Gatekeepers as Care Providers: The Care Work of Patient‐centered Medical Home Clerical Staff

Abstract

International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority.

Patient-Rated Access to Needed Care: Patient-Centered Medical Home Principles Intertwined

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Those with the Most Find It Hardest to Share: Exploring Leader Resistance to the Implementation of Team-based Empowerment

“…As the parallel component within a convergent mixed methods design, qualitative data were drawn from participant interviews conducted as part of a larger study of VHA teams. Data from these interviews have been previously published in medical studies describing specific role experiences within VHA teams (Patterson et al, 2015;Solimeo, Ono, Stewart, Lampman, Rosenthal, & Stewart, 2017;Solimeo, Stewart, Stewart, & Rosenthal, 2014;Stewart et al, 2015;True et al, 2014). These role experiences have been published in the medical literature as predominantly descriptive, atheoretical reports.…”

Keeping out and getting in: reframing emergency department gatekeeping as structural competence

“…Jean , Smith , Solimeo et al . ). For instance, Vosk and Milofsky () contend that most ED gatekeeping is performed by someone other than the medical provider.…”