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Transforming Primary Care with the Medical

Home Model
By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Winter 2014
www.spacemed.com

BACKGROUND
The patient-centered medical home (PCMH) model also referred to as advanced
primary care and the healthcare home holds promise as a way to improve American healthcare by transforming how primary care is organized and delivered. This
team-based model of care is led by a personal physician who ideally provides continuous and coordinated care throughout the patients lifetime to maximize health
outcomes. The PCMH practice is responsible for all of a patients healthcare needs
or appropriately arranging care with other qualified professionals. This includes the
provision of preventative services, treatment of acute and chronic illness, and assistance with end-of-life issues.
KEY PRINCIPLES
The American Academy of Family Physicians, the American College of Physicians,
the American Academy of Pediatrics, and the American Osteopathic Association
agreed on a common definition in the 2007 Joint Principles for the Patient Centered
Medical Home.
Key principles of the PCMH model include:

Personal relationship. Each patient has an ongoing relationship with a


personal physician and a healthcare team such as nurses, counselors, and
social workers who provide continuous and comprehensive care.

Team approach. Each member of the healthcare team, including the clinical
support staff, takes responsibility for the patients care.

Expanded access. Access to care is available through scheduled and sameday appointments, communication takes place between the patient, physician,
healthcare team and support staff via email and telephone, and patients also
have secure access to their own health records online.

Comprehensive care. Each healthcare team manages a broad range of


healthcare needs for patients of all ages and care is arranged with specialists
when necessary.

Coordinated care. Care is coordinated with specialists and outside services to


assure that the patient gets the best possible care.

Quality and safety. The entire medical home team is involved in continuous
quality improvement base on patient and staff input.

The PCMH model seeks to foster a relationship of trust between the care team and
the patient, and to actively engage patients as partners in their health care. Care
coordination is an essential component of the PCMH model and requires additional
resources such as health information technology and appropriately trained staff to
provide coordinated care through team-based models.

2014.7.1

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www.spacemed.com

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Transforming Primary
Care with the Medical
Home Model
Continued

FACILITY IMPACT
From a facility perspective, the goal is to decrease the level of stress from home to
the exam/consult/treatment room to encourage patient self-disclosure and to optimize the interaction with the provider. This should begin with intuitive wayfinding,
appropriate building drop off points and access, welcoming reception area, and a
comfortable waiting area. The facility must be designed with the flexibility to provide
a variety of technologies and spaces to allow patients, partners, and the interdisciplinary care team to select the best method for assessment, development, and implementation of the patients plan of care.
Specific spaces may be needed for:

Group medical visits to accommodate six to ten persons around a table or in


a more open room configuration with direct access to a handwashing sink,
toilet room, scale, specimen processing counter, and an exam room.

Group education visits with direct access to/from the public waiting area and
toilet facilities without entering clinical or administrative areas. Group education
rooms should have a digital screen and a whiteboard, a staging area for
refreshments, and an internal closet to store tables, chairs, mats and audiovisual equipment to facilitate the efficient room set-up for different types of
education activities. The number and size of meeting rooms will depend on the
specific patient population.

Telemedicine visits using an exam/consult room dedicated for telemedicine


encounters with cameras and computer screens that allow viewing by the care
provider, patient, and family members or partners.

Multidisciplinary visits with exam/consult rooms that can accommodate


providers from different disciplines.

Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

2014.7.1

Copyright SpaceMed

www.spacemed.com

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