David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Health Aff (Millwood). 2012 Mar;31(3):627-35. doi: 10.1377/hlthaff.2011.0908. Epub 2012 Feb 15.
The patient-centered medical home model holds the potential for reducing disease complications and improving health, and the federal government is now promoting the adoption of the model within federally qualified community health centers. In a group of Los Angeles community health centers, we found that all would have qualified as patient-centered medical homes under a widely used assessment tool developed by the National Committee for Quality Assurance and endorsed by the federal government for the community health center program. However, we also found that there was no significant relationship between how well these centers performed on the assessment and whether they achieved a range of process or outcome measures for diabetes care. These findings suggest that the federal government is promoting medical home redesign that may not be sensitive to, or inclusive of, services that will actually improve diabetes care for low-income patients. Therefore, additional methods are required for measuring and improving the capabilities of community health centers to function as medical homes and to deliver the scope of services that impoverished patients genuinely need.
以患者为中心的医疗之家模式具有减少疾病并发症和改善健康的潜力,联邦政府目前正在促进在合格的联邦社区卫生中心中采用该模式。在洛杉矶的一组社区卫生中心中,我们发现,根据国家质量保证委员会制定的、并得到联邦政府为社区卫生中心计划认可的广泛使用的评估工具,所有中心都符合以患者为中心的医疗之家的标准。然而,我们还发现,这些中心在评估中的表现与他们在糖尿病护理方面实现的一系列过程或结果指标之间没有显著关系。这些发现表明,联邦政府正在推动医疗之家的重新设计,而这些设计可能对实际改善低收入患者糖尿病护理的服务并不敏感或不包容。因此,需要采取其他方法来衡量和提高社区卫生中心作为医疗之家的功能,并提供贫困患者真正需要的服务范围。