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Specialists/Subspecialists and the Patient-Centered Medical Home

2009; Elsevier BV; Volume: 137; Issue: 1 Linguagem: Inglês

10.1378/chest.09-0060

1931-3543

Neil Kirschner, Michael S. Barr,

Healthcare Systems and Technology

This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices. The authors conclude that the model for effective connections between the PCMH and specialty/subspecialty practices requires further development, including the cross-specialty establishment of guidelines and processes regarding referrals, information flow, transitions in care, and accountability. The efforts of the American College of Physicians' Council of Subspecialty Societies PCMH Workgroup to further develop this model are described. The authors encourage involvement from all interested stakeholders to ensure that the issues and challenges identified are addressed through collaboration and consensus based on available evidence. This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices. The authors conclude that the model for effective connections between the PCMH and specialty/subspecialty practices requires further development, including the cross-specialty establishment of guidelines and processes regarding referrals, information flow, transitions in care, and accountability. The efforts of the American College of Physicians' Council of Subspecialty Societies PCMH Workgroup to further develop this model are described. The authors encourage involvement from all interested stakeholders to ensure that the issues and challenges identified are addressed through collaboration and consensus based on available evidence. Primary Care, Specialist Care, and Chronic Care: Can They Interlock?CHESTVol. 137Issue 1PreviewIn this issue of CHEST (see page 200 ), Kirschner and Barr1 present the concept of the Patient-Centered Medical Home (PCMH) in the context of the opportunities it presents to specialists to contribute to advances in the organization and delivery of health services in the United States. It is only recently that the challenge of coordination of care when patients move from inpatient to outpatient and from doctor to doctor has been appreciated.2 The challenge is considerable: in the United States, most patients see both primary care physicians and specialists in any given period of time. Full-Text PDF Is There Room for Specialists in the Patient-Centered Medical Home?CHESTVol. 137Issue 1PreviewThe Patient-Centered Medical Home (PCMH) is one of the new ideas being proposed as a transformative health system innovation. More than 30 states are testing medical homes in Medicaid and State Children's Health Insurance Programs, which is sensible given the medical home's long-standing use by some pediatrics practices.1 But medical homes are also now being broadly tested in practices serving adults; more than 20 multistakeholder demonstration projects are underway in 14 states, and the Centers for Medicare and Medicaid Services are prepared to initiate PCMH demonstrations in 400 practices in eight sites, pending possible expansion of the demonstration as a result of health-care reform legislation. Full-Text PDF