Department of Urology, University of Michigan, Ann Arbor, Michigan.
J Urol. 2013 Oct;190(4):1345-9. doi: 10.1016/j.juro.2013.03.119. Epub 2013 Apr 9.
Hopes are high that the delivery system reforms embodied in the patient centered medical home will improve the quality of care for patients with chronic diseases. While primary care physicians, given their training, will likely be the locus of care under this model, there are certain conditions for which urologists are well suited to provide the continuous and comprehensive care called for by the patient centered medical home. To assess the feasibility of the urology based patient centered medical home, we analyzed national survey data.
For our measure of medical home infrastructure, we mapped items from the 2007 and 2008 NAMCS (National Ambulatory Medical Care Survey) to the NCQA (National Committee on Quality Assurance) standards for patient centered medical home recognition. We determined the proportion of urology practices in the United States that would achieve patient centered medical home recognition. Finally, we used NAMCS data to estimate the impact of consolidating genitourinary cancer (ie prostate, bladder, kidney and testis) followup care among the current supply of urologists.
Nearly three-quarters of urology practices meet NCQA standards for patient centered medical home recognition. At present, primary care physicians spend 9,295 cumulative workweeks providing direct and indirect care to survivors of genitourinary cancers. Off-loading half of this care to urology practices, in the context of the patient centered medical home, would generate an average of 0.73 additional workweeks for each practicing urologist.
Urology practices may possess the capacity needed to direct medical homes for their patients with genitourinary cancers. Successful implementation of this model would likely require a willingness to manage some nonurological conditions.
人们寄希望于以患者为中心的医疗之家所体现的交付系统改革将提高慢性病患者的护理质量。虽然初级保健医生由于其培训，可能是该模型下的护理中心，但对于某些疾病，泌尿科医生非常适合提供患者为中心的医疗之家所要求的连续和全面的护理。为了评估基于泌尿科的患者为中心的医疗之家的可行性，我们分析了国家调查数据。
对于我们的医疗之家基础设施的衡量标准，我们将 2007 年和 2008 年 NAMCS（国家门诊医疗保健调查）的项目映射到 NCQA（国家质量保证委员会）对患者为中心的医疗之家认可的标准。我们确定了美国有多少泌尿科实践可以获得患者为中心的医疗之家认可。最后，我们使用 NAMCS 数据来估计在当前泌尿科医生的供应下，整合泌尿生殖系统癌症（即前列腺、膀胱、肾脏和睾丸）随访护理的影响。
近四分之三的泌尿科实践符合 NCQA 对患者为中心的医疗之家认可的标准。目前，初级保健医生花费 9295 个累计工作周直接和间接照顾泌尿生殖系统癌症的幸存者。在患者为中心的医疗之家的背景下，将一半的护理工作转交给泌尿科实践，每个执业泌尿科医生将平均增加 0.73 个额外的工作周。
泌尿科实践可能具备为其患有泌尿生殖系统癌症的患者指导医疗之家的能力。成功实施这一模式可能需要愿意管理一些非泌尿科疾病。
