Patient-centered care has received new prominence with its inclusion by the Institute of Medicine as 1 of the 6 aims of quality. Seven attributes of patient-centered primary care are proposed here to improve this dimension of care: access to care, patient engagement in care, information systems, care coordination, integrated and comprehensive team care, patient-centered care surveys, and publicly available information. The Commonwealth Fund 2003 National Survey of Physicians and Quality of Care finds that one fourth of primary care physicians currently incorporate these various patient-centered attributes in their practices. To bring about marked improvement will require a new system of primary care payment that blends monthly patient panel fees with traditional fee-for-service payment, and new incentives for patient-centered care performance. A major effort to test this concept, develop a business case, provide technical assistance and training, and diffuse best practices is needed to transform American health care.

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A 2020 vision of patient-centered primary care.

PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care. METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to fioriginal English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence. RESULTS Forty-one research articles reporting the results of 40 studies were identifi ed that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were signifi cantly improved and only 2 were signifi cantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported signifi cantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity. CONCLUSIONS Although the available literature refl ects persistent methodologic problems, it is likely that a signifi cant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specifi c and measurable outcomes and more direct costs and should seek to defi ne and measure interpersonal continuity more explicitly.

https://www.annfammed.org/content/annalsfm/3/2/159.full.pdf

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

This question, posed to Jim Collins over dinner one evening, inspired the book Good to Great. Collins and his research team spent five years answering that question. What makes this book so interesting is not only what was discovered, but the rigor of the discovery process. Collins and his team of twenty dedicated researchers did not hypothesize or theorize, but went directly to data to find the answers.

Good to great.

Introduction: A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient’s health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans. Methods: Standard literature databases, including PubMed, and Internet sites of numerous professional associations, government agencies, business groups, and private health organizations identified over 200 references, reports, and books evaluating the medical home and patient-centered primary care. Findings: Evaluations of several patient-centered medical home models corroborate earlier findings of improved outcomes and satisfaction. The peer-reviewed literature documents improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home. Patient autonomy and choice also contributes to satisfaction. Although industry has funded case management models demonstrating value superior to traditional fee-for-service reimbursement adoption of the medical home as a basis for medical care in the United States, delivery will require effort on the part of providers and incentives to support activities outside of the traditional face-to-face office visit. Conclusions: Evidence from multiple settings and several countries supports the ability of medical homes to advance societal health. A combination of fee-for-service, case management fees, and quality outcome incentives effectively drive higher standards in patient experience and outcomes. Community/ provider boards may be required to safeguard the public interest. (J Am Board Fam Med 2008;21: 427– 440.)

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The Medical Home: Growing Evidence to Support a New Approach to Primary Care

The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care. The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change.

 Measuring the PCMH involves the following:
 Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster individual and population health.

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Defining and measuring the patient-centered medical home

BACKGROUND Recognizing fundamental fl aws in the fragmented US health care systems and the potential of an

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The Future of Family Medicine: a collaborative project of the family medicine community.

BACKGROUND To ensure the success of the proposed New Model of family medicine and to create a better understanding of the nature and role of family medicine, an effective communications plan must be developed and implemented. This Future of Family Medicine task force report proposes strategies for communicating the role of family physicians within medicine, as well as to purchasers, consumers, and other entities.

METHODS After reviewing the findings from the research conducted for the Future of Family Medicine project, the task force presents a preliminary brand-positioning strategy for family medicine messages. Based on this strategy, the task force identifies 5 major audiences to which family medicine communications should be directed. A consistent method was used to determine optimum strategies to address each audience: defining the audience, assessing the literature and other pertinent evidence, identifying the communication objectives, determining the key messages, developing brand promises, and proposing strategies and tactics to support the messages and objectives. Preliminary communications plans are then presented for each of the 5 target audiences.

MAJOR FINDINGS It is important that the organizations involved in family medicine make a multiyear commitment of resources to implement and support an aggressive communications strategy, which is based on key messages to target audiences. A concerted effort is particularly needed to address the declining interest among medical students in the specialty. Implementing a comprehensive family medicine career development program may be one effective strategy to reverse this trend. To help eliminate the current confusion among the public regarding family medicine and to promote clarity and consistency in terminology, the specialty should replace the name family practice with family medicine and a new graphic symbol for the discipline of family medicine should be developed.

CONCLUSION As a discipline, family medicine has failed to formulate and deliver a compelling message. New communications strategies must be implemented that will reach audiences in terms they understand and care about and in ways that convey a sense of the exciting role family physicians will play in the future. By actively implementing the communications plans described in this report, the specialty can enhance the impact and help ensure the widespread implementation of the proposed New Model of family medicine.

https://www.annfammed.org/content/annalsfm/2/suppl_1/S75.full.pdf

Kenneth L. Evans

Papers

The Future of Family Medicine: a collaborative project of the family medicine community.

Task Force Report 4. Report of the Task Force on Marketing and Communications