The medical home: another model for managing chronic conditions?

I have been reading around the concept of the “medical home” . This has been a hot topic in the US in terms of disease management. US Physicians from the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) have offered their support to the medical home model.

I can't say that I am across the whole concept but I am interested in how it is developing in terms of primary care reform.

In short the term medical home describes:

a health care model in which individuals use primary care practices as the basis for accessible, continuous, comprehensive and integrated care. The goal of the medical home is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.

Source Deloitte Centre for Health Solutions

The research documents the critical features of the medical home which they have identified as forming the platform for guided self-care management. This can be useful in our discussions in terms of primary care model and managing chronic conditions.,

If you are interested in reading more about this you might like to follow the links below:

The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, referring to a central location for archiving a child’s medical record. In its 2002 policy statement, AAP expanded the concept to refer to primary care that emphasizes timely access to medical services, enhanced communication between patients and their health care team, coordination and continuity of care, and an intensive focus on quality and safety.

In 2007, a set of seven principles describing the characteristics of a practice-based care model was issued by four physician membership organizations representing over 300,000 physicians. The authoring organizations are: the American Academy of Family Physicians, the American College of Physicians, the American Osteopathic Association, and AAP. The clinicians represented by these organizations provide the majority of primary care in the United States.

Source ICIC

“Disease Management and the Medical Home Model: Competing and Complimentary” — has been published in the peer reviewed journal of Disease Management and Health Outcomes. The author has arranged with the publisher to make copies available through his website.

It seems that there are more challenges to moving to this model that solutions at this stage. There are issues around the start up costs for clinicians and services, including IT infrastructure as well as training for clinicians.

US Study into consumer attitudes and expectations of health care

I stumbled across an American research study by the Deloitte Center for Health Solutions through one of the research blogs I regularly check (Resource Connection).

The blog posted a good summary which led me to seek the Executive Summary:

Deloitte’s 2008 Survey of Health Care Consumers, an online poll of more than 3,000 Americans ages 18-75, provides an important and timely perspective on health care consumerism. The survey assesses consumers’ behaviors, attitudes, and unmet needs related to health, health care and health insurance. It also points to six discrete segments of the overall consumer market, providing a profile of their key characteristics and differences. Each segment presents opportunities and risks for health care industry stakeholders.

Source (Resource Connection)

The conceptual framework upon which this research is built reflects what they consider to be the five major domains of health care consumer activity:

1. use of traditional health services from medical professionals and hospitals,
2. use of alternative and non-conventional approaches to care,
3. self-directed care,
4. information seeking and
5. financing.

It is based on the company's belief that consumers will play a significant and increasingly important role in the U.S. health care system’s efforts to improve quality, reduce errors, increase access to services, reduce unnecessary costs, and promote laws and campaigns that address its issues and challenges.