Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions

Pourat, Nadereh; Charles, Shana Alex; Snyder, Sophie

doi:10.1097/mlr.0000000000000498

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…One US PCMH study 91 confirmed that having an embedded case manager using joint care planning and motivational interviewing resulted in 91 Similarly, a case study in a PCMH found that case managers using motivational interviewing, assessment skills and joint care planning enhanced the value of primary care visits for patients and engaged patients more in their own care. 137 In contrast, a survey of 10,990 adults with asthma, diabetes mellitus or chronic heart disease in a US PCMH 138 found that having an individual treatment plan was not associated with patient empowerment. Nevertheless, these adults were more likely to report using preventative and ambulatory care when their care involved at least two of care co-ordination, care continuity and a care plan.…”

Section: Care Planning For Individual Patientsmentioning

confidence: 98%

“…Taken together, the findings from the three relevant studies 91,137,138 on preventative care imply that patient empowerment is sufficient, but not necessary, to stimulate increased use of preventative and ambulatory care.…”

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

“…Referrals to non-hospital physiotherapy, podiatry, occupational therapy, dietetics and psychosocial services (but not to community nursing) increased. 62 Against this, Pourat et al 138 found that the combination of care co-ordination, continuity of care and care plans did not decrease the likelihood of ED use, although it did increase use of preventative and ambulatory care and improved clinicians' communication with patients. This is an absence of evidence for the outcome that NHS policy-makers had assumed, not evidence of an opposite effect.…”

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

“…Nevertheless, these adults were more likely to report using preventative and ambulatory care when their care involved at least two of care co-ordination, care continuity and a care plan. In this study, 138 unlike the others, the unit of analysis was the patient rather than the provider organisation.…”

Section: Care Planning For Individual Patientsmentioning

confidence: 99%

“…One study 138 did not (described below). Two studies 105,140 found that care planning during and after the transition from secondary to primary care reduces readmission rates, and another two 86,105 that having operational facilitators to support care planning reduced readmission rates.…”

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

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From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Background The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience. Study registration This study is registered as PROSPERO CRD42016038900. Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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Section: Care Planning For Individual Patientsmentioning

confidence: 98%

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

Section: Care Planning For Individual Patientsmentioning

confidence: 99%

Section: Causal Link 10:9 -Contextsmentioning

confidence: 99%

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From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Ambulatory Primary Care and Urgent Care

Denniston

Jackson

2023

Chronic Illness Care

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Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges.

Kazak

Nash

Hiroto

et al. 2017

American Psychologist

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The patient-centered medical home (PCMH) is an increasingly common model of health care delivery with many exciting opportunities for psychologists. The PCMH reflects a philosophy and model of care that is highly consistent with psychological science and practice. It strives to provide patient-centered, comprehensive, team-based, coordinated, accessible, and quality and safety-oriented health care delivery to individuals and families. Moreoever, in keeping with changes in the health care system more broadly, the PCMH model prioritizes the integration of behavioral and physical health care, and this emphasis lays the foundation for active and full engagement of psychologists in this context. This article provides an overview of the PCMH and the evidence and roles for psychologists across a range of pediatric, adult, and geriatric health care populations and settings. Current challenges to the necessary expansion of psychology in the PCMH are discussed, with particular attention to the needs for training and advocacy to support the contributions of behavioral health care in the PCMH. Psychology must embrace its rightful place as a health profession and appreciate and highlight the ways in which psychologists can play unique and critical roles in transforming present and future health care delivery models. (PsycINFO Database Record

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Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions

Abstract: Patients who received care that met 3 key aspects of PCMH: coordination, continuity, and management, had better quality of care and more efficient use of the health care system.

Cited by 16 publications

References 29 publications

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Ambulatory Primary Care and Urgent Care

Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges.

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