Patient-Centered Medical Home in chronic obstructive pulmonary disease

Ortiz, Gabriel; Fromer, Len

doi:10.2147/jmdh.s22811

Cited by 21 publications

(17 citation statements)

References 36 publications

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“…1,2 Several large demonstration projects have associated use of the PCMH model with improvements in measures of cost related to healthcare utilization and quality markers of chronic care management. [3][4][5][6][7] However, we know little about the transformation process itself and what changes are necessary in order to achieve improved clinical performance. Practices seeking to become PCMHs require deconstructing traditional primary care practice models and developing new roles and a practice culture more aligned with this new paradigm of healthcare delivery.…”

Section: Introductionmentioning

confidence: 99%

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

et al. 2013

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BACKGROUND:The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized. OBJECTIVE: To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project. DESIGN: Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania. PARTICIPANTS: A total of 118 individual interviews were conducted with clinicians (N=47), patient educators (N=4), office administrators (N=12), medical assistants (N=26), front office staff (N=7), nurses (N=4), care managers (N=11), social workers (N =4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation. KEY RESULTS: Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice-patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care. CONCLUSIONS: Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, selfassessment, and the development of shared decisionmaking. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of teambased care.KEY WORDS: patient-centered care; primary health care; delivery of health care; workplace; program evaluation.

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Section: Introductionmentioning

confidence: 99%

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

et al. 2013

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“…It is evidence-based that integrating two or more components of chronic care model leads to significantly reduced hospitalization rates, lengths of stay, emergency/unscheduled outpatient department visits, and costs [2••, [24][25][26].…”

Section: Effective Integration Into New Models Of Palliative Carementioning

confidence: 99%

Role of Palliative Care in Improving the Quality of Life in Elderly with Advanced Lung Disease

Bilaçeroğlu

2016

Curr Geri Rep

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The traditional Beither cure or comfort^approach does not optimize palliative care in elderly with advanced lung disease. Instead, a holistic, patient-centered, Bcomfort and cure together^approach with palliative and best care practices integrated as needed across the entire illness course will improve quality of life and other outcomes in these patients and their families. Competency in primary palliative care, identification of patient and family vulnerability, care plans formed by patient-centered communication, timely palliative responsiveness, and effective advance care planning are key components that support this approach. Dependency of patients on emergency or in-patient care for crisis of dyspnea and other symptoms is costly. To resolve this issue, a proactive, collaborative management with appropriate and carefully monitored use of opioids and other treatment is recommended. A revised primary care-integrating palliative care to curative/restorative care and judiciously referring to specialist palliative care-is essential for sustainable improvement in palliative care delivery.

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“…Considered an extension of the chronic care model [38], it includes five general principles: 1) comprehensive care; 2) patient-centered, holistic care; 3) coordination of care; 4) greater accessibility of services; and 5) system based approach to quality and safety [39,40]. As a broad concept, this comes close to integrated care.…”

Section: Patient-centered Medical Homementioning

confidence: 99%

Integrated Care: What does this Mean for the COPD Patient?

Williams¹,

Wilcox²,

ZuWallack³

et al. 2016

Chron Obstruct Pulmon Dis

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Despite remarkable advances in medicine and technology, the management of the patient with COPD is often inefficient and fragmented. Optimizing care for these individuals requires that a proactive, patient-centered, defragmented and integrated plan of care. Integrated care, which draws heavily from the chronic care model, incorporating holistic, self-management and care coordination principles to meet the needs of the complex COPD patient, is a desirable approach to improving medical management. The relationship of integrated care to other, similar conceptual models, including self-management, disease management, care coordination, and patient centered medical home is discussed.

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Patient-Centered Medical Home in chronic obstructive pulmonary disease

Cited by 21 publications

References 36 publications

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

Role of Palliative Care in Improving the Quality of Life in Elderly with Advanced Lung Disease

Integrated Care: What does this Mean for the COPD Patient?

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