Bringing Patients, Families Into the PCMH Critical to Model's Success

Often, it is the patient who is left out of the mix in today's health care system, but in a patient-centered medical home (PCMH), it is critical to the delivery of quality, effective health care that patients and their families be engaged in the care process. This patient piece of the PCMH was one of the focuses at the most recent stakeholder's meeting of the Patient-Centered Primary Care Collaborative (PCPCC).

"We need to get away from this idea that all we need to do is educate patients and we have magically solved whatever issues that patient has," said Marci Nielsen, M.P.H., Ph.D., the newly installed executive director of the PCPCC, which held a stakeholder's meeting here April 23-24. "We need to engage patients where they are as consumers, and we need to engage their entire family when appropriate."

Nielsen also called for bringing patients into health care entities so that the patients themselves "can help set the stage for their own health care delivery."

Conference speakers repeatedly expounded on that theme, providing concrete examples of how physicians, payers and purchasers of health care have been able to partner with patients and their families to deliver a higher level of care.

"Patient- and family-centered is the goal we are really trying to achieve as we transform health care," said Beverley Johnson, the president and CEO of the Institute for Patient- and Family-Centered Care, who moderated and participated in a plenary session on patient partnerships.

She cited examples of how various physician practices and health systems have partnered with patients and their families "to really change the level of care." For example, a health system in the Northeast turned to its patients and family advisers to help define 24/7 access, a key component of the PCMH. By consulting patients and their family members, the health system was able to create an enhanced access-to-care system that works well for patients and their families, as well as the health system, according to Johnson.

Johnson also mentioned a medical group in Oregon that relied on family and patient advisers to help create a patient portal and a family physician practice in Rhode Island that incorporated patient and family feedback into the redesign of a diabetes checklist.

Patients and their families don't have the only answers, said Johnson, but they bring an important and needed perspective to the table. "At the core of achieving true innovation, we need lots of voices, lots of different perspectives."

Gordon Harvieux, M.D., a pediatrician and medical director of the medical home for Essentia Health, a health system in Duluth, Minn., expanded on that theme when he explained how he partners with patients and their families to improve health care within his PCMH practice.

"We have four parent partners who are on our (advisory) committee," said Harvieux. "They come to the table with us. We meet every two weeks. We ask them what needs to be done to improve health care in our practice, and we take their advice."

For example, the practice put in a dedicated patient line for its most complicated patients so these individuals can get in touch with the person they need to reach within the practice immediately.

In addition, said Harvieux, all patients in the practice have a printed health care plan that summarizes their health history and their diagnoses and that provides a description of their diagnoses. "I think the (care plan) is the single most important thing that will keep patients out of the emergency room and out of the hospital," said Harvieux.

The practice also employs a care coordinator to manage patient care and to work with patients and their families on a care plan. The care coordinator calls the family before the patient comes in for a visit to ask them what they would like to accomplish during the visit. "So often the family comes in, and I think I know what I am doing; I will go through the entire visit, and at the very end, the family will tell me why they really came in," said Harvieux.

In a session on using technology in the PCMH, Daniel Sands, M.D., M.P.H., director for medical informatics at Cisco Systems, talked about using technology to break down barriers and enhance patient access to care. In particular, according to Sands, the creation of an electronic patient portal has resulted in better communication between patients, their families and their health care team.