The Patient-Centered Medical Home as a Community-based Strategy

Abstract

Increasing attention has been devoted to the important role that primary care will play in improving population health. One innovation, the patient-centered medical home (PCMH), aims to unite a variety of professionals with patients in the prevention and treatment of illness. Although patient perspectives are critical to this model, this article questions whether the PCMH in practice is truly community-based. That is, do physicians, planners, and other health care professionals take seriously the value of integrating local knowledge into medical care? The argument presented is that community-based philosophy contains a foundational principle that the perspectives of health care practitioners and community members must be integrated. Although many proponents of the PCMH aim to offer patient-centered and sustainable health care, focusing on this philosophical shift will ensure that services are organized by communities in collaboration with health care professionals.

Culturally Sensitive Interventions in Pediatric Primary Care Settings: A Systematic Review

“…53 In addition, it has been suggested that to be effective, the patient-centered medical home should extend beyond the health care setting to the communities where patients and families live, work, and play. 54 Results of the studies included in this review reinforce the feasibility of including community stakeholder perspectives when developing interventions for pediatric primary care settings.…”

Changing Clinic-Community Social Ties in Immigrant-Serving Primary Care Practices in New York City: Social and Organizational Implications of the Affordable Care Act's Population-Health-Related Provisions

“…The small practices in our study made EHR system changes that enabled some to achieve PCMH recognition (Lopez et al 2019). But for physicians and staff, truly engaging their South Asian immigrant patients entailed acknowledging community preferences and building on a fundamental understanding that people's personal and collective beliefs and experiences shaped how they made sense of health and illness (Franz and Murphy 2017). This understanding drove how physicians listened and responded to patients as well as which EHR tools they used and how.…”

“…Physicians' narratives suggest that their motivation to develop EHR systems lay as much in the EHR tools' potential to improve patient engagement as in the critical external incentives linked to the tools. Researchers note that initiatives that certify practices as PCMH-EHRs, staff skills, and teamwork, among others (Kieber-Emmons and Miller 2017)-may not all enable practices to substantively respond to community needs (Franz and Murphy 2017). One study, conducted among primary care innovators, found that the decision to pursue PCMH certification was, "in many cases, based on financial incentives and not necessarily on a belief that the recognition would result in higher quality of care" (Hahn et al 2014, 313).…”

“…For instance, the ACA includes directives for nonprofit healthcare organizations to conduct community health needs assessments, but these are mostly led by hospitals (Skinner et al 2018). The ACA also promotes the patient-centered medical home (PCMH) as a model of community-based primary care (Franz and Murphy 2017). PCMH principles include care that is comprehensive, encompasses disease prevention and chronic disease management, and is coordinated across the health-care system and the patient's community (Ferrante et al 2010).…”

The Roadmap for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health

“…California's existing PCMH infrastructure and transformation efforts can be leveraged to meet the prevention, early intervention, and healing goals of toxic stress screening. [1576][1577][1578] Key PCMH components relate to access to care, teamwork, and the technology to coordinate referrals, data, and care. 1579 Attention is also needed in regard to developing an organizational climate that encourages implementation optimization and use of evidence-based interventions in PCMH settings.…”