A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multimorbid Older Adults

Boyd, Cynthia M.; Shadmi, Efrat; Conwell, Leslie Jackson; Griswold, Michael; Leff, Bruce; Brager, Rosemarie; Sylvia, Martha; Boult, Chad

doi:10.1007/s11606-008-0529-9

Cited by 85 publications

(89 citation statements)

References 36 publications

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“…While many of these chronic conditions cluster together, e.g., hypertension, congestive heart failure, diabetes, chronic renal failure, etc., current episode payment approaches (as well as clinical practice guidelines and P4P measures) generally assume independence of these conditions. 19 Indeed, even the concept of an episode of a chronic condition might be viewed as an oxymoron since they generally do not end, except in death. 59 …”

Section: Recalibrating Fee-for-service: Episode-based Payment and Bunmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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The purpose of this paper is to address why the three dominant alternatives to compensating physicians (feefor-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.KEY WORDS: primary care; reimbursement; health care delivery.

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Section: Recalibrating Fee-for-service: Episode-based Payment and Bunmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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“…Relying on an EMR that is specialized for these patients, the Guided Care RN collaborates with the patient's PCP to manage elements of the CCM and specifically target clinical problems seen in the frail elderly, such as depression and hearing loss. 36 Preliminary evidence suggests that this "streamlined" approach doesn't require major practice redesign; however, efficient use of the dedicated Guided Care RN would usually require the number of chronic care patients served by several physicians. 37 n Patient populations served by the medical home.…”

Section: Challenges To Pcmh Adoptionmentioning

confidence: 99%

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Berenson¹,

Hammons²,

Gans³

et al. 2008

Health Affairs

211

171

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The patient-centered medical home could well be a transformative innovation-for some practices now, but for many others only in the long run.by Robert A. Berenson, Terry Hammons, David N. Gans, Stephen Zuckerman, Katie Merrell, William S. Underwood, and Aimee F. Williams ABSTRACT: The "patient-centered medical home" has been promoted as an enhanced model of primary care. Based on a literature review and interviews with practicing physicians, we find that medical home advocates and physicians have somewhat different, although not necessarily inconsistent, expectations of what the medical home should accomplish-from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions. As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care. T h e pat i e n t-c e n t e r e d m e d i c a l h o m e (PCMH) is the newest idea being promoted as a transformative health system innovation. Proponents believe that it will improve the quality of and patients' experiences with care and alter the trajectory of inflationary health care spending. 1 The PCMH has been proposed by four primary care physician specialty societies; has been endorsed by a range of purchaser, labor, and consumer organizations, including IBM, Merck and Company, the ERISA Industry Committee, and AARP; and is being tested in demonstrations by major public and private health plans, including Medicare, various Blue Cross and Blue Shield plans, UnitedHealthcare, and Aetna. 2 The medical P r a c t i c e R e d e s i g n H E A LT H A F F A I R S~Vo l u m e 2 7, N u m b e r 5 1 2 1 9

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“…7 Other studies reported that case management can improve the quality of communication between the health team and patients and help to satisfy those involved in the experience of care, whether doctors, patients or families. 8,16,19 The use of the GRACE and PACE models and Gundersen program, patients reported receiving more information about their conditions, they had fewer needs that were not cared for, and the last aspect led to change the outbreak of the disease for the patient. 16,20 A trial with bipolar affective disorder patients tested the case management and noted that…”

Section: Discussionmentioning

confidence: 99%

“…A Pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults 8 Boyd et al…”

Section: Case Managementmentioning

confidence: 99%

Care models for people with chronic diseases: integrative review

et al. 2017

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Article linked to the research: Predictive factors for complications and nursing care management actions in hypertensive people in primary careFundings: The article is part of a project that received funding from the National Council for Scientific and Technological Development and the Araucária Paraná Foundation. Conflicts of interest: none.Receipt date: February 12, 2016. Resultados. La muestra estuvo constituida por 17 artículos sobre el tema de interés. Del análisis emergieron tres categorías: los costos del cuidado de la salud, la experiencia de atención basada en un modelo y la autonomía del paciente. Los artículos abordaron la autogestión, la gestión de casos y el modelo de cuidado a personas con enfermedades crónicas. Los mayores impactos en la utilización de los modelos fueron: una mejor relación del paciente con el profesional de salud, aumento de la autonomía de la persona con enfermedad crónica y la reducción del gasto en salud personal y del sistema sanitario. Conclusión. La utilización de modelos de cuidado de personas con enfermedades crónicas presenta beneficios al paciente y al sistema de salud, modelos en los cueles los enfermeros deben participar activamente en su aplicación.Descriptores: enfermedad crónica; modelos de enfermería; atención de enfermería; enfermería práctica. Descritores: doença crônica; modelos de enfermagem; cuidados de enfermagem; enfermagem prática. Modelos de cuidados á pessoas com doenças crônicas: revisão integrativa

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A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multimorbid Older Adults

Cited by 85 publications

References 36 publications

US Approaches to Physician Payment: The Deconstruction of Primary Care

US Approaches to Physician Payment: The Deconstruction of Primary Care

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Care models for people with chronic diseases: integrative review

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