Fernandes Susan M, Sanders Lee M
aDivision of Pediatric Cardiology, Department of Pediatrics bDivision of Cardiovascular Medicine, Department of Medicine cDivision of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
Curr Opin Pediatr. 2015 Oct;27(5):581-6. doi: 10.1097/MOP.0000000000000258.
Originally conceived by pediatricians as a model for the care of children with special healthcare needs, the 'patient-centered medical home' (PCMH) has been identified by the Affordable Care Act as a model for all future outpatient care delivery. Although few studies have demonstrated its efficacy in improving care for children with congenital heart disease (CHD), access to a PCMH is likely to improve CHD-patient outcomes, including global function and quality of life, while reducing healthcare costs.
To date, most patients with complex CHD have their care anchored in cardiology subspecialty-care clinics, which lack many of the attributes of a PCMH. Given that many of these patients have noncardiac morbidities, including neurocognitive impairment and multiorgan dysfunction, we believe such patients will benefit from a PCMH model of care based on primary care.
The PCMH based on primary care for patients with complex CHD could result in improved clinical outcomes, improved patient satisfaction and quality of life as well as decreased healthcare costs. Policy and practice reform are required to increase CHD-patient access to a PCMH, based on primary-care settings.
“以患者为中心的医疗之家”（PCMH）最初由儿科医生构想为照顾有特殊医疗需求儿童的模式，《平价医疗法案》已将其确定为未来所有门诊医疗服务的模式。尽管很少有研究证明其在改善先天性心脏病（CHD）患儿护理方面的疗效，但获得PCMH服务可能会改善CHD患者的预后，包括整体功能和生活质量，同时降低医疗成本。
迄今为止，大多数复杂CHD患者的护理都集中在心脏病专科诊所，这些诊所缺乏PCMH的许多特征。鉴于这些患者中有许多人存在非心脏疾病，包括神经认知障碍和多器官功能障碍，我们认为这类患者将受益于基于初级保健的PCMH护理模式。
基于初级保健的复杂CHD患者PCMH模式可能会改善临床结局、提高患者满意度和生活质量，并降低医疗成本。需要进行政策和实践改革，以增加CHD患者在初级保健环境中获得PCMH服务的机会。
