Patient-Centered Medical Homes - Essay Example

Patient-Centered Medical Homes Abstract In recent times, the concern towards providing quality and cost efficient patient care has gained substantial priority. The countries such as the United States and Canada among others have initiated several models and schemes towards addressing the issue of quality patient care. In relation to this, one vital initiative called Patient Centered Medical Homes (PCMH) has been launched by the US government to eliminate poorly organized healthcare practices along with ensuring timely, cost effective and enhanced quality primary healthcare. The patient centered medical homes are intended towards facilitating enhanced physician-patient relationship as well as improving coordination among physicians, specialists and other people involved in providing quality care to the patients. Contextually, the proposed study intends to explore the benefits provided by patient centered medical homes to patients’ and critically evaluates and measures the impact and the effectiveness of patient centered medical homes on providing quality primary healthcare. The study proposes central question (qualitative) for analyzing the existing scenario related to patient centered medical homes. Moreover, the study proposes the use of both primary and secondary data collection techniques for collecting necessary data for attaining the research objective. The proposed research findings will help to identify the gap between the existing practices in primary healthcare and the required set of practices. Background Patient centered medical homes (PCMH) are considered by many to be one of the most promising initiatives towards bringing enhanced quality cost efficient primary healthcare. Patient centered medical homes ensure co-operation between individual patients and their personal healthcare physicians. Care through patient centered medical homes is provided by health information exchange, information technology, registries and other means for assuring that patients can avail the prescribed care when and where they need in the most suitable way (National Committee for Quality Assurance, 2012). Patient centered medical homes are the standards and principles that are used to guide medical home development. Currently, in many developed countries including the United States, there are many efficient healthcare practices. However, most of the practices are poorly organized and are unable to provide timely and high quality care to patients. Moreover, it has been observed that a large number of patients do not understand what their primary healthcare physicians tell them because most visits of their physicians are too short to address their health concerns. At the same time, a lack of coordination between primary care physicians, specialists and hospitals makes each of them unaware of the other’s treatment plans. In relation to this, may experts believe that such problems can be solved with the application of a recently developed model called, the patient centered medical homes. In general, patient centered medical homes are often viewed as effective principles that emphasis on timely admittance to primary care and continuing relationship with a primary care provider (Cassidy, 2010). Purpose of Statement The criticism related to existing standards reveals that they are biased and are not sufficient to solve all the primary care related shortcomings. However, with the applications of the patient centered medical care, it is believed that many shortcomings related with patient healthcare shall be efficiently solved and also it would facilitate in rendering quality and timely patient care. Furthermore, it is expected that such efforts will revitalize the primary care and shall capitalize on investment in health IT. It is further hoped that these efforts will result in eliminating duplication and unnecessary testing along with services and shall result in better patient care at much affordable costs. However, the study does not examine the advantages or the disadvantages related with patient centered medical homes instead the study intends to identify whether the these model actually help the patients to avail quality and timely care at affordable costs or not. Moreover, the study would be intended towards collecting and analyzing relevant data for providing appropriate information to other researchers and to serve as a means of secondary data for future research studies. Central Question (Qualitative) Recent studies have identified that patient centered medical home model has the ability to bring fundamental changes in ongoing patient care systems primarily in within the relationship in between physicians and patients. Although it is believed that the patient centered medical care would substantially help in augmenting quality of care as well as reducing costs, the most immediate impact shall be on the physicians and patients. Contextually, it should be ensured that both patients and their primary care physicians are ready to adopt the model of medical homes. Moreover, it is also recognized that widespread adoption of this approach will also consume considerable time and funds. Thus, the assessment to determine the impact of this approach is essential for preventing any fatal consequences. In relation to above stated issues, centered question (qualitative) has been prepared for the further study and is depicted below: “How does the Patient Centered Medical Homes benefit patients in availing quality and timely care at affordable costs?” Literature Review and Summary Literature Review According to Nielsen, Langer, Zema, Hacker, & Grundy (2012), the patient centered medical homes are not limited to a single place or location. It is an efficient model of primary care that is patient centered, synchronized, group based and comprehensive which focuses on quality of patient care and their safety. Furthermore, it is claimed that the mode is supported by robust health information technology and provides appropriate payment reforms all focused on patient outcomes and health system efficiencies (Nielsen, Langer, Zema, Hacker, & Grundy, 2012). Similarly Adams, Grundy, Kohn, & Mounib (2009) stated that patient centered medical homes can serve as a foundation for transforming of the US healthcare system. It was emphasized that the best advantage of the model can be attained if the model is appropriately conceived and properly implemented. Moreover, it was revealed that properly implemented model shall immensely help in replacing inadequately coordinated healthcare. It would also facilitate to provide practical and long-term quality care. Accordingly, it was postulated that principles of patient centered medical homes accompanied with quality and safety are facilitated by combined care coordination and proper reimbursement which benefit patients in terms of flexible scheduling as well as communication channels. It was further stated that patient centered care provides keys to the success of enhanced quality care and patient safety. However, it was also identified that strong leadership and clear vision are necessary to achieve the benefits from the application of this model (Adams, Grundy, Kohn, & Mounib, 2009). National Committee for Quality Assurance in its report ‘Patient Centered Medical Home’ (2012) proclaimed that each patient has a constant relationship with their primary care physicians. It was further stated that a patient’s primary care physicians often lead a team and take shared responsibility for patient care, identifying the patient’s needs and wants as well as arranging apposite care. Contextually, the medical home facility in this regard has been intended to provide more personalized, effective, efficient and coordinated care to respective patients according to their needs and wants. In addition to this, the model also ensures enhanced access to quality care through increasing hours, open arrangement and other innovative practice of communication (National Committee for Quality Assurance, 2012). According to American Hospital Association Committee on Research (2010), patient centered medical home model emphasizes on managing the health of patients and augmenting the access to healthcare. However, it proclaims the in order to achieve the desired results of quality care and safety; it will require primary care physicians to function beyond the walls of their offices. Moreover, it was believed that transforming primary care to patient centered medical homes shall contribute towards reduction of healthcare costs and shall further lead towards improving quality of treatment for patients with chronic conditions. In addition to this, it was also acclaimed that this model shall immensely help in improving patient-physician relationship and shall further add realigning payment incentive more closely with evidence-based medicine. Apart from facilitating quality patient care, it has also been identified that the model shall greatly help in lowering socio-economic disparities in healthcare related with racial and ethnic issues (American Hospital Association Committee on Research, 2010). Frampton & Guastello (2010) stated that quality patient care and safety go hand in hand in patient centered medical home model. It was further emphasized that patient centered medical care shall ensure greater patient satisfaction. However, it is equally important that this model is flexible enough to acquire appropriate changes. It was further argued that role of nurses with respect to patient care shall also be augmented. Contextually, the model shall facilitate continuity and accountability in terms of patient care and shall permit primary healthcare physicians as well as nurses to personalize care for each patient (Frampton & Guastello, 2010). Gaudet (2011) advocated patient centered medical care facility as a cultural transformation. Contextually, it was stated that quality patient care and safety can be delivered by engaging and collaborating teams in certain environments that promote and support learning, discovery and constant improvements. Furthermore, it has been argued that model shall contribute towards a nation’s wellbeing through effective education and services in national emergencies. It was also identified that patient centered medical home is an initiative towards better customer service and better access to efficient clinic. Moreover, it was argued that patient centered medical homes focus and promote on treating patients with respect and as human beings rather than as diseased body parts (Gaudet, 2011). According to a report of Canadian Medical Association (2007), patient centered medical home enables physicians to understand the value of collaborative care. Contextually, it was identified that the extensive application of patient centered medical home model shall help in constraining healthcare costs, reducing healthcare physicians influence, changing physician payment methods as well as shall aid in reconfiguring models related with healthcare. Moreover, it was argued that this model shall facilitate in supporting patients and their families and further assist them in their healthcare decision making. Consequently, the concept of “most responsible physician” would be evolved who will be responsible for collecting and processing clinical management of the patient (Canadian Medical Association, 2007). According to Berwick (2009), patient centered medical homes shall ensure transparency almost in all aspects of care relating to costs, process outcomes and errors. At the same time, such system will facilitate in taking control related to all factors of patient care with consent freely granted. It was also identified that healthcare physicians may fear that patient centered care may demand them increased time and energy with little or no reimbursement. However, physicians concern can be lessen if population based payment is extensively utilized (Berwick, 2009). Summary Patient centered medical home is relatively a new concept which comprises all synonymous facets related with good care and good communication. Many experts believe that significant benefit can be achieved in terms of patient healthcare, if patient centered medical homes are adapted extensively. However, it has also been identified that any missteps towards its application may worsen the financing and workforce challenges currently faced by the primary care that could reduce the ability to access quality healthcare amenities. In addition to this, patient-physician communication is regarded as the most crucial component while delivering quality healthcare. However, communication problems occur at several occasions between patients and physicians which often deprive the patients from achieving quality healthcare. Consequently, it has been observed that the proper implementation of paient centred medical homes immensely helps in removing patient-physician communication gap and facilitating enhanced patient healthcare. Furthermore, patient centered model also focuses on eliminating any discrimination based on race and ethnic origin as well as promotes respect to every individual. It has also been viewed that the model will immensely assist patients and their families in making their health related decisions. The more significant impact of the model can be realized in terms of reducing healthcare costs and physicians influence on healthcare. It is argued that the application of this model shall ensure in delivering better customer service and also would promote an environment which supports learning and constant improving. Moreover, the model shall encourage team efforts and help to advance quality of care during chronic conditions. Precisely stating, the application of patient centered medical homes shall have a comprehensive impact on delivering overall transparency in healthcare. Research Methodology Research study can be isolated into two approaches namely qualitative and quantitative. The distinction between the research designs usually occurs at methodology level of the research study. With respect to human related issue, qualitative research is considered to be most appropriate. Consequently, qualitative research is being selected to undertake the research study related with people health and illness. The primary reason behind the selection of the qualitative research is due to the involvement of human participants. Moreover, qualitative research will also enable to critically address the emotions and the sentiments of the human participants. Data Collection and Analysis Data Collection Collection of relevant data is essential for further analyzing and drawing research inferences. Generally, there are two methods of data collection, primary and secondary data collection. Both the methods of data collection have their own merits and demerits. Primary data collection facilitates greater amount of control and is usually focused on specific issues or the research topic. Another benefit of primary data ensures the availability of original and unbiased data. However, primary data collection is time consuming and requires a lot of efforts and time to analyze and evaluate their findings. On the other hand, secondary data is economical that saves both effort and expenses. Furthermore, it also serves as a basis for comparison for the data collected. Similar to primary data collection technique, secondary data collection also possesses demerits such as data collected through secondary sources may not be genuine and may facilitate biased viewpoints in the study. Moreover, it renders insufficient control over data collected and at the same time these data may be obsolete. Consequently, both the techniques of data collection are vital for conducting successful research study. Hence, both these techniques of data collection are being selected for collecting data. As a tool of primary data collection, open ended questionnaires shall be prepared for healthcare working staff and patients. On the other hand, reports released by different organizations and committees including both private and government agencies shall be considered as secondary technique of data collection (Nicholson & Bennett, 2008). Data Analysis Descriptive research studies are a form of qualitative research that help to discover new meanings and provide new knowledge when there is very little known about a topic. Moreover, the descriptive research intends to produce a straight forward description of participants’ experience with minimal inference and interpretation than other qualitative methods like grounded theory. Consequently, qualitative descriptive method has been selected as a method for data analysis. In relation to this, the fundamental objectives of the patient centered medical care will be identified and further the actual benefits provided by the patient centered medical homes shall be evaluated. Later, both the objectives and benefits (if any) of patient centered medical homes shall be collaborated and compared with the established standards and stated objectives in order to measure the actual benefits or detriments arising from the application of patient centered medical homes (Hancock, 2002). Ethical Considerations and Limitations of Research Design Ethical Consideration The study considers that the participants involved in the research are real and are unbiased to the largest possible manner. Since the study is based on the experience of people with respect to their health and illness, the study shall firmly respect the human participants at all times and full disclosure about the research process shall be revealed to each participant. The study shall further attempt to maintain the confidentiality of the information provided by different participants and make sure that any disclosure of participants’ vital information without their permission are avoided (Lowe, 2007). The moral and emotion aspects of the participants shall also be considered during the process of research. Moreover, the study shall critically consider the principle of informed consent and shall ensure adequate privacy, secrecy and confidentiality of every participant (Orb, Eisenhauer, & Wynaden, 2001). Finally, the study shall strive to achieve relevant, fair and unbiased outcome from the research conducted that shall benefit various interested users with vital information and knowledge for their understanding and future research. Limitation of Research Design There are certain limitations with qualitative research approach. It can be recognized that descriptive qualitative research is entirely descriptive and is not rigorous as well as the descriptive research is too subjective as well as impressionistic. In addition to this, often the qualitative research process lacks in revealing transparency. Another major limitation with qualitative descriptive research includes the issue of confidentiality and privacy. Contextually, the participants may find it reluctant to provide personal information related with their health and illness. Consequently, the tendency of false and biased information may arise that may impose serious threats on the reliability of research findings. In addition to this, the qualitative research process requires substantial cognitive and language ability as well as stamina. Moreover, qualitative descriptive research is also hard to generalize (University of Tasmania, 2012). Summary and Implications for Intervention and for Public Health Summary This study’s intent is to address and explore the actual benefits of patient centered medical homes in relation to patient and their health. Furthermore, the qualitative centered question is prepared to highlight the likely impact of patient centered medical homes on patient health and their relationship with primary healthcare physicians. In order to ensure that every aspect related with patient centered medical homes is primarily addressed, both primary and secondary data collection has been adopted. In addition to this, qualitative descriptive method has been selected to critically analyze the data collected from different sources. At the same time, the study carefully considers the ethical considerations and the limitations associated with the research study. Public Health Interventions A few interventions have been designed to influence patient centered medical homes. These interventions have been undertaken as described in the literature and by the participants. The patient centered medical home is comparatively a new model in the primary healthcare segment that has been able to received substantial attention of many health and research experts. The patient centered medical homes have largely achieved the various healthcare needs of patients and alongside they intend to improve patient as well as staff experience, outcome, safety and system. The concept of patient centered medical home has significantly expanded over the last few years and is based on redesigning the primary care in order to provide the highest quality care as possible. Intervention based on patient centered medical homes focused on patient health has been able to improve patient outcome and quality of care. It has been hypothesized that all-inclusive patient centered medical homes intervention hold assurance as an initiative to improved primary healthcare quality, safety and effectiveness (U.S. Department of Health & Human Services, 2012). The patient centered medical homes have been described as a primary tool from transforming and increasing the viability of primary healthcare. Many illnesses require the participation of the patient in making decisions relating to their health, the interventions address the functioning of nurses and physicians in assisting patients in their healthcare decisions. The study shall highlight that the role of physicians and nurses in assisting patients with respect to decisions relating to treatment options is crucial. Contextually, the healthcare physicians should not only act as treatment provider but should also act as advisors in certain circumstances. Health literacy is another important issue related with patients’ health. Many times patients do not possess clear understanding of their health conditions. The intervention in this regard states that every patient should understand the concept of disease and it ensures that the patients are actively participating in their health related decision making. Implication for Intervention The study uses a variety of instruments to measure the benefits of patient centered medical homes. In relation to this, the study identifies the most relevant and useful benefits of patient centered medical homes at a particular situation. It identifies the differences between the patient centered interventions and the already available benefits (i.e. ‘it identifies what is missing’). It also identifies the ideal unit of intervention–communication with patients, respect for the patient and a system based approach towards improving quality and safety. The study recognizes the value of patient-physician relationship in the promotion of patient centered medical care. Consequently, it will help the readers to understand the importance of patient centered medical homes. It will further aid in understanding the certain vital components that need to be paid special attention for improving the model of patient centered medical homes. Furthermore, the study will provide firm evidences and assist in making any future improvement related with patient centered medical homes in delivering quality patient care and safety. Quality patient care can significantly benefit the nation to improve upon its mortality rate which in turn would enable to set forth the status of the US in the global platform. References Adams, J., Grundy, P., Kohn, M. S. & Mounib, E. L. (2009). Patient-centered medical home what, why and how. BM Global Business Services pp. 1-32. American Hospital Association Committee on Research. (2010). Patient centered medical home. AHA Research Synthesis Report pp. 1-21. Berwick, D. M. (2009). What ‘patient-centered’ should mean: confessions of an extremist. Project HOPE–The People-to-People Health Foundation, Inc. pp. 555-565. Canadian Medical Association. (2007). Putting patients first: patient-centered collaborative care a discussion paper. The Alberta Medical Association pp. 1-12. Cassidy, A. (2010). Patient-centered medical homes. A new way to deliver primary care may be more affordable and improve quality. But how widely adopted will the model be. Health policy brief pp. 1-6. Frampton, S. B. & Guastello, S. (2010). Patient-centered care: more than the sum of its parts. American Journal of Nursing 110 (9), pp. 49-53. Gaudet, T. W. (2011). Patient centered care: is it really a cultural transformation. Retrieved from http://www.va.gov/WOMENVET/2011Summit/PatientCenteredCareGaudet_preso.pdf Hancock, B. (2002). Trent focus for research and development in primary health care. Cape Breton University, pp. 1-27. Lowe, P. (2007). A descriptive research study on factors that impact upon the quality of life of elderly women with co-morbid chronic illnesses; three women's perspectives. Victoria University of Wellington, pp. 1-128. National Committee for Quality Assurance (2012). Patient-centered medical home. Retrieved from http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx Nielsen, M., Langer, B., Zema, C., Hacker, T. & Grundy, P. (2012). Benefits of implementing the primary care patient centered medical home: a review of cost & quality results, 2012. Patient-Centered Primary Care Collaborative pp. 1-41. Nicholson, S. W. & Bennett, T. B. (2008). Transparent practices: primary and secondary data in business ethics dissertations. Retrieved form http://staff.lib.msu.edu/nicho147/Research/fulltext.pdf National Committee for Quality Assurance. (2012). NCQA patient-centered medical home. Retrieved from http://www.ncqa.org/Portals/0/PCMH%20brochure-web.pdf Orb, A., Eisenhauer, L. & Wynaden, D. (2001). Ethics in qualitative research. Journal of Nursing Scholarship 33 (1), pp. 93-96. University of Tasmania. (2012). Research methodology and design. Retrieved from http://eprints.utas.edu.au/8527/16/Chapter_5_lehman.pdf U.S. Department of Health & Human Services. (2012). The Patient-Centered Medical Home. Evidence Report/Technology Assessment (208), pp. 1-17. Read More