Am Fam Physician. 2008 Mar 15;77(6):751-752.
Family medicine is in a dire situation, and things within the specialty must change. Many discussions in national health care politics are focused on payment changes so that primary care can be financially recognized for its value. That discussion is important, but the perceived value of family medicine may not change until family medicine changes itself. The U.S. health care system has evolved over the years to include more patients with chronic diseases such as diabetes and heart disease.1 These patients require increased care management, yet family medicine has not kept pace with their needs.
To help initiate the needed changes in the field of family medicine, TransforMED (www.transforMED.com) launched a National Demonstration Project in July 2006 that selected 36 medical practices from around the country to initiate a new model of clinical care, which focused on eight major practice components:
Information systems that provide a better quality of care and increased office efficiency;
Redesigned offices that optimize patient flow and use of space;
Quality and safety that incorporate patient feedback, outcomes analysis, and evidence-based best practices;
Practice management that includes disciplined financial management, promotes change management, and fosters practice leadership;
Point-of-care services that provide ancillary services and procedures, disease prevention, wellness promotion, and chronic disease management processes;
A team method that encompasses a collaborative approach to the patient's care, optimized use of the clinical team, prearranged relationships with other specialists, and strong communication within the practice;
Access to information that provides the patient with multiple venues to access their medical charts (e.g., getting laboratory results through the practice's Web site or by phone);
Access to care that offers group visits; e-visits; and same-day visits or a multilingual approach to care, when needed.
What we have learned, in less than one year, is enlightening. The new model, described in the Future of Family Medicine report1 and by the Institute for Healthcare Improvement,2 works. Based on anecdotal and emerging qualitative data, it appears as though practices incorporating components of the model are experiencing economic improvements and better physician and staff satisfaction. Practices that have been successful in implementing chronic disease registries are starting to see improvements in patient care.
It is time to begin raising our sights from these 36 practices and to find a way for all family medicine and primary care practices to provide this higher quality of care. It is important for family medicine to provide the level of care that patients and payers are demanding, and this dilemma presents both an opportunity and an immediate challenge.
Change needs to occur, and it will occur whether we like it or not, so it must be anticipated and managed. The ability to change, and to successfully manage that change, is based on fundamental concepts of communication and leadership that need to occur from the foundation of our practices to the upper ranks of our specialty organizations. Thus, a practice should incorporate ways to communicate between physicians and staff on a regular basis. The demonstration project taught us that most practices are poorly equipped to communicate and to change, and that leaders who serve as champions by diligently promoting practice transformation are critical to success.
A practice should next identify components of the new model that are most easily accomplished, such as a practice Web site, e-visits, group visits, and advanced-access scheduling. Information and literature are available about how to accomplish these projects within a practice.3 Other components are more difficult to implement, such as an electronic health record (EHR) system or disease- and population-based registries.
Although more complex, these changes provide the greatest opportunities for family medicine. The efficiencies that can be gained from an EHR system are impressive if done right by anticipating and managing the change, and by selecting the best system for the practice. Although it may seem daunting to implement disease registries, practices using them are finding them to be a valuable tool in proactively managing chronic diseases. More than 40 percent of the U.S. population has a chronic disease requiring additional care management, and patients with chronic disease currently account for nearly 80 percent of all health care spending. Better coordination of outpatient care for those with multiple target conditions may improve patient outcomes, reduce the number of preventable hospitalizations, and lower overall health care spending.1
As family physicians, we have an important role to play within the U.S. health care system. We will distinguish ourselves in this system not by taking care of the sick, even though that will always be a principal role, but by preserving health. The approach to doing this is a population-based registry that provides tools to manage patients proactively. This is not a pipe dream—the technology exists. Family physicians need to demand that these systems fit their practice needs (including ownership of the resulting data), and that it be affordable to do so.
This is a unique time in history, and family medicine is positioned to take a leadership role. We must do this—nobody else will do it for us. If we take the lead, be aggressive, tell our stories, and set the bar high, then the proven value of our specialty will follow. We must embrace the new model of care, but, more importantly, we must continue to be physicians who focus on the patient as a whole person with whom we are in a comprehensive relationship. By doing so, family medicine practices will be synonymous with the ideal patient-centered medical home.
1. Anderson GF, Wilson KB. Chronic disease in California: facts and figures. California Healthcare Foundation. October 2006. http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=125683. Accessed October 15, 2007.
2. Institute for Family-Centered Care. Advancing the practice of patient- and family-centered care: how to get started. Bethesda, Md: Institute for Family-Centered Care; 2007. http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/Literature/AdvancingthePracticePFCCHowtoGetStarted.htm. Accessed October 15, 2007.
3. TransforMED model of care resources. http://www.transformed.com/resources.cfm. Accessed October 15, 2007.
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