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toddSpring 2012Leave a Comment

By David Robinson

Every patient deserves a medical home; that place where each patient’s care is personalized and the clinic’s caregivers work as a team to help patients address chronic conditions, such as diabetes or heart disease.

To that end, UAMS is applying the principles of a new model known as the patient-centered medical home. This approach requires information technology upgrades, teamwork and additional staff, but also provides more strategic contact with patients.

Patient-centered medical homes are designed to give patients the care they need and in a manner that works best for them. Secure email exchanges and telephone visits with the doctor are now possible, along with patients’ ability to check their lab results electronically.

Patients with chronic diseases will notice increased monitoring. Rather than broaching issues of obesity, tobacco use and exercise as an awkward afterthought during a clinic visit, doctors and clinic staff in a medical home work with patients on health behaviors to improve chronic conditions.

Patient-centered medical homes also emphasize evidence-based approaches to medical care. They require careful monitoring to ensure adherence to standards of care, which includes regular comparisons to practices locally and nationally.

UAMS’ Family Medical Center in 2009 was the first in Arkansas recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home.

Now, UAMS is seeking the same recognition for its other primary care clinics:

Charles W. Smith, M.D., executive associate dean for clinical affairs in the College of Medicine, is leading the on-campus patient-centered medical home project at the UAMS Center for Primary Care.

“If we can prevent readmissions, hospitalizations and long-term complications of chronic diseases like hypertension and diabetes, the potential economic and care benefits are astronomical,” Smith said.

The AHEC–linked Family Medical Centers in Arkansas began implementing the patient-centered medical home model in 2008. The centers are on track to have full NCQA recognition by the end of 2013, said Mark Mengel, M.D., M.P.H., vice chancellor for regional programs and AHEC executive director.

At the Family Medical Center, the emphasis is on teamwork, said Jamie Howard, M.D., a long-time UAMS family medicine physician and medical director of clinical services in the Department of Family and Preventive Medicine.

“What we expect in a patient-centered medical home can’t be done by the doctor alone,” she said. “You have your front office engaged, the nursing area, the clinic’s radiology and lab – all are engaged along with the physicians and advanced practice nurse.”

Another vital part of the model is the care manager, a position created just for the patient-centered medical home. The care manager checks with patients between appointments to determine how well they are adhering to their self-management goals and advises them on ways to address their disease condition.

Mengel notes studies that show traditional primary care clinics achieve good outcomes with chronically ill patients only about half the time, but when using the medical home model, good outcomes improve to about 80 percent. Demonstration projects using the model around the country have found it saves about $1.50 for every dollar invested.

The model has been endorsed by nearly all primary care organizations.  The American Medical Association has embraced it as the future of primary care.

Arkansas Blue Cross and Blue Shield and its Blue & You Foundation for a Healthier Arkansas provide financial support to the model at UAMS and elsewhere and track its results.

“It works,” Mengel said.

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