Joint Principles of the Patient Centered Medical Home February 2007

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1 American Academy of Family Physicians (AAFP) American Academy of Pediatrics (AAP) American College of Physicians (ACP) American Osteopathic Association (AOA) Joint Principles of the Patient Centered Medical Home February 2007 Introduction The Patient Centered Medical Home (PC MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient s family. The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC MH. Principles Personal physician each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. Physician directed medical practice the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. Whole person orientation the personal physician is responsible for providing for all the patient s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient s community (e.g., family, public and private community based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. Quality and safety are hallmarks of the medical home: Practices advocate for their patients to support the attainment of optimal, patient centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient s family. Evidence based medicine and clinical decision support tools guide decision making Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement. Patients actively participate in decision making and feedback is sought to ensure patients expectations are being met. Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication. Practices go through a voluntary recognition process by an appropriate non governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model. Patients and families participate in quality improvement activities at the practice level.

2 Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff. Payment appropriately recognizes the added value provided to patients who have a patient centered medical home. The payment structure should be based on the following framework: It should reflect the value of physician and non physician staff patient centered care management work that falls outside of the face to face visit. It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources. It should support adoption and use of health information technology for quality improvement; It should support provision of enhanced communication access such as secure e mail and telephone consultation; It should recognize the value of physician work associated with remote monitoring of clinical data using technology. It should allow for separate fee for service payments for face to face visits. (Payments for care management services that fall outside of the face to face visit, as described above, should not result in a reduction in the payments for face to face visits). It should recognize case mix differences in the patient population being treated within the practice. It should allow physicians to share in savings from reduced hospitalizations associated with physician guided care management in the office setting. It should allow for additional payments for achieving measurable and continuous quality improvements. Background of the Medical Home Concept The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, initially referring to a central location for archiving a child s medical record. In its 2002 policy statement, the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective care. The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) have since developed their own models for improving patient care called the medical home (AAFP, 2004) or advanced medical home (ACP, 2006). For More Information: American Academy of Family Physicians American Academy of Pediatrics: American College of Physicians American Osteopathic Association Is this practice currently part of an integrated health system (with specialists and hospital)? Are the patients in this practice assigned to and/or identify with a personal physician? 1.02A. If the practice setting is a residency program, are there patients assigned to residents as their personal physician? t Applicable

3 1.02B. If the practice setting is a residency program, are there patients assigned to attending physicians as their personal physician? t Applicable Questions 1.03, 1.04, and 1.05 may require discussion with and guidance from your preceptor Please indicate the number of days on average to the first available new patient appointment. If practice is entirely closed to new patients, write "closed". ("0" is same day) Please indicate the number of days on average to the first available follow up appointment. ("0" is same day) Please indicate the number of days on average to the first available acute appointment. ("0" is same day)

4 1.06. For each component below, please select the answer that best represents your perspective of the status of this teaching practice. Refer to definitions sheet when completing this question. Absent Planning Present Mature Status of EMR (Electronic Medical Record) in this practice. Status of practice as paperless (all interfaces and scanning work no paper charts). Status of full secured remote access. Status of electronic scheduling system integrated with EMR. ** Status of electronic billing system integrated with EMR. Status of electronic order (e.g., lab, x ray) integrated with EMR. Status of secure HIPAA compliant asynchronous communication with patients, include e mail. Status of asynchronous communication with other providers. Status of ongoing population based Quality Assurance using an EMR. Status of chronic disease management registries. Status of EBM based preventive services registries. Status of practice based research using an EMR. ** Status of advanced or open access scheduling. Status of expanded hours (e.g., clinic hours after 6pm on weekdays or weekend clinic hours). ** Status of functional quality monitoring telephone system (e.g., system to monitor call abandonment or time to answer). ** Status of full asynchronous patient accessible scheduling (e.g., Internet based patient scheduling). ** Status of credible, reliable patient satisfaction survey. Status of sufficient and adequate physical space. Status of adequate, free parking. Status of convenient public transportation access. Status of using teams to manage patient care. Status of integrated behavioral health. Status of integrated case management, social services. Status of clinical pharmacy support. Status of group visits. Overall status of your practice as patient centered versus physician centered My preceptor's practice has an EMR. Complete questions 1.07A, 1.07B, and 1.07C only if the answer to 1.07 is.

5 1.07A. How long has the EMR been implemented in your preceptor's practice? Less than one year More than one year 1.07B. Do the physicians use the EMR in formal clinical quality improvement processes or projects? If yes, please describe briefly giving an example C. Do the physicians use the EMR to promote patient safety? If yes, please describe Data from this survey (which is not identified by preceptor, practice nor student) will be combined in a research database characterizing the PCMH characteristics of primary care practices of preceptors in Louisiana and the Gulf Coast region. Unless you indicate otherwise below, responses collected by you to this survey will be included in the research database. Select below only if you are not willing to allow the responses that you collected in this survey to be included in the research database: Do not include my responses. Thank you for completing this survey about your Family Medicine Clerkship site.

6 Family Medicine Clerkship PRACTICE SITE SURVEY DEFINITIONS Index Integrated health system Group visit Remote access HIPAA Asynchronous communication Registries EBM Advance or Open Access Scheduling Teams Integrated behavioral health Clinical pharmacy Full secured remote access Quality improvement Integrated health system A managed health care system in the United States that includes a hospital organization that provides acute patient care, a multispecialty medical care delivery system (almost always with a primary care component), the capability of contracting for any other needed services, and a payer or coordinated relationships with a payer. Group visit a patient visit that includes multiple patients with a single condition. Group learning and support as well as individual care are usually performed in the visit. Remote access able to log into the electronic medical record from a location that is not the practice setting. HIPAA Health Insurance Portability and Accountability Act of 1996 which among other things protects patient privacy. Asynchronous communication a mediated form of electronic communication in which the sender and receiver (typically, doctor and patient) are not concurrently engaged in face-to-face or live communication. For example versus the telephone, or communication through a webbased "Patient Portal" to access test results, rather then a face-to-face office visit. Registries collections of patient data based upon a particular diagnosis, procedure or condition used to track quality data with regards to patient care. EBM Evidence Based Medicine. Advance or Open Access Scheduling a scheduling method that minimizes advance and fixed appointments and instead allows all patients to receive an appointment slot when they want it, particularly on the day they call, and usually with their personal physician. Teams a multidisciplinary team usually organized under the leadership of a physician. Each member has specific responsibilities and contributes to the whole person care of the patient. Integrated behavioral health a combination of behavioral health and primary care in order to better address the mental health needs that are often dealt with in primary care clinics. The behavioral health specialist is usually on-site or immediately available.

7 Family Medicine Clerkship PRACTICE SITE SURVEY DEFINITIONS (cont.) Clinical pharmacy A division or service of a pharmacy or a pharmacist that provides patient services in order to optimize the use of medications. Often, they run medication dosage adjustment clinics (i.e. Coumadin Clinic), do medication-related counseling, or review medical profiles for synergy, interactions or optimizing regimens. Full secured remote access Access to the electronic medical record from an off-site terminal in which the access is password secured. Quality improvement An organized and systematic approach to positively affect efficiency, safety and/or clinical outcomes by assessing and then improving practice processes. In the context of population based and clinic quality improvement this often refers to screenings and immunizations (i.e. flu vaccines and pap smears), to commonly agreed upon clinical measures such as Hemoglobin A1C in diabetes, or to improvements in processes such as the days to next patient appointment or patient flow through a clinic.