Category Archives: Medical homes
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.
The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.
The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.
In late January, the nation’s second-largest health insurer announced a new initiative designed to improve care and reduce costs by raising reimbursements for primary care. WellPoint will provide additional revenue to primary care providers for “non-visit” services that it does not currently reimburse, such as preparing care plans for patients with multiple and complex conditions. The new program is designed to build and expand on WellPoint’s existing medical home program.
“Primary care physicians who are committed to expanding access, to coordinating care for their patients and being accountable for the quality of care and the health outcomes of those patients, will get paid more than they do today, and we’re committed to helping them achieve these quality and cost goals,” Dr. Harlan Levine, WellPoint executive vice president, Comprehensive Health Solutions, said in a statement. “Primary care is the foundation of medicine, and it can and should be the foundation of our members’ health.”
WellPoint predicts the program will reduce overall medical costs by as much as 20 percent by 2015. The program will launch in select markets later this year.
A new study in the Archives of Internal Medicine finds that some of the key characteristics of medical homes promote stronger morale and job satisfaction among providers and staff at community health centers.
In a survey of more than 600 employees at 65 clinics participating in the Safety Net Medical Home Initiative, more than half (53.7 percent) reported being satisfied with their jobs. About one third (32.8 percent) rated their morale as good. In particular, clinics with high scores on three key characteristics – access to care, communication with patients and quality improvement – enjoyed higher morale and job satisfaction among providers, and higher morale among other staff.
While employees at clinics with the characteristics of a patient-centered medical home reflected positively on their jobs, the study also finds that they are at higher risk for burnout. Only half of the respondents (49.5 percent) at such facilities agreed with the statement, “Occasionally I am under stress at work, but I don’t feel burned out.”
Read more about the study.
In 2008, six RWJF Clinical Scholars at Yale University set out to improve health care in New Haven, Connecticut. They envisioned a coordinated system of physicians, hospitals and community organizations working together to provide donated specialty health care for people who have the most trouble getting it: the poor and uninsured.
This September, their vision became a reality with the opening of Project Access–New Haven. The project provides eligible applicants with patient navigators, who help their assigned patients connect to specialty health care in their community. The project has so far helped 46 patients access care.
But the project does more than just connect patients to health services. Project Access-New Haven organizers also aim to narrow health disparities, collect and report data on care utilization and associated costs, and create a blueprint for other specialty care health systems.
“For too long, academic centers have ignored the needs of the populations around them,” said Harlan Krumholz, M.D., S.M., director of the Clinical Scholars program at Yale University. “With the Foundation’s support, we are seeking to train physicians and leave a legacy of contribution to the community through scholarship and service.”
Read the story.