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Health Reform and the Medical Home


The Medical Home

“The better the primary care, the greater the cost savings, the better the health outcomes, and the greater the reduction in health and health care disparities.” get Valtrex 1

Australia, through the National Health and Hospitals Reform Commission, is seeking the best way to deliver health services into the future.

In the collaborative program, practices have been challenged to deliver evidence based care to every single patient, every single time.

In answering this challenge, a model of care has been developed by practices which is comprehensive, team based, systematic, proactive and patient-centred. At the core is a rich therapeutic relationship between a patient and a particular doctor and the team that supports them.

We would contend that ‘the General Practice’ unit remains the best block from which to build Australia’s primary care system. Organised and well-resourced general practice can deliver the best health outcomes, with most efficiency, and with the greatest equity.

Is there international evidence for this ‘collaborative model’?

The American Board of Family Medicine has been advocating for ‘the medical home’ to form the basis of their health system.

A Patient-Centered Medical Home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient’s lifetime to maximize health outcomes.

We would recognise ‘a medical home’ as ‘a general practice’.

Therefore, this recent study published in the The Journal of the American Board of Family Medicine is of interest: The Medical Home: Growing Evidence to Support a New Approach to Primary Care.

This literature review looked at over 200 references, reports, and books evaluating the medical home and patient-centered primary care.

Their conclusions:

Evidence from multiple settings and several countries supports the ability of medical homes to advance societal health. A combination of fee-for-service, case management fees, and quality outcome incentives effectively drive higher standards in patient experience and outcomes.
Community/provider boards may be required to safeguard the public interest.

Going a step further, The American College of Physicians calls for an Advanced Medical Home.

Practices and physicians that adopt the advanced medical home structure-

  • a) use evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based on patient-specific factors
  • b) organize the delivery of that care according to the Chronic Care Model (CCM), but leverage the core functions of the CCM to provide enhanced care for all patients with or without a chronic condition
  • c) create an integrated, coherent plan for ongoing medical care in partnership with patients and their families
  • d) provide enhanced and convenient access to care not only through face-to-face visits, but via telephone, email and other modes of communication
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  • e)identify and measure key quality indicators to demonstrate continuous improvement in health status indicators for individuals and populations treated
  • f)adopt and implement technology to promote safety, security, information exchange and portals for patient access to their health The information
  • g)participate in programs that provide feedback and guidance on the overall performance of the practice and its physicians.

What would you say in your submission to the National Hospital and Health Reform Commission? Comments welcome below.

More on the Medical Home :

Epstein AJ. The role of public clinics in preventable hospitalizations among vulnerable populations. Health Serv Res 2001; 36: 405–20

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