Health

Knowing your patients and their medical issues is often what separates good care from unintentional bad outcomes. Let me give you an example: Last year, one of my 48-year-old patients was in the emergency room in one of the top cardiology centers in Minnesota and was having chest pain. The ER physician called to tell me that they had called in a cardiologist because her electrocardiogram (ECG) was so abnormal that they were about to take her to the “cath” lab for an emergency angiography. I thought about this patient for a moment; she had no risk factors for premature heart disease, but wait…she did have dextrocardia. I told him that her heart was on the opposite side of her body and her internal organs were also reversed from the side that they should be on. I told him to try hooking up the ECG backwards before taking her into such a risky procedure that I doubt she needed. Sure, enough – the ECG was then normal. We were able to save her a potentially risky and expensive procedure and they went on to diagnose her ulcer and she left the ER happy and on her way to health.

She knew she was “reversed,” but forgot as she was healthy and it never seemed to affect her, so she didn’t tell the ER doctor. I had the privilege of stepping up to the plate for her and getting her the right care at the right time. This information was documented in our computer and all over her chart, but the ER did not have access to that after hours.

I had a similar case in a man who had had his spleen surgically taken out and was in the ER with bronchitis. The ER doctor was going to send him home without any antibiotics. I recommended that they not only give him antibiotics, but told them about his “missing” spleen and that he needed a specific kind of antibiotic. People who get certain infections and are missing their spleen can die in 24 hours from an out of control infection. These two cases are why the American Academy of Family Practice is recommending that everyone have a medical home.

What is a medical home?

The American Academy of Family Practice has coined this phrase as a way of encouraging people to establish a relationship with one medical provider or group of providers in order for you to get the best medical care possible. Why is the American Academy of Family Practice (AAFP) recommending that?

I have been a family physician for more than 25 years and I know that I can better care for people that I know well and have helped with their health care over the years. I know when a family has genetic issues and I know to watch for the complications in other members of that family. Continuity of care is what primary care has been all about over the years. I have seen some people straying from their care with a family physician, pediatrician or internist (internal medicine specialist) and going right to a specialist for the problem at the moment – for example going to a dermatologist for warts instead of starting with your primary care provider.

Here’s what the AAFP has to say about a medical home: “The American Academy of Family Physicians believes that everyone should have a personal medical home that serves as the focal point through which all individuals-regardless of age, sex, race or socioeconomic status-receive acute, chronic and preventive medical services. Through an ongoing relationship with a family physician in their medical home, patients can be assured of care that is not only accessible but also accountable, comprehensive, integrated, patient-centered, safe, scientifically valid and satisfying to both patients and their physicians. (2006)” This new model produces better care and lower costs.

A practice can be designated as a patient-centered medical home – a more effective and efficient model of health care delivery if the following happens:

• The practice-based care team takes collective responsibility for patient’s ongoing care.
• The medical home models health care delivery that is based on an ongoing personal relationship with a physician. This personal patient/physician relationship provides continuous and comprehensive health care.
• The care team is responsible for providing and arranging for the health care needs of all patients.
• Patients can expect care to be coordinated across care settings and disciplines (I like to think of this as the family physician becomes your “quarterback”).
• Quality is measured and improved as part of daily work flow.
• Patients experience enhanced access and communication.
• Practice uses computerized medical records, registries and other clinical support systems.

The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for managing care with other qualified professionals. This includes care for all stages of life: acute care, chronic care, preventive services and end-of-life care.

Care is coordinated across all elements of the patient’s community including the health care system (hospitals, home health agencies, nursing homes, consultants and other components of the complex health care system), facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it.

Quality and safety are hallmarks of the patient-centered medical home. Physician practices that adopt the medical home model become advocates for their patients to support the attainment of the best health outcomes. These outcomes are defined by a care planning process driven by a compassionate partnership between the patient, the patient’s primary physician, other physicians, health care providers and family members. The patient actively participates in decision making and provides feedback to ensure expectations are being met.

This enhanced access to health care means the practice provides patients with options such as open scheduling, expanded hours and various arrangements for communication between patients, the physician, the practice team and office staff.

Why is This Model Important?

The U.S. health care system currently produces poorer health outcomes at much greater costs than do the health systems of other industrialized nations. Insurance companies and patients alike are looking for better value in health care and desire better quality at lower cost. A recent report, Financing the New Model of Family Medicine (2004), estimates that if every American had a medical home, health care costs would likely decrease by 5.6 percent, resulting in national savings of $67 billion dollars per year, with an improvement in the quality of the health care provided.

So, if you are ready for better and more cost effective care, find yourself a “medical home” and befriend your medical provider.

Ruth A. Bolton MD, ISJ Urgent Care, 101 Martin Luther King Jr. Drive, Mankato, MN 56001, 507.304.7000