Mead Holly, Andres Ellie, Regenstein Marsha
1George Washington University, Washington, DC, USA.
Med Care Res Rev. 2014 Feb;71(1):61-84. doi: 10.1177/1077558713509890. Epub 2013 Nov 27.
The patient-centered medical home (PCMH) has gained significant interest as a delivery system model that can improve health care quality while reducing costs. This study uses focus groups to investigate underserved, chronically ill patients' preferences for care and develops a patient-centered framework of priorities. Seven major priorities were identified: (a) communication and partnership, (b) affordable care, (c) coordinated care, (d) personal responsibility, (e) accessible care, (f) education and support resources, and (g) the essential role of nonphysician providers in supporting their care. Using the framework, we analyzed the PCMH joint principals as developed by U.S. medical societies to identify where the PCMH model could be improved to better meet the needs of these patients. Four of the seven patient priorities were identified as not present in or supported by current PCMH joint principles. The study discusses how the PCMH model can better address the needs of low-income, disadvantaged patients.
以患者为中心的医疗之家（PCMH）作为一种能够在降低成本的同时提高医疗质量的服务提供系统模式，已引起了广泛关注。本研究采用焦点小组来调查未得到充分服务的慢性病患者的护理偏好，并制定了一个以患者为中心的优先事项框架。确定了七个主要优先事项：（a）沟通与伙伴关系，（b）可负担的护理，（c）协调护理，（d）个人责任，（e）可及的护理，（f）教育与支持资源，以及（g）非医师提供者在支持其护理方面所起的重要作用。利用该框架，我们分析了美国医学会制定的PCMH联合原则，以确定PCMH模式在哪些方面可以改进，从而更好地满足这些患者的需求。七个患者优先事项中有四项被确定为当前PCMH联合原则中未体现或未得到支持的。该研究讨论了PCMH模式如何能够更好地满足低收入、弱势患者的需求。
