (MARC), which houses UT Medicine San Antonio, the faculty practice group of the UT Health Science Center’s School of Medicine. The MARC was not among the practices studied in the national demonstration project.
The MARC clinic has electronic medical records, offers evening and weekend hours and is beginning to incorporate group visits for certain patient populations.
What makes a patient-centered medical home was sketched out in the 2003 Future of Family Medicine Report and further detailed in a 2007 policy statement issued by four professional organizations: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.
The project undertaken by Dr. Jaén and his co-investigators attempts to implement nearly all principles of a patient-centered medical home outlined in these publications.
After studying 36 diverse U.S. primary care practices, Dr. Jaén and his co-investigators found that a highly motivated practice can put into place many elements of a patient-centered medical home. However, absent larger health care system and payment reform, these changes lead to modest improvement in disease-specific measures of quality of care while slightly worsening the patient experience, at least in the short term.
The authors conclude that “both practice and system reforms are needed to make it easier to integrate, personalize and prioritize care for whole people, communities and populations.”
Dr. Jaén believes that, for now, the patient-centered medical home is more aspiration than reality, but it has the potential to move the doctor-patient relationship closer to the ideal: “It combines the latest in evidence-based medicine with the best in doctor-patient relationships and best practice organization practices.”
Others who worked on the demonstration project and authored articles for the supplement include: Robert L. Ferrer, M.D., M.P.H., and Raymond C. Palmer, Ph.D., both associate professors of Family and Community Medicine at the UT Health Science Center; Benjamin F. Crabtree, Ph.D., professor at the UMDNJ Robert Wood Johnson Medical School; William Miller, M.D., M.A., with the Lehigh Valley Health Network; Paul A. Nutting, M.D., M.S.P.H., director of research with the Center for Research Strategies in Denver, Colo.; Kurt C. Stange, M.D., Ph.D., professor of family medicine, epidemiology & biostatistics, sociology and oncology at Case Western Reserve University; and Elizabeth E. Stewart, Ph.D., senior scientist with the American Academy of Family Physicians National Research Network.
To learn more about the national demonstration project, visit http://www.transformed.com/ndp.cfm.
UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at www.UTMedicine.org for a complete listing of clinics and phone numbers.