Engaging Patients and Families in the Medical Home

June 2010
AHRQ Publication No. 10-0083-EF
Prepared For:
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850, www.ahrq.gov

Contract Number: HHSA290200900019I TO2
Submitted By: Mathematica Policy Research, 600 Maryland Avenue SW, Suite 550, Washington, DC 20024-2512
Authors: Sarah Hudson Scholle, Phyllis Torda, Deborah Peikes, Esther Han, and Janice Genevro

Table 2. Comparison of joint principles and consumer principles for the medical home
 Joint Principles of the Patient-Centered Medical Home (AAFP, AAP, ACP, AOA 2007)Principles for Patient- and Family-Centered Care: The Medical Home From the Consumer Perspective (NPWF 2009)How Consumer Principles differ from Joint Principles
Care Team
  • Personal physician. Each patient has an ongoing relationship with a personal physician trained to provide first contact and continuous, comprehensive care.
  • Physician-directed medical practice. The personal physician leads a team of people at the practice level who collectively take responsibility for the ongoing care of patients.
  • In a patient-centered medical home (PCMH), an interdisciplinary team guides care in a continuous, accessible, comprehensive and coordinated manner.
  • The care team is led by a qualified provider of the patient’s choice, and different types of health professionals can serve as team leader.
Patients choose the leader of the team, not necessarily a physician
Whole-Person Orientation
  • Whole-person orientation. The personal physician is responsible for providing all the patient's health care needs and for arranging care with other qualified professionals.
  • The PCMH "knows" its patients and provides care that is whole-person oriented and consistent with patients'; unique needs and preferences.
More emphasis on patients’ needs and preferences
Care Coordination
  • Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services).
  • The PCMH takes responsibility for coordinating its patients’ health care across care settings and services over time, in consultation and collaboration with the patient and family.
More emphasis on patients’ needs and preferences
Self-Management Support
  • Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care-planning process driven by a compassionate, robust partnership of physicians, patients, and patients’ families.
  • Patients and their caregivers are supported in managing the patient’s health.
Shared Decisionmaking
  • Patients actively participate in decisionmaking, and feedback is sought to ensure that their expectations are being met.
  • Patients and clinicians are partners in making treatment decisions.
Quality Improvement
  • Evidence-based medicine and clinical decision-support tools guide decisionmaking
  • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
  • Patients and families participate in quality improvement activities at the practice level
  • Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication
  • Practices go through a voluntary recognition process by an appropriate nongovernmental entity to demonstrate that they have the capabilities to provide patient-centered services consistent with the medical home model.
  • The PCMH provides care that is safe, timely, effective, efficient, equitable, patient-centered, and family-focused.
  • Seeks out and encourages patient feedback on experience of care, and uses that information to improve the quality of care the care team provides.
  • Collaborates with patient and family advisors in quality improvement and practice redesign.
  • Collects data on race, ethnicity, sex, primary language, and language services for each patient and records that information in a manner that can be reported and used to plan and respond to the health and language needs of patients in the practice.
  • Regularly evaluates and improves the quality, safety, and efficiency of its care using scientifically sound measures and reports that information to an entity that will make it publicly available in a way consumers can understand and access.
  • Routinely undertakes efforts to identify and eliminate any disparities in the quality of care received by its patients.
Focuses on multicultural population Collects health and language needs of patients Publicly reports outcomes Aims to reduce disparities
  • Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication among patients, their personal physicians, and practice staff.
  • The patient has ready access to care.
  • Open communication between patients and the care team is encouraged and supported.
  • Payment recognizes the added value provided to patients who have a PCMH.
  • Does not mention payment
Communication and Trust
  • The PCMH fosters an environment of trust and respect.
Emphasizes trust and respect