Annals of family medicine
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Annals of family medicine · Mar 2010
Principles of the patient-centered medical home and preventive services delivery.
Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services. ⋯ Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes.
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Annals of family medicine · Jan 2010
Randomized Controlled TrialSuicide inquiry in primary care: creating context, inquiring, and following up.
We wanted to describe the vocabulary and narrative context of primary care physicians' inquiries about suicide. ⋯ Although most suicide inquiries by primary care physicians are sensitive, clear, and supportive, some language is used that may inhibit suicide disclosure. Some physician responses may unintentionally reinforce patients for remaining silent about their risk. This study will inform future research in the development of quality improvement interventions to support primary care physicians in making clear, appropriate, and sensitive inquires about suicide.
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Annals of family medicine · Jan 2010
Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project.
The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices' transition to patient-centered medical homes (PCMHs). ⋯ After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience. PCMH models that call for practice change without altering the broader delivery system may not achieve their intended results, at least in the short term.
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Annals of family medicine · Jan 2010
Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home.
The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year patient-centered medical home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH. ⋯ Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient's experience of care. Intense facilitation increases the number of components implemented and improves practices' adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs.