Why use the term ‘medical home’? Isn’t that an American term?

The term Patient Centred Medical Home was developed and defined in the USA to describe what (for them) was a new approach to comprehensive primary care.

The model of care it represents has developed significant momentum in the USA and subsequently in Australia, and is now often cited in policy documents by federal and state governments.

There is also a large and growing body of research that demonstrates the effectiveness and efficiency of the model.

What are the features of the Medical Home?

The US Patient Centred Primary Care Collaborative identifies five key features of the Medical Home.

  • Patient-centered: A partnership among practitioners, patients, and their families ensures that decisions respect patients’ wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients are able to access services with shorter waiting times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

In Australia there is a long standing tradition of quality general practice. Our ACMH collaborative identifies the following eleven attributes of the Medical Home in Australia.

  • Accountability The medical home partners with a patient and their family to be responsible for their care, even when that person is not standing in front of them. It will be proactive in providing for the care needs of its population. It will assist patients to navigate the health system, and share in the informed decision making by each patient.
  • Comprehensive, whole person care A medical home will be the custodian of a person’s whole health story. It will either provide care itself, or make sure that people can access the most appropriate provider for all their health needs.
  • Continuity of Care People benefit from a long term relationship with a particular general practitioner, or another generalist primary care provider if a GP is not available,
  • Team Based Care A medical home adopts a team based approach that includes practice nurses in the role of care managers, and other allied health providers.
  • Self Management A medical home will have systems to foster self management of each person’s health
  • Patient Participation Patients will be able to participate in the design of the services that a medical home offers.
  • Accessibility A medical home will actively manage its appointment systems to improve the provision of timely routine appointments. It will have systems to provide proactive chronic disease management and preventative health care. It will be accessible for patients with acute care needs when required, and will either provide after hours acute care or have clear arrangements in place for its patients to access after hours care.
  • Excellent Clinical information A medical home will have a systematic approach to curating each patients medical history and will ensure that their is appropriate information available to all providers of care. It will make full use of eHealth technologies.
  • System based approach and participation in Quality Improvement A medical home will have a system based approach to make sure that each patient receives best practice care. It will participate in quality improvement initiatives to improve the care it provides.
  • Connections to the ‘medical neighbourhood’ A medical home will have good relationships with other providers in their community. It will act as a gateway to the health system. and will have developed systems to make sure that all providers in a patients care are part of an integrated care team – with clear roles, goals and communication pathways.
  • Education and Training ‘Giving back’ to the next generation of clinicians is an important role for the Medical Home, and they will participate in training health professionals – not only within their disciplines, but also in the skills needed to work in a Medical Home model.

Doesn’t using the term ‘Medical Home’ just reinforce the ‘medical model’ of health care? Is it all about doctors?

A person’s ‘medical home’ will have a team based approach to providing care.

The roles of nurses, care managers and allied health providers are respected. All members of the team will work at the higher levels of their skill set.

In addition, the person will have an ongoing relationship with a particular primary care physician – a general practitioner. This partnership between a person, their family and their GP is a core part of the model. However, the care the person receives at many times will be led or delivered by other providers.

Why not use another term, such as ‘Health Care Home’ or ‘Primary Care Home?

The term Medical Home, with its defined specific criteria, has a large body of evidence to demonstrate its effectiveness. If you change the name, you risk losing some of the rigorousness of the criteria. It becomes easy for every service to call itself a ‘Health Care Home’. An ongoing relationship with a particular GP is an essential component of the Medical Home. The term also has a significant amount of momentum politically, with the benefit of moving the focus from hospital based care to better primary care.

Isn’t ‘Medical Home’ another word for ‘General Practice’?

In Australia, all medical homes are general practices, but not all general practices are medical homes. Some general practices would have to change some of the ways they deliver care to meet the criteria of a medical home. This may include measures to improve continuity, or team based care, or comprehensiveness, or care coordination, or access, or participation in quality improvement programs. Quality General Practice, as defined by the RACGP, is an excellent blueprint for a medical home.

Does the ‘medical home’ act as a gatekeeper, reinforcing the closed shop created by the medical profession? Is it just another method to shut allied health out of the system.

The medical home acts as a gateway for each person to access the rest of the health system. One of the goals of a medical home is to create an integrated care team that meets each person’s health needs. People who belong to a medical home are more likely to receive care from a range of allied health care providers, and to have this care feel’joined up’.

Does the ‘Medical Home’ model restrict a person’s right to choose their general practice?

Patients who belong to a medical home maintain the right to receive health care from other general practices. Care received elsewhere should be connected with the care they receive at their usual practice by timely communication. Although a patient is free to change their nominated ‘medical home’ at any time, there are many benefits from long term relationships.

Does the Medical Home restrict a persons right to see other primary care providers, such as physiotherapists?

People always have the right to seek care from primary care providers who work ‘outside’ their medical home. Often this is most appropriate. In the Medical Home model, each provider in a person’s care team will feel part of the loop – and share the information they need to provide best care for that patient.

Are Aboriginal Medical Services medical homes?

Many Aboriginal Medical Services serve as  excellent models of the Patient Centre Medical Home, providing team based, comprehensive, whole person care, based on relationships over time, with good systems for proactive care delivery and a commitment to quality improvement processes.

 

Can small or solo practices act as medical homes?

Patients often have a particularly strong relationship with small or solo practices, which is a strength. Smaller practices can also be more agile in developing better systems for care. They can make up for their small team by having strong relationships with the rest of the medical neighborhood.

Is a Medical Home the same as a One-Stop Shop?

The term ‘Medical Home’ does not imply that all medical services can be accessed under the one roof. It does imply that the practice will be able to determine the care team you need, and make it available to you in an integrated way, especially when services are delivered elsewhere.
Co-location of medical services is not a defining characteristic of a medical home, and does not guarantee integration.
Very large practices with collocated services need to develop specific systems to develop a sense of accountability, to provide continuity of care and to foster ongoing relationship with particular providers.

 

Can the Medical Home model work in remote areas?

Many remote health services provide excellent models of a medical home.
In remote towns and communities where there are often health workforce issues, it is common for all the health providers to cooperate in innovative ways to make sure patients can access the care that they need.
In some parts of Australia, Remote Area Nurses or Aboriginal Health Workers fill the role of the particular provider who has an ongoing relationship with each patient.

Isn’t this medical home stuff happening already?

Absolutely.

Many people in Australia are accustomed to receiving quality, integrated primary care through their general practice and other providers. They have an ongoing relationship over many years with their GP and their general practice team, and practice nurses work as care managers to help them navigate the health system, and make sure they receive allied health services as required.</dd>