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Am Fam Physician. 2007;75(7):963-964

Primary Care Organizations Agree on Principles of Medical Home

Four primary care organizations have agreed on a definition of the personal medical home that they believe could improve the capability of the health care system. “Joint Principles of the Patient-Centered Medical Home,” released on March 5, was developed by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians, and the American Osteopathic Association. The definition describes the characteristics of a practice-based model for comprehensive primary care, encompassing the physician-patient relationship, the quality of health care, the infrastructure, and the payment system that are needed for ongoing, cost-efficient, and effective health services. According to the principles, the key elements of the personal medical home are a physician who has an ongoing relationship with patients and arranges care with other qualified professionals; the implementation of evidence-based medicine, quality improvement measures, information technology, and patient participation in care decisions; improved access to care that includes open scheduling, expanded hours, and new options for communication with patients; and a payment system that recognizes the medical expertise, administrative requirements, and time demands of providing a personal medical home. For more information, visit

CMS Will Use Physician Data to Drive Quality Improvements

Delmarva Foundation for Medical Care, a quality improvement organization of the Centers for Medicare and Medicaid Services (CMS), has signed subcontracts with four regional health care collaboratives. Each collaborative will start combining Medicare data with information from other payers—including private payers—to produce data on the performance of physicians within the Medicare program. The contracts are part of the Better Quality Information to Improve Care for Medicare Beneficiaries project, which will publicly report physician performance information from multiple sources for the first time. The aggregated information will provide Medicare patients with an overview of provider performance, according to CMS. The generated data also are expected to provide physicians with a more comprehensive view of the quality of care they provide, which should enhance their ability to improve performance, CMS said. For more information, visit, or

Medicare Advisory Commission Presents Report on Physician Payment

In a report to Congress, the Medicare Payment Advisory Commission (MedPAC) suggested changing the way physicians are paid for Medicare services. It recommended establishing expenditure targets based on geographic location and physician subspecialty, or repealing the sustainable growth rate formula (SGR), which is used to establish payment levels for Medicare physician services. MedPAC did not suggest a substitute payment system. In response to the report, the AAFP urged Congress to replace the current payment structure with a system that compensates physicians for care coordination services and creates incentives for the establishment of patient-centered medical homes. Instead of the SGR, the AAFP recommended using a system based on the Medicare economic index. For more information, visit

AAP Issues Policy Statement on High-Deductible Health Plans

The AAP issued a policy statement expressing concern about the potential impact of high-deductible health plans on children's care. “High-Deductible Health Plans and the New Risks of Consumer-Driven Health Products” (published in the March issue of Pediatrics) discusses the implications of these health plans for children and physicians and makes recommendations for plan design, education, practice administration, and research. High-deductible health plans represent a focus shift from benefits to contributions, the AAP states. Although the impact of such plans on children's access to care and the functioning of the medical home is not yet clear, the AAP is concerned that families with low to moderate incomes and children with special health care needs may be at risk. Families may delay seeking care before the deductible is met, which could result in lower rates of preventive care and immunizations, less treatment compliance, and lower use of care services, the AAP said. In addition, physicians may be asked more about the costs, content, and value of their services, and patients may request more telephone and e-mail assistance to avoid office visits. The AAP recommends that these plans provide coverage for preventive services such as immunizations and screenings before the deductible is met, and that they consider giving payment for telephone and e-mail services. For more information, visit

AHRQ Finds Improvement in Health Care Quality, Continuing Disparities

Two reports issued by the Agency for Healthcare Research and Quality (AHRQ) found that although the overall quality of health care in the United States continues to improve, health care disparities persist among racial, ethnic, and socioeconomic groups. The “2006 National Healthcare Quality Report,” assessing 40 core measures of quality, shows a 3.1 percent overall improvement compared with the quality level described in the 2005 report. Combined rates of delivery of appropriate vaccinations to children, adolescents, and older persons improved by almost 6 percent, but combined improvement rates for other preventive measures (e.g., health screenings, advice, and prenatal care) totaled less than 2 percent. The “2006 National Healthcare Disparities Report,” which compares health care measures across various populations, found that blacks received poorer-quality care than whites for 73 percent of the 22 core measures used, and Hispanics received poorer-quality care than non-Hispanic whites for 77 percent of the core measures. For more information, visit, or

CDC, HHS Announce New Efforts to Aid Pandemic Preparedness

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) announced two efforts designed to help state and local decision makers optimize their pandemic influenza preparedness activities. The CDC, in collaboration with other federal agencies and public health and private partners, has developed a guide focusing primarily on community-level strategies that could be used during the initial stages of a pandemic to delay or mitigate the spread of infection until a targeted vaccine becomes available. These strategies are largely nonpharmaceutical interventions such as social distancing to reduce person-to-person contact. The guide also introduces a pandemic severity index intended to help forecast a pandemic's impact and inform implementation of specific recommendations based on its severity. The HHS introduced several radio and television public service announcements aimed at encouraging people to learn more about pandemic influenza and the preparedness efforts being undertaken by their state and local community. For more information, visit, or

Study Shows Middle-aged Americans Today in Poorer Health Than in Previous Years

An analysis published by the National Bureau of Economic Research showed that Americans who are in their early to mid-50s today report poorer health, more pain, and more difficulty with everyday tasks than older Americans did at the same age. The researchers compared the self-reported health of persons in three birth-year groups as recorded in a survey that began in 1992. Those born in 1942–1947 or 1948–1953 (now ages 54 to 65) were less likely than those born in 1936–1941 (now ages 66 to 71) to have reported excellent or good health at ages 51 to 56. The youngest group reported more pain, chronic health conditions, and psychiatric problems than the oldest group had at the same age, and had more difficulty walking, climbing steps, and doing other physical tasks. According to the National Institute on Aging, the results could be an indication of increasing health costs for society as these Americans reach retirement in poorer health than their predecessors. For more information, visit

AHRQ Launches Campaign Encouraging Patients to Ask Questions

The AHRQ, in partnership with the Ad Council, launched a campaign to encourage patients to take a more pro-active role in their health care by asking questions. The campaign, “Questions Are the Answer: Get More Involved with Your Health Care,” has a toll-free number and a Web site providing information and tips. Listed on the Web site are 10 questions for patients to ask their physicians, such as “What is the test for?” Web site users can also build their own list of questions to give to their health care providers, and can access fact sheets on safer care and preventing medical errors, in addition to other resources. The campaign was launched during Patient Safety Awareness Week (March 4–10) with the aim of reducing the number of medical errors in the United States through a more proactive patient base. For more information, visit, or


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