Researchers conducted an observational study to assess the effect of Patient-Centered Medical Home (PCMH) implementation on patient satisfaction, quality of care, staff burnout, and emergency department use. Information was gathered from 913 Veterans Health Administration (VHA) hospital-based and community-based clinics through the use of several surveys. Composite scores were then arranged into eight core domains of Patient Aligned Care Team (PACT)—the VHA’s version of a PCMH model. Researchers then developed a PACT Implementation Progress Index (Pi2) tool which was used identify the effectiveness of PACT implementation at each participating clinic. Clinics were awarded a scored between-8 and 8. Those with scores between 5 and 8 were said to have effectively implemented their programs. Researchers ultimately found that clinics with higher Pi2 scores had less reported staff burnout, better overall patient satisfaction, improved patient outcomes and lower rates of hospital admissions. This was a very large scale study that provided important insight about the outcomes associated with effective implementation of PCMH-like model. However, generalization of the findings is limited because the study only assessed clinics within the VHA system. Other limitations included the presence of personal biases in self-reports, and low survey response rates. Nevertheless, the study supports that effective implementation of PCMH has positive implications on patient satisfaction, quality
The Hospital Consumer Assessment of Healthcare Providers (HCAHPS) began in 2006 with a 27 question survey that is distributed to discharged patients. This survey process was originally designed to help patients compare hospitals in their area to be able to make an informed choice for their healthcare needs. In January 2013, five additional questions were added to the survey. Beginning this year, Medicare reimbursement rates to a hospital are tied to the hospital’s patient satisfaction scores. Therefore, hospitals are continually looking for ways to improve
Nevertheless, many organizations continue to struggle with what “it” is. This ambiguity ultimately leaves many with vague or muddled expectations for what constitutes patient-centered care. Is it a surprise, then, that many leaders report feeling bewildered at how to go about becoming more patient-centered? Or that others, convinced that their approach is indeed a patient-centered one, are surprised to find data reflecting patient and/or staff discontent? In the broadest terms, patient-centered care is care organized around the patient. It is a model in which providers partner with patients and families to identify and satisfy the full range of patient needs and preferences. Not to be overlooked in defining patient-centered care is its concurrent focus on staff. To succeed, a patient-centered approach must also address the staff experience, as staff’s ability and inclination to effectively care for patients is unquestionably compromised if they do not feel cared for themselves. Although patients may not always be able to accurately assess the clinical quality of their care, or whether safety processes are in place, patient safety and high clinical quality are fundamental to a patient-centered approach. Patient-centered care does not replace excellent medicine―it both complements clinical excellence and contributes to it through effective partnerships and communication. A wealth of resources exists to guide organizations in addressing clinical
Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value
In Nursing, there will always be instances where the patient's nurse needs to advocate for their patient. There are numerous reasons why a nurse would advocate for their patient ranging from getting the doctor to change the patient’s orders, helping the patient’s treatment team understand what it is the patient is requiring for the day, to expressing the patient’s last wishes before death. In every situation, the nurse should do what is in the patient’s best interest. Tomajan (2012), “Advocacy skills are the ability to successfully support a cause or interest on one’s own behalf or that of another. Advocacy requires a set of skills that include problem solving, communication, influence, and collaboration”(p. 2). With those skills, the
Overview of the Patient Centered Medical Home project piloted by Geisinger Health System in Danville, Pennsylvania
Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.
With patients today using the threat of reporting low satisfaction rates in the hopes of receiving faster or higher quality care, they seem to have taken the upper hand in some of the decision making of what will take place in the healthcare world (Sullivan). But is it really the survey results that will make the drastic changes that are needed?
In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s
One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.
The patient- centered medical home is designed to improve quality of care through a team-bases coordination of care, which would treat the majority of a patients needs at once by increasing access to care and empowering patients to be a part of their own care (U.S Department of Health and Human Services, 2014). In order for these homes to work, the authors suggest that specialists might be the best candidates to certain conditions, however for these specialist to function in the capacity that is needed in these medical homes, they would have to have interest and proficiency to manage other conditions that fall outside of their
Mobile Integrated Healthcare, Community Paramedic (MIH/CP) is a nationally recognized program where local Emergency Medical Services (EMS) have become involved in providing patient-centered care in partnership with local resources such as social services and primary care (Mobile Integrated Healthcare and Community Paramedicine (MIH-CP): A National Survey, 2015). These programs range in services from in-home consultation for chronic disease management to deploying telemedicine to connect homebound patients with offsite care givers. The author states: “From medical homes to care teams to accountable care organizations, the concept of collaborative, integrated, patient-centered care is a major theme of healthcare reform - and MIH-CP (p. 9)”.
This essay aims to describe briefly what is meant by patient-centred care. It will also focus and expand on two key aspects of patient dignity - making choices and confidentiality. Patient-centred care (PCC) is an extensively used model in the current healthcare system (Pelzang 2010:12). PCC is interpreted as looking at the whole person and considering their individual values and needs in relation to their healthcare. By implementing a PCC approach it ensures that the person is at the very centre of any plans that are made and has a dynamic role in the decision making process (Pelzang 2010:12).
In conclusion, this paper explored the strengths and weaknesses of this organization. A weakness is identified and improvement is recommended to create a Patient Advisory Council in the Shared Governance to promote better patient-centered care. In doing so, patients will have sense of empowerment by having their input in the plan of care. To measure the success of the recommended change, the use of HCAHPS and patient metrics are utilized and compared nationally.
This essay is based on the Case study of a patient named as Mrs Ford. It will be written as a logical account, adopting a problem solving approach to her care. She is elderly and has been admitted onto a medical ward in the hospital, following a stroke. This essay analyses the care that she will receive and focuses on the use of assessment tools in practice. Interventions will be put in place directly relating to the assessment feedback and in line with best practice.
According to Healthy People 2012 there are more then 800,000 new cases of diabetes each year, with the numbers on the rise. With this in mind, Healthy People 2012 has identified diabetes as their number five focus area. In order to reach their goal of improving the quality of life for people with diabetes they have identified diabetes teaching as their number one objective. Furthermore, in order to reduce the number of complications of diabetes, Healthy People 2012 has identified foot ulcers as their ninth objective. Through patient education Healthy People 2012 hopes to reduce the number of foot ulcers in people with diabetes, as diabetes is the number one cause of nontraumatic amputations in the United States. In order to