Traditional doctor's offices are being converted to the medical home model across the United States. Medical homes involve team-based care, preventive, and comprehensive healthcare as opposed to 1-to-1 fee for service or managed care. Record keeping in medical homes is shared, seamless, and electronic. Clinicians are accessible to patients 24 hours a day in person or via the Internet. However, pilot projects are identifying problems with the medical home model that relate directly to patients.

Interestingly, the American Academy of Family Physicians and TransforMED piloted transitioning 36 traditional primary care offices into patient-centered medical homes. Care focused on the patient's comprehensive and ongoing management. Quality of care and preventive health ratings showed improvement. Staff were streamlined, efficient, and satisfied. Physicians reported that they were content with the new model. Unfortunately, patients reported feeling disoriented. Their 1-to-1 doctor-patient interactions were replaced with 1-to-3 or 1-to-4 relationships. Patients perceived that clinicians focused more on new computer systems and technologies than on providing patient care.

Following identification of patient dissatisfaction, clinicians were encouraged to discuss the premise of medical home with patients and to form patient advisory councils. The American Academy of Family Physicians and TransforMED also suggested that patients should be asked for their opinions in a short survey. Additionally, Dr Joseph Mambu, a family physician in a Philadelphia suburb, developed the Patient-Centered Primary Care Collaborative as a national coalition of patient advocacy groups, payers, and providers. The goal of this organization is to create more medical homes nationwide, but with patient input into strategies.

The initial response of patients in this report regarding medical homes reminds us of the most critical aspect of healthcare reform-the patient. If any of our new strategies are to meet with success, the patient must be consulted, included, and advised as to the changes. When this is forgotten, consumer dissatisfaction will occur.

Source: Chen P. Putting patients at the center of the medical home. New York Times. July 15, 2010. Available athttp://www.nytimes.com/2010/07/15/health/15chen.html?_r=3&ref=health. Accessed July 16, 2010.

Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at[email protected].