Tuesday, August 9, 2011

The Patient Centered Medical Home: An AHRQ Search Engine and A Note About A Cancer PCMH

Candidate for a Medical Home?
Do you wish you could find and quote some published scientific evidence on the Patient Centered Medical Home (PCMH)?  While you already have a leg up thanks to joining thousands of readers that regularly check the DMCB, you may also want to use and bookmark this very handy AHRQ site.  It provides a definition, a bibliography of "foundational" articles and, best of all, a search engine that will provide the citation, an abstract and a link to PubMed.  Unfortunately, however, the full article remains under the control of the publisher which may or may not be open access.

Speaking of the PCMH, the DMCB was alerted to this interesting article on the PCMH for cancer patients that appeared in a journal called Community Oncology.  An independent Philadelphia area oncology practice used a high performance EHR, relied on "patient navigators" to coordinate care and routinely worked with patients to make them be as fully engaged as possible in self-care.  While they were at it, they attained Level III NCQA PCC PCMH recognition.  While the outcomes are presented in a narrative pre-post fashion, the author John Sprandio MD describes a credible increase in patient phone calls, greater reliance on the care of symptoms at home, a "50%" drop in referrals to the emergency room, a sustained 9-16% drop in admissions, expanded use of standardized protocols that anticipated and prevented dehydration, fewer admissions for gastroenteritis, less chemo-induced nausea and greater use of same day clinic appointments.

The DMCB is intrigued by the idea of expanding the PCMH to the field of outpatient cancer treatment.  It used the AHRQ site above to search for similar studies and didn't find much.  On the other hand, the concept seems promising, especially if robust non-physician care coordination is paired with physician leadership.  It been long known to work in classic oncology disease management, so why shouldn't it be adapted here?

Image from Wikipedia

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