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July 2010 Issue

Manoj Singh, MD, and Sri Murthy, MD, both of UC’s family medicine department, say annual checkups are important for people of all ages.
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Patient Centered Medical Homes Gain Recognition, Improve Patient Care

By Katie Pence
Published July 2010

It’s been almost a year since the Patient Centered Medical Home pilot began with UC Health primary care practices.


And all of their hard work is paying off.


Three UC primary care practices—West Chester, Montgomery and Union Centre—have been recognized by the National Committee for Quality Assurance (NCQA) as Physician Practice Connections Patient Centered Medical Homes.


West Chester and Union Centre received Level 3 distinction, which is the highest possible; Montgomery received Level 1 distinction, which is the entry level.


These practices are among the first in Greater Cincinnati and Ohio to receive the designation.


Manoj Singh, MD, a family medicine physician in the UC Health West Chester practice, says this recognition is truly an honor and is encouraging to physicians who have worked diligently to improve the efficiency of their practices.


"We’re really hearing some great feedback from our patients,” he says. "Now, our hope is to take what we’ve learned and spread our knowledge among the other UC practices.”


Currently, 11 primary care practices in Greater Cincinnati are receiving support and training to transform their clinics through a program developed by the Health Improvement Collaborative’s Aligning Forces for Quality initiative, in partnership with the Robert Wood Johnson Foundation.


The Patient Centered Medical Home is a health care model that facilitates partnerships between individual patients, their physicians and their families, when necessary. It focuses on disease prevention and maintenance of good health with primary care physicians coordinating care with specialists to tailor care to a patient’s specific needs.


Registries, information technology, health information exchange and other means are used in care to assure that patients get what they need when they need it.


In order to gain this distinction, the UC Health practices had to meet certain criteria including patient self-management support, care coordination, evidence-based guidelines for chronic conditions and performance reporting and improvement.


Kelly Fischbein, director of quality and performance improvement with UC Health, says the patient-centered medical homes in place are just one initiative helping position the system for expected reform changes. 


"With these beginning pieces in place, we are now able to frame out the ‘medical neighborhood’ to these ‘medical homes,’” she says. "Ways we are doing this are building stronger coordination between these medical homes and our specialty network and improving these critical patient handoffs.


"UC Health is in a uniquely fortunate position to deliver highly coordinated care to this community.”


Singh says his clinical group, which includes Sri Murthy, MD, has put a number of care practices in place to highlight coordination, ensure access for patients and organize using electronic medical records.


"We’ve been setting aside a few available spaces every morning and afternoon for same-day appointments, helping our patients who don’t want to go to urgent care,” he says. "We’ve also been providing patients with more self-education tools and are in the process of trying to develop a patient-focused education center in the corner of our waiting room to provide not only information on hypertension, diabetes and high cholesterol, but also to include information that may be location-specific to patients, like alerting them to other experts available through UC Physicians in the same location as their doctor’s appointment or letting them know about local health fairs, screenings and more.”


He adds that physicians are also contacting patients the day following discharge from the hospital or an emergency visit to see if they need to schedule a follow-up appointment with a physician or specialist.


Nita Walker, MD, internal medicine physician in the UC Health Montgomery practice, says her clinic evaluated all office policies and procedures to ensure that they were centered on the patient.


"We've increased same-day access and set guidelines to improve phone contact,” she says. "We are working to ensure that our diabetic and hypertensive patients receive care that is consistent with well-established national guidelines and goals, and we're making sure that we measure our progress in this regard. In addition, we are regularly looking at patient satisfaction and ways we can improve service.”


Fischbein says the evidence and momentum created by some of these early pilots cannot be ignored. 


"Research supports that care delivered by primary care physicians in a patient-centered medical home is consistently associated with better outcomes, reduced mortality, fewer preventable hospital admissions for patients with chronic diseases, lower utilization, improved patient compliance with recommended care, and lower Medicare spending,” she says.


Performance data for this pilot is being collected and should be released sometime this fall.


 "In the long term, this is going to improve the quality of care provided to patients and reduce the cost of care,” Singh says. "In traditional medicine, there are often redundancies because there are so many handoffs. If the patient is admitted to the hospital, the tests run and the information collected may be done again after they are discharged.


"This model has the potential to improve care while reducing costs.”


He says preliminary data conducted by his clinic before the start of the pilot shows this model did improve patients’ outcomes and reduce costs in a diabetic population.


And so far during this pilot, Singh says he’s heard positive responses from the general population.


"Patients who call for same-day appointments are so grateful that they don’t have to wait to get in to see their physician,” he says, adding that doctors are explaining this change to their patients so that they know what to expect. "We want people to know that we are their physicians, when they are healthy and when they are ill, and that we will help coordinate their care, whether they are at home, in the hospital, or in a nursing home.”

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