Moving Beyond the Medical Model to Enhance Primary Care

Published on Aug 1, 2012in Population Health Management2.086
· DOI :10.1089/pop.2011.0106
Tracy A. Riley1
Estimated H-index: 1
Janine E. Janosky54
Estimated H-index: 54
  • References (28)
  • Citations (4)
#1Hayley B. Gershengorn (Beth Israel Medical Center)H-Index: 14
#2Hannah Wunsch (NewYork–Presbyterian Hospital)H-Index: 36
Last. Phillip Factor (Beth Israel Medical Center)H-Index: 2
view all 7 authors...
Background As the number of ICU beds and demand for intensivists increase, alternative solutions are needed to provide coverage for critically ill patients. The impact of different staffing models on the outcomes of patients in the medical ICU (MICU) remains unknown. In our study, we compare outcomes of nonphysician provider-based teams to those of medical house staff-based teams in the MICU. Methods We conducted a retrospective review of 590 daytime (7:00 am -7:00 pm ) admissions to two MICUs a...
72 CitationsSource
21 CitationsSource
Background: Making the kind of improvement changes necessary to move toward a patient-centered medical home will continue to challenge small, independent primary care practices. Here we describe further analysis of a successful program to understand the roles of coleaders of a change management process. Methods: Through an improvement collaborative we trained 2 coleaders (a physician and a non-physician) from 16 small primary care practices to institute depression care improvements. These colead...
14 CitationsSource
#1Stephen M. Shortell (University of California, Berkeley)H-Index: 72
#2Lawrence P. Casalino (Cornell University)H-Index: 45
Last. Elliott S. Fisher (The Dartmouth Institute for Health Policy and Clinical Practice)H-Index: 16
view all 3 authors...
The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that t...
100 CitationsSource
#1Robert A. Berenson (Urban Institute)H-Index: 16
#2Eugene C. Rich (Mathematica Policy Research)H-Index: 23
The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary car...
92 CitationsSource
#1Mark McClellanH-Index: 45
#2Aaron McKethanH-Index: 8
Last. Elliott S. Fisher (Dartmouth College)H-Index: 70
view all 5 authors...
The concept of accountable care organizations (ACOs) has been set forth in recently enacted national health reform legislation as a strategy to address current shortcomings in the U.S. health care system. This paper focuses on implementation issues related to these organizations, building on some initial examples. We seek to clarify definitions and key principles, provide an update on implementation in the context of other reforms, and address emerging issues that will affect the organizations’ ...
305 CitationsSource
#1Benjamin F. Crabtree (UMDNJ: University of Medicine and Dentistry of New Jersey)H-Index: 63
#2Paul A. NuttingH-Index: 31
Last. Carlos Roberto JaénH-Index: 33
view all 6 authors...
This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a mul...
190 CitationsSource
#1Carlos Roberto Jaén (University of Texas Health Science Center at San Antonio)H-Index: 33
Last. Kurt C. StangeH-Index: 5
view all 10 authors...
PURPOSE Understanding the transformation of primary care practices to patient- centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country's fi rst national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches. METHODS The National Demonstration Project (NDP) was a group-randomized clinical trial of facilitate...
94 CitationsSource
#1Thomas Bodenheimer (UCSF: University of California, San Francisco)H-Index: 58
#2Hoangmai H. PhamH-Index: 11
In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining pro...
395 CitationsSource
The term primary care is widely used as if it were consistently defined or well understood. In fact, neither is the case. This paper offers a definition of primary care derived from historical perspectives—from both the United States and abroad. We discuss the evidence for primary care’s important functions and international experiences with primary care. We also describe how and why the United States has deviated from this fuller realization of primary care, as well as the steps needed to achie...
78 CitationsSource
Cited By4
#1Judi Allyn Godsey (Xavier University)H-Index: 1
#2Thomas J. Hayes (Xavier University)H-Index: 6
Last. Robert Kallmeyer (Christ University)H-Index: 1
view all 4 authors...
Purpose Nurses have been called to be leaders in the transformation of health care and to help improve health-care access for the nation’s most vulnerable populations. However, to lead health-care transformation, the profession of nurses must first see themselves as leaders. Unfortunately, nursing has been described as lacking cohesiveness and failing to communicate a consistent brand image. No empirically tested quantitative tools exist to measure the brand identity of nursing, making it diffic...
#1Jeffrey I. Mechanick (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 1
#2Robert F. Kushner (NU: Northwestern University)H-Index: 49
The question ‘Why Lifestyle Medicine?’ is answered by discussing the concept of chronic diseases and their increased prevalence rates that are resistant to current care models. The great burden of this problem is described and the need for a new chronic disease care model is proposed. Epidemiological dimensions as well as issues with health messaging and campaigns that are scalable to address this problem are presented. A new lifestyle medicine paradigm that incorporates the facets of preventive...
3 CitationsSource
Abstract Approximately 3 million patients with symptoms suggestive of obstructive coronary artery disease (CAD) present to primary care offices in the United States annually, resulting in approximately $6.7 billion in cardiac workup costs. Despite wide application of existing diagnostic technologies, yield of obstructive CAD at invasive coronary angiography (ICA) is low. This study used a decision analysis model to assess the economic utility of a novel gene expression score (GES) for the diagno...
5 CitationsSource
#1Janine E. JanoskyH-Index: 54
#2Erin M. ArmoutlievH-Index: 1
Last. Penny RileyH-Index: 1
view all 7 authors...
Abstract Community coalitions have the potential to catalyze important changes in the health and well-being of populations. The authors demonstrate how communities can benefit from a multisector coalition to conduct a community-wide surveillance, coordinate activities, and monitor health and wellness interventions. Data from Summit County, Ohio are presented that illustrate how this approach can be framed and used to impact community health positively across communities nationwide. By jointly sh...
6 CitationsSource