Specialty care and the patient-centered medical home

Authors, Primary Hollingsworth,J. M.;Saint,S.;Hayward,R. A.;Rogers,M. A.;Zhang,L.;Miller,D. C.
Title Primary Specialty care and the patient-centered medical home
Periodical Full Medical Care
Pub Year 2011
Volume 49
issue 1
Start Page 4-9
Abstract BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by specialists for 7 chronic conditions, and to estimate the implications associated with reallocating half among the PCP workforce. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Physicians from the 2007 National Ambulatory Medical Care Survey. MEASURES: We identified adult ambulatory visits for chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease, and depression. We calculated the time spent by specialists in direct and indirect care for established patients with these conditions. We summed individual physician estimates across specialists and converted the total into annual work weeks. After reducing this figure by half, we divided by the number of active PCPs. RESULTS: Most specialty visits (76.8%; 95% confidence interval [CI]: 73.6%-79.7%) were made by established patients. Specialists spent 552,844 (95% CI: 454,660-651,029) and 108,113 (95% CI: 86,103-130,122) cumulative work weeks providing direct and indirect follow-up care, respectively. Reallocating half of this care would generate 3.2 (95% CI: 2.6-3.8) additional work weeks for each PCP. CONCLUSIONS: The cumulative time spent by specialists in routine chronic disease follow-up is nontrivial. Reallocation of this care to PCP-directed medical homes may require multidimensional efforts to expand the primary care workforce.
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Place of Publication Not Available
Author/Address Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI 48105-2967, USA.; Publisher URL: www.cinahl.com/cgi-bin/refsvc?jid=1743&accno=2010898963
PubMed Link
Reference Type(s) Journal Article
Topic Tag(s) Comprehensive Care;Care Coordination;Primary Care Workforce Issues;Outcomes
Special Population(s) Individuals with Multiple Chronic Conditions
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
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