协调是以病人为中心的护理的基石. And while the patient-centered medical home (PCMH) is designed to provide 全面的, 协调护理, patients often require services that extend beyond the primary care realm. Outside the PCMH, though, that same level of coordination is often lacking. Specialists have long worked in care models that differ from those of their primary care counterparts. 另外, patients may have access to any number of community resources, 但没有足够的资金来利用它们.
Bringing specialists and nonclinical providers into the “medical neighborhood” is one approach to mitigating fragmented care, 减少挫败感, 并最终改善结果. 接下来的一个月, we’ll talk with Emma Mandell about the concept of the medical neighborhood and why providers are embracing this transformative model of care delivery – and why patients are expecting them to.
简单地说, 什么是医疗社区, 它与以病人为中心的医疗之家有何不同?
The medical neighborhood is a clinical community that includes medical, 行为健康, and social/社区云顶集团 that are necessary to ensure 全面的 and coordinated patient care delivery. Some organizations like to call it the “medical home on steroids.” Essentially it’s an expansion of the PCMH, with the same foundation and the same key competencies. 然而, the PCMH has been a model that focuses mainly on primary care and doesn’t always expand beyond those walls to integrate specialty care, 医院, 社区云顶集团, 以及其他临床和非临床支持云顶集团. So the medical neighborhood takes that model to the next step, to ensure care coordination across all sites of care and across all providers involved in a patient’s care.
What types of entities or providers might you see in a medical neighborhood?
它可以包括初级护理和专科护理, 医院, 行为健康云顶集团, 家庭健康, 熟练的护理设施, and other nonclinical providers such as community resources – things like transportation services, 上门送餐计划, 公共卫生机构, 和教堂, all working to coordinate the needs of the patient in a more integrated and less fragmented manner.
The inclusion of specialty care is one of the most notable differences between the medical home and the medical neighborhood models. 是什么让这种模式吸引专家呢?
Specialists view the medical neighborhood as an opportunity to improve the way they deliver care by breaking down silos. Primary and specialty care providers want to be working together within a consistent model, 与医院和其他护理机构协调护理工作. Doing so allows them to focus on providing clinical care to patients instead of worrying about other tasks.
And one of the tasks that occupies so much of their energy is referral management. Closing the loop on referrals continues to be an issue for both primary and specialty care providers. 病人经常在提供者之间转诊, but when it’s up to the patients to coordinate their own care, they sometimes get lost in the system without completing important tests and other services. 所以从提供者的角度来看, t在这里’s certainly a lot of frustration over the inconsistencies stemming from primary care working in a different model than specialty care.
另外, specialists are starting to receive some of the same pressures from state and federal agencies that primary care has been experiencing for the last 10 years or so in terms of providing value-based care. 例如, 在一些州, specialists are beginning to report certain quality and performance metrics, and they’re providing additional non-face-to-face services in terms of coordinating care. 不幸的是, some of these new value-based care requirements are not yet supported by value-based payment models. So specialists are shifting away from volume-based care delivery, but more slowly than primary care.
You mentioned how that lack of coordination frustrates providers. 对病人来说肯定更糟. 他们是如何影响这个讨论的?
As patients continue to become more savvy in their healthcare, 他们开始期待高质量, 高价值的护理模式. 所以当病人从初级医疗机构转过来, 他们的护理在哪里得到协调, 到专科护理机构去,可能不是, 沮丧和困惑开始袭来. 当病人感到沮丧时, we begin to see an increase in gaps of care – patients don’t follow through with their care or recommended services, 或者他们选择一个新的提供者.
It’s the same phenomenon you see across almost every industry providing services to consumers: services are catered to the individual consumer’s need and available when the consumer needs them; otherwise the consumer finds a new service provider. In healthcare, this means primary care providers and specialists must provide patient-centered care.
除了, payers and providers are now marketing the idea of a medical home or neighborhood w在这里 care is patient-centered, 全面的, 并在整个过程中进行协调. Some payers are even incentivizing patients to seek care at medical homes – for example, 他们将免除某些云顶集团的自付费用. So now patients are actually going to offices and asking whether they’re part of a medical home; and if not, they might take their care elsew在这里 because it’s more cost-efficient and effective. It’s a trend that’s likely to continue as the medical home and neighborhood become the standard of care that patients expect.
Emma Mandell is a Manager with 心电图 and has written extensively about care model transformation – including the medical home and medical neighborhood models. Her recent article, “It Takes a Village: Integrating the Medical Neighborhood,” appears in AMGA’s 小组实践日志,你可以读一下 在这里.
2015年12月2日发布