When an award was made last year in the name of Paul Lembcke at a conference on "The Horizons and Prospects for Outcome Research", at the Dartmouth Medical Center, there was curiosity by some as to who Paul Lembcke was-an ironic commentary on the evanescent reputation of pioneering contributors to social advance. Establishing the need for evaluation of the utility and quality of medical care, along with an appropriate methodology, was the life work of Dr. Lembcke. And even more ironically, quality and the study of efficiency and effectiveness of medical care (along with its impact on cost) is a paramount concern of the public, government officials, and the academic medical community today.We are beset today with questions of cost and quality. The characteristic reach of his intelligence is evident in his paper on the mortality rate differences among hospitals in the treatment of appendicitis. His focus was the differential in rates and the possible causes, but he also had a larger view. He mentioned in passing that advances in medication could very well render surgery for appendicitis obsolete.
This article describes how one large not-for-profit home health care agency sought to stimulate a practice change among their nurses to better service the frail, complex patient population in a Long-Term Home Health Care Program (LTHHCP). This LTHHCP designed an innovative initiative that encouraged a combination of coaching techniques, assessment tools, and a range of patient-centered evidence-based practices to provide clinicians with necessary skills and competencies to provide the highest standards of care for their patients. The innovative model, called patient-centered care model (PCCM) was piloted in one service area, and a formal evaluation was integrated into the initiative to allow measurement of desired outcomes. This article describes the long-and short-term goals of PCCM, examine the components of the PCCM model, and discuss how the progress of the initiative is being evaluated and assessed.
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