There is a large gap between the promise of patient-centered medical home (PCMH) and our current capacity to define and measure it. The purpose of this article is to describe the findings of "real-time" patient-reported data about constructs of the PCMH and to demonstrate how an Internet-based method can be useful for obtaining patient report about the PCMH. We find that patients' Internet ratings seem stable and demonstrate relationships that fit constructs and models for the PCMH. We also find that current PCMH performance across this sample of 69 clinical settings is highly variable and still leaves a great deal of room for improvement.
Collaborative Care refers to a partnership between healthcare professionals and patients who feel confident to manage their health conditions. Using an Internet-based assessment of health needs and healthcare quality, we surveyed 24,609 adult Americans aged 19 to 69 who had common chronic diseases or significant dysfunction. In these patients, we examined the association of Collaborative Care with specific measures for treatment effect, disease control, prevention, and economic impacts. These measures were adjusted for respondents' demographic characteristics, burden of illness, health behaviors, and overall quality of healthcare. Only 21% of respondents participated in good Collaborative Care, 36% attained fair Collaborative Care, and 43% experienced poor Collaborative Care. Regardless of overall care quality or the respondents' personal characteristics, burden of illness, or health behaviors, good Collaborative Care was associated with better control of blood pressure, blood glucose level, serum cholesterol level, and treatment effectiveness for pain and emotional problems. Some preventive actions were better, and some adverse economic impacts of illness were mitigated.
A community health alliance brings together divergent interests within a community for the betterment of personal and population health. In this report we describe how a community responsive strategy in Chicago is facilitating the improvement of healthcare by providing local information of what needs to be done, supporting change at the practice level to meet these needs, and initiating community-wide approaches to manage prevalent and important needs without waiting for direct involvement of health professionals.
In this report, we compare healthcare processes for patients with low (n = 7467) and adequate financial status (n = 43,701) after adjustment for age, gender, burden of illness, and health behaviors. Patients with low financial status were 10% to 30% less likely to report good service and collaborative care; they report that markers of disease management and prevention were 7% to 18% below the levels of patients with adequate income. From the patient perspective, these results confirm that inadequate financial status has a broad and adverse influence on health and healthcare. Technology for patient-centered, collaborative care alone will not remedy the problem of health disparity.
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