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Am Fam Physician. 2009;79(3):191-192

Report Outlines Four Key Elements of the Patient-Centered Medical Home

The Center for Studying Health System Change and Mathematica Policy Research Inc. have issued a joint report outlining four core elements that could significantly affect the patient-centered medical home model. According to the report, much of the responsibility rests on payers and insurers. First, payers and insurers will need to identify what capabilities practices must demonstrate to qualify as medical homes. Additionally, they will need to decide how to match patients to medical homes; how to encourage patients and physicians to use the medical home to coordinate care; and how to pay practices for serving as medical homes. The report underscores the importance of payment reform to help make the medical home model sustainable for practices. Establishing a fixed per-patient fee would be necessary to cover the costs of acquiring and maintaining the extra services required of a medical home, such as disease management and open-access scheduling. The report also calls for information exchange between medical homes and their patients to promote effective communication. For more information, visit or the Center for Studying Health System Change Web site at

Study Shows Physicians With EHR Systems Less Likely to Pay Malpractice Claims

Physicians may have a new incentive to purchase an electronic health record (EHR) system, according to a study in the November 24, 2008, Archives of Internal Medicine. The study, “Electronic Health Records and Malpractice Claims in Office Practice,” examined data on paid malpractice settlements in Massachusetts over 10 years. One third of the 1,140 physicians studied used EHRs in their practices. Of these physicians, 6.1 percent had a record of paid malpractice claims, compared with 10.8 percent of physicians who did not use an EHR. Study results, although sparse, were consistent across all specialities of care. Lead study author Steven Simon, MD, MPH, said the results suggest that EHRs can help physicians provide higher quality and safer care for patients. However, Simon stressed that owning an EHR is not enough; physicians must also learn how to use its functions. High users of EHRs (i.e., those who reported using 50 percent or more of the available functions most or all of the time) were less likely to have paid a malpractice claim in the previous 10 years compared with low users. For more information, visit or the Archives of Internal Medicine Web site at

Newly Formed Coalition Supports Efforts to Reform U.S. Health Care System

The New America Foundation has formed a coalition of health care leaders from six major health providers to address the progress of national health care reform. During a December 11, 2008, press briefing in Washington, DC, Len Nichols, PhD, director of the foundation’s health policy program, emphasized that urgent action is needed to fix America’s health care system. Coalition members agreed that the transformation will require a fundamental reform of the delivery and payment systems. A new payment system and an emphasis on primary care and the patient-centered medical home were recognized as important steps to improve quality and reduce expenses. The United States currently spends 16 to 17 percent of its gross domestic product on health care, but ranks 29th in infant mortality, 48th in life expectancy, and 19 out of 19 in preventable deaths among industrialized nations. For more information, visit or the New America Foundation Web site at

Americans Cite Variety of Reasons for Skipping Seasonal Influenza Vaccination

Fewer than one third of U.S. adults surveyed in a nationwide poll conducted by the Rand Corp. had received the seasonal influenza vaccine as of mid-November 2008. Of those who had not been vaccinated, more than one half had no intention of getting the vaccine. The Centers for Disease Control and Prevention (CDC) places 70 percent of Americans in one or more categories of persons who should receive the influenza vaccine. These include persons 50 years and older, health care workers, caregivers to children or older adults, and persons with high-risk health conditions. However, only 37 percent of respondents in these categories had been vaccinated. More than 40 percent of respondents who had not been vaccinated cited inadequate free time as a reason for not getting vaccinated. Other reasons included forgetting to get vaccinated, not knowing where to receive the vaccine, and not knowing it was flu season. Respondents who had no intention of getting vaccinated cited reasons such as belief that they did not need it, belief that the vaccine is ineffective, and fear of adverse effects. For more information, visit or the Rand Corp. Web site at

CDC Report Reveals Thousands of Patients at Risk of Hepatitis B and C Viruses

More than 60,000 patients in the United States may have been exposed to hepatitis in the past decade, according to a CDC report in the January 6, 2009, Annals of Internal Medicine. A review of the CDC’s health care–associated viral hepatitis outbreak information revealed 33 identified outbreaks outside of hospitals in 15 states during the previous 10 years. A total of 450 hepatitis B and C infections were confirmed. John Ward, MD, director of the CDC’s Division of Viral Hepatitis, described the report as a wake-up call for health care personnel in outpatient settings. The study found a lack of basic infection control procedures and aseptic technique in injection safety, including the reuse of syringes. Blood contamination of medications, equipment, and devices was also a common factor in the outbreaks. CDC officials say the report indicates a need for ongoing professional education for health care providers, and consistent state oversight in detecting and preventing the transmission of blood-borne pathogens in health care settings. For more information, visit or the Annals of Internal Medicine Web site at

IOM Recommends Adjustments to Residents’ Duty Hours and Workloads

The Institute of Medicine (IOM) has recommended new restrictions on medical residents’ duty hours and workloads to minimize fatigue and maximize patient safety. The report, “Resident Duty Hours: Enhancing Sleep Supervision and Safety,” focuses on increasing residents’ opportunities for sleep during training to prevent sleep deprivation and reduce fatigue-related errors. Although the report recommends maintaining the current maximum of 80 work hours per week, it suggests limiting shifts to a maximum of 16 hours of continuous work. The current maximum shift length of 30 hours must be broken up after 16 hours by five hours of uninterrupted sleep between 10 p.m. and 8 a.m. In addition to the proposed changes in work hours, the report calls for greater supervision of residents by experienced physicians, limits on residents’ patient caseloads, and overlaps in residents’ schedules during shift changes. The Accreditation Council for Graduate Medical Education is scheduled to meet in March to discuss the report’s recommendations. For more information, visit or the IOM Web site at

Redesigned Patient Education Web Site Offers Interactive Video Content

The American Academy of Family Physicians’ patient education Web site,, has a new look for the new year. The redesigned site is the first medical association–sponsored Web site to offer health care information in text-based, video, and combined formats. Nearly 100 interactive, high-definition videos are currently available, with topics such as common medical conditions, treatments, and preventive health services. Several videos are also available in Spanish. Other features scheduled to appear on the site in coming months include a daily healthcast with health-related news updated five times per week, trigger points to access bonus material in videos, expandable and searchable text surrounding video content, and links to allow visitors to e-mail content to others. For more information, visit or

ACIP Issues Provisional Recommendations for Pneumococcal Immunizations

The CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended adding smoking and asthma as indications for routine administration of the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The provisional recommendation applies to adults 19 to 64 years of age. ACIP has also revised its pneumococcal immunization recommendations for American Indians and Alaska Natives, as well as for high-risk children. In its 2007–08 adult immunization schedule, ACIP recommended that Alaska Natives and certain American Indian populations receive the vaccine. However, the new recommendations state that the PPSV23 should not be used routinely in these ethnic groups before 65 years of age, unless there is an underlying condition that is a PPSV23 indication. Alaska Native and American Indian children who are 24 to 59 months of age should receive PPSV23 only if they live in areas with an increased risk of invasive disease. For more information, visit or the CDC Web site at


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