Tuesday, October 7, 2008

The Patient-Centered Medical Home

Did you know that...
  • 44,000-98,000 Americans die from medical errors annually?
  • only 55% of patients receive the recommended care?
  • there is a 17-year lag between the discovery of more effective treatments and implementation into routine patient care?
(Institute of Medicine, Chasm in Quality)
As part of National Primary Care Week, Dr. Charles Williams (BMC Dept. of Family Medicine) spoke - at a lunchtime discussion with Thai food - about how the proposed Patient-Centered Medical Home (PCMH) attempts to make the quality improvements that are lacking in the US health care system. The discussion went through the features of the PCMH model and how they attempt to make improvements. Dr. Williams mentioned Dr. Gordon Moore's "Ideal Medical Practice" and how he borrowed from Toyota's famous "Lean Manufacturing" process to create a medical practice that would reduce the seven types of waste (Muda):
  1. Defects
  2. Overproduction
  3. Conveyance
  4. Waiting
  5. Inventory
  6. Motion
  7. Overprocessing
For example, Dr. Williams said, to reduce the waste of "Motion", Dr. Gordon placed his office as close to the parking lot as possible so that patients would waste as little energy as possible getting from their cars to the bed.

Questions from students included:
  • Is the Patient-Centered Medical Home a physical building?
"It could be," said Dr. Williams. He further explained that the PCMH is more of a model for looking at a medical practice and measuring it's many different properties to make improvements.
  • Would this receive opposition from medical insurance companies?
Dr. Williams mentioned a project in Boston that is trying to show that by implementing the model they can make improvements in both quality and cost. This, in theory, should make it more attractive for insurance companies.
  • Isn't this already being implemented by Community Health Centers?
Yes, in fact there are some local CHCs that are using this, or something similar, to do reviews of their current practices.
References

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