Jessica Lobban, PGY-3 CCLP Family Medicine Residency Program Can Patient Centered Medical Home effectively manage our Diabetic Patients? Jessica Lobban, PGY-3 CCLP Family Medicine Residency Program

Is Patient Centered Medical Home the future of Healthcare?

Objectives Brief History of Patient Centered Medical Home (PCMH) Define and explain PCMH Identify Components of PCMH Case discussion Discuss how implementation of this model can effectively manage our Diabetic patients Describe the challenges of PCMH Conclusion

Medical Home History Medical home dates back to 1967 American Academy of Pediatrics envisioned ideal healthcare delivery to children as family centered, comprehensive, and coordinated In 2002, chronic care model was born, emphasizes role of primary care to prevent and manage chronic illness In 2006, Patient Centered Primary Care Collaborative was created to improve patient-physician relationship and healthcare delivery In 2010 Affordable Care Act was implemented

Patient Centered Medical Home PCMH is model of primary care: Patient centered care Comprehensive Team Based Accessible Focused on quality and safety

Patient Centered Care Patient Centered Care allows patients and their families to make educated decisions and participate in their own care. goal is to maximize adherence along with self-management through proper education and consistent follow-ups

Comprehensive A team of care providers is responsible for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.

Team Based Approach Coordination of care through a diverse team of primary care physicians, specialists, nurses, social workers, physician assistants, and other nonclinical staff Daily huddles (preview cases, go over labs, and coordinate expertise of necessary team members)

Accessible Open scheduling Expanded hours Patient Portal (patients are able to email their physician)

Quality and Safety  Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

National Committee of Quality Assurance NCQA Patient-Centered Medical Home (PCMH) Recognition is the most widely- used way to transform primary care practices into medical homes. Access During Office Hours Advanced electronic communication Care Management Support Self-Care Process Referral Tracking and Follow-Up Implement Continuous Quality Improvement

Can Patient Centered Medical Home effectively manage our Diabetic Patients?

Quick Facts about Diabetes Diabetes is most common chronic disease 174 billion in medical care each year Cost of care averaging 2.3 times higher than patients without diabetes Only 7 % patients meet evidenced based goals of HgbA1c

Case 60 y/o AAF PMH Diabetes Mellitus Type 2 presents to clinic for routine office visit. She has no complaints today, states she does not take her insulin as prescribed. She often skip her 2nd dose of insulin in the evening. She states her FBS at home ranges from 200-210. She denies any hypoglycemic episode. Her vital signs are stable and physical exam is unremarkable except for Obese. Upon chart review her HgbA1c is 12 and she is currently on metformin 1000mg PO BID and Insulin 70/30 20 units sub Q BID. How can we effectively manage her diabetes over the next 3-6 months?

How can we implement this model to effectively manage our patient? Diabetes Educators Education about disease and its complications Counseling and guidance with self management and goal setting Nutrition and Close follow up A care coordinator/care manager can follow up between visits to address potential barriers to adherence Encourage medication compliance

Diabetes and PCMH Pennsylvania, 23,390 patients, Publication Date: July 2013 18.3 % reduction hospital admissions 2.6 % reduction in total costs 7 % increase in patients with controlled HgbA1c 23.2 % increase in eye exams 9.7% increase in LDL Screenings

Diabetes and PCMH Michigan (statewide 3 million patients) 10 % fewer adult ED visits 17% fewer inpatient admissions 6 % fewer hospital readmissions The data from this study also showed that when physicians fully transform their practice to PCMH, resulted in higher quality and improved preventative care.

PCMH Challenges

PCMH Challenges Initial Capital and Restructuring Costs Staff Training Electronic Medical Records Scheduling (Extended/Alternative Hours of Service)

PCMH Challenges Even though, there are challenges to this model PCMH has been shown to be effective by improving glycemic control in our Diabetic Patients and improve overall health outcome. Ultimately the future of PCMH is bright and it will continue to evolve and demonstrate that primary care organized around patients and their families is key to health care reform.

Conclusion Medical Home Concept dates back to 1967, first envisioned by AAP PCMH is model of primary care: Patient centered care Comprehensive Team Based Accessible Focused on quality and safety

Conclusion With the use of Diabetes Educators, Research has shown that PCMH has been effective for patients with chronic disease such as Diabetes by reducing hospital admissions and ultimately improving glycemic control. Even though this is a new change to health care, there are also some challenges PCMH such as Payment reform, EMR and scheduling

What are some of the changes we can make to PCMH implemented at our clinic?

Resources http://care.diabetesjournals.org/content/34/4/1047.extract http://www.ajmc.com/publications/evidence-based-diabetes-management/2013/2013-1-vol19- sp2/Diabetes-and-the-Patient-Centered-Medical-Home http://pcmh.ahrq.gov/citation/patient-centered-medical-home-how-it-affects-psychosocial-outcomes- diabetes http://www.colmr.research.va.gov/publications/transition_watch/TransitionWatch_Vol6 http://www.internalmedicinenews.com/single-view/patient-centered-medical-home-making-progress-in- diabetes/9f84e6853a.html http://hitconsultant.net/category/policy/patient-centered-medical-home-policy/ www.constructinglifecoaching.com http://www.stritch.luc.edu/depts/fam_med/residency/index.htm