The Patient Centered Assessment Method (PCAM): Integrating the Social Dimensions of Health into Primary Care

Abstract

BackgroundSocial dimensions of health are known to contribute to what is often termed “patient complexity,” which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs.ObjectivesTo examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM’s perceived applicability for use in a complex patient population.DesignTwo studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population.ResultsUse of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity.ConclusionsThe PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study

“…MCAM originated from INTERMED, was designed for action-based evaluation of complexity in primary care settings, and has been used mainly in educational settings. PCAM, which was developed from MCAM by Pratt et al 20 , evaluates patients’ centeredness in addition to their experience and is intended for use with patients with comorbid conditions or multimorbidity. It has been suggested that PCAM assists medical staff to refer patients to non-medical services dealing with psychosocial needs and that evaluation of PCAM by nurses improves their understanding of each patient’s complexity.…”

“…The Patient Centred Assessment Method (PCAM) 20 is an advanced version of the Minnesota complexity assessment method (MCAM), 21 which originated from INTERMED, a tool for practical use in the primary care setting that was developed in Scotland. PCAM comprises 12 items in contrast with the 20 items of INTERMED.…”

Reducing Emergency Room Visits and In‐Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data

“…A second technological innovation was the development of an evidence‐based CDS tool to incorporate information about social and behavioral determinants of health into the EHR for exchange across healthcare settings. Researchers at the University of Minnesota Department of Family Medicine and Community Health developed the Patient Centered Assessment Method (PCAM; Maxwell, Hibberd, Pratt, Cameron, & Mercer, ; Pratt, Hibberd, Cameron, & Maxwell, ; Yoshida et al., ). The PCAM is a 12‐item screening tool with a four‐level rating scale of social and behavioral determinants of health.…”

Predictive Value of Screening for Addressable Social Risk Factors

“…From a social determinants of health perspective, many unmet social needs can create barriers to treatment compliance and are in fact, potentially addressable either directly by health care providers; through referral to community based organization; or with improvements in community infrastructure [4][5][6]. Systematic risk assessment screening can detect these addressable risk factors and, when combined with historical utilization and cost data, may suggest a superior algorithm to stratify individuals for care management interventions [7]. Accordingly, CMS recently released the accountable health communities model request for proposal to test whether enhanced clinical-community linkages can improve health outcomes and reduce costs.…”