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Understanding Medical Homes A European study funded by the Commonwealth Fund Marjan J Faber GE Voerman Baker R, Constantinidis A, De Lepeleire J, Eriksson T, Lilienkamp C Richard PTM Grol. Introduction (I).
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Understanding Medical HomesA European study funded by the Commonwealth FundMarjan J FaberGE VoermanBaker R, Constantinidis A,De Lepeleire J, Eriksson T, Lilienkamp CRichard PTM Grol
Introduction (I) • Concept introduced in the US 40 years ago, in order to face the care for children with special health care needs [CSHCN] (Sia et al., 2004) • Medical Home is defined as • A place—a single source of all medical information about a patient • A partnership approachwith families to provide primary health care that is 1) accessible 2) family centered 3) coordinated 4) comprehensive 5) continuous 6) compassionate 7) culturally effective (Sia et al., 2004)
Medical Home: domains • A personal physician (3) • Physician-directed medical practice (3) • Whole-person orientation (8) • Coordination/integrated care (5) • Quality and safety (8) • Improved access (6) • Payment (3) • Source: Joint Principles of the Patient-Centered Medical Homes (2007)
Problem definition • There is no research evidence on the characteristics of the MH in European primary care • There is no evidence on whether care provided according to the MH is associated with patient population, practice, or healthcare system characteristics • There is no evidence on best practice
Project goals • To achieve consensus about the concept of MH • To describe and compare current (and desired) care provision according to the MH concept in a number of (European) countries with strong primary care systems • To analyze the degree of care provided according to the MH concept in relation to characteristics of patients, practices, and countries • To identify best practice for MH and the problems that are encountered in organizing a MH • Part 1 of MH project: Literature review and expert consultation • Part 2 of MH project: Instrument development • Part 3 of MH project: Fieldwork • Part 4 of MH project: Analysis, interpretation, and dissemination
Instrument development Requirements instruments: Short and simple to complete Addressing corresponding elements between the 3 instruments when possible
Fieldwork: 5 countries High performing countries Low performing countries Source: Starfield & Shi, Health Policy 2002
Overview of data collection * Flemish practices only** Overall responsratio 35%
As to Flanders (Belgium) • Very satisfied patients with high level - home visits - same day appointments (95%) - Regular visits after 6 pm - consultation in the weekend - patient expectations are met
As to Flanders (Belgium) but: • Low level of • Clinical audit • Annual reports • Compliant procedure • Concertation with other professionals • Attachmen t guidelines • Preventive actions • Direct patient access to medical file • High cost for patients
Special thanks to ... • Richard Baker, Leichester, United Kingdom • Jan De Lepeleire, Leuven, Belgium • Antje Erler, Frankfurt, Germany • Tina Eriksson, Copenhagen, Denmark • Gerlienke Voerman, Jako Burgers & Richard Grol, Nijmegen, the Netherlands • Robin Osborn, CommonwealthFund, New York, US
Additional analysis • Non-response analysis • Relation between patient experiences and characteristics of: • Patients • GP practices • Healthcare systems • Relation between patient ratings and professional ratings for same item • Include interviews with best practice GPs
Scoring across 7 countries on key-elements for a medical home (Schoen et al 2007) AUS = Australia; CAN = Canada; GER = Germany; NETH = Netherlands; NZ = New-Zealand; UK = United Kingdom; US = United States.
