Patient-centered Medical Home Primary Care Transformation

Patient-centered Medical Home Primary Care Transformation

Abstract

Purpose: As the government strives to transform patient-centered medical home primary care (PCMH), it is crucial to consider implementation improvement structures and strategies to strengthen the health systems. Further, ensure citizens not only get access to health services but quality patient care, especially to chronic patients. It is essential to consider the preparedness and acceptance of the exercise by both practitioners and patients/families. The objective of the study is to assess the health practitioners’ availability/preparation and perception of citizens regarding the approach to deliver a quality PCMH that concur with the guidelines of the National Committee for Quality Assurance Standards.

Methodology. The researcher intends to randomly recruit 200 respondents (health practitioners, managers, and patients/families) from 3 health facilities. Distribute questionnaires and conduct interviews to collect information. Then use both qualitative and quantitative technics to analyze the data. The outcome measure includes the category and skills level of staff in PCMH and the willingness degree of patients to be put under home care.

Results. The study expects the majority of people to embrace the PCMH system, whereby many patients will enroll in it. On the other hand, the study is likely to find that most of the highly experienced health practitioners work in the hospital, leaving the lowly skilled and learning students to work in PCMH.

Conclusion. Evaluating the quality of staff and perception of people on PCMH will encourage and equip policymakers with adequate knowledge and alternative on the best approach to PCMH transformation. Consequently, there is a need for further training of home-based practitioners as well as incorporate the experienced practitioners to achieve quality PCMH. Additionally, the government should allocate enough resources to implement PCMH that will enhance quality patient care.

Keywords: quality practitioners, quality patient care, people’s perception, patient-centered medical home primary care, chronic diseases.

                                                                   Introduction               

The health sector is a crucial area that calls on every government to allocate more resources to facilitate the healthy living of its citizens. Patient-centered home care (PCMH) is among significant health transformation strategies that United States (US) has put in place in primary care to ensure all people have access to treatment and, more importantly, reduces treatment cost and time. The approach will mostly help the elderly population with chronic diseases. To achieve quality PCMH, it requires leaders to reorganize health facilities from business-oriented health care to individual patient’s empowerment. According to Howard, Malouin & Callow-Rucker (2016), the main objective of PCMH is to reduce cases of missed treatment and or prolonged time taken by patients to seek medical treatment as well as improve the quality of patient care. More importantly, the approach aims to reduce occurrences of illness comorbidity and complications and also boost people’s healthy living by ensuring every person regardless of diversity, such as socioeconomic status, has access to treatment across the nation. Therefore, policymakers should evaluate the quality of practitioners’ skills and citizens’ perceptions concerning the PCMH transformation so that they not only implement the approach but arrive at a quality model that favors the consumers and equip health centers with the necessary resources. Several communities where the people around are low-income earners and minority groups experience difficulties when the need for treatment arises because the health facilities within such communities are underequipped and also understaffed. Further, poor lifestyle characterizes those areas, which further expose residents to all kind of diseases affecting mostly young ones and old adults. Therefore, the implementation of PCMH is essential to uplift the health of such societies, which, in return, will boost their living standards since productivity will also improve.

Background

The whole world is concerned about health matters. Hence, the formation of organizations, such a world health organization (WHO), to check and advise nations about global health issues. For example, Covid-19, a health issue that does not know any boundary has affected and captured worldwide attention. Currently, the world has buried all differences to combat the pandemic, a move that should always be there, and not only when there is a crisis, as suggested by the affordable care Act. Primary care practices are targeting the reduction of cost and improve the quality of health care through the prevention and management of diseases, coordination of health care systems, and improved health of the entire nation. Health policymakers introduced a patient-centered medical home (PCMH) aiming to improve the quality care, health of people, and reduce the treatment cost. According to Magill, Ehrenberger, Scammon, Day, Allen, Reall & Kim (2015), the transformation of PCMH will require some crucial changes like new workflow strategies, systems to manage and improve access of patients and more importantly it may require additional of staffs and training programs to carry out new services. Goldman, Parker, Brown, Walker, Eaton & Borkan (2015) claim that patients/family culture, the preparedness of nurses, political and economic factors have a significant influence on the success of PCMH transformation. Therefore, for the new reforms to work smoothly, the government should involve the citizens in decision making so that they can communicate their views and perceptions, which can help in modeling the system to ensure every person benefits and thus help in the implementation process.

Further, it should invest fully in the labor force because employees are the backbone of the success of any institution. Howard et al. (2016) suggest that as the government focuses on transforming PCMH, it should as well facilitate cost reduction of employers and health insurance companies through measures such as the reduction in hospitalization cases and emergency visits. On that note, most chronic patients are prone to other diseases which complicates their health status further, and as a result treatment costs also rises due to frequent hospital visit. Perhaps, proper implementation of PCMH can reduce hospitalization and even chances of other diseases since patients can timely get access to medical treatments and walk with the primary caregiver through the treatment procedure.

Nevertheless, even though the cost reduction is among the primary expectation of PCMH transformation, various studies have revealed that some areas require more consideration since many patients claim to see very little difference on treatment cost while using the new approach (Rosenthal, Alidina, Friedberg, Singer, Eastman, Li, & Schneider, 2016). Howard, Etz, Crocker, Skinner, Kelleher, Hahn & Crabtree (2016) claim that culture, such as language plays a crucial role in making PCMH successful. Bearing in mind that practitioner interacts with people from different diversity, there should be training programs for not only health worker but also the community so that they work toward a common goal of achieving quality health. Consequently, health practitioner engaged in PCMH should involve the community as a whole (patients, families and local authorities) and the behavioral team then communicate strategies to fight against health disparities focusing on improving the health and reducing treatment cost (Reynolds, Klink, Gilman, Green, Phillips, Shipman, & Davis, 2015). Further, policymakers should install technology that will boost friendly communication among patients and health workers and also facilitate quality assessment to identify areas that need improvement.

PCMH continue yielding more benefits, especially to patients with severe/complicated illness. As claimed by Tate, Hopper & Bergeron (2018), pharmacists work closely with PCMH by offering medical advice such as the cost of drugs and drug reconciliation. Notably, implementation of the approach will reduce gaps in cultural difference especially on the side of practitioners as they engage and visit directly different families, whereby they will be able to learn and familiarize with different cultures. As claimed by Moshkovich, Lebrun-Harris, Makaroff, Chidambaran, Chung, M., Sripipatana & Lin (2015), Obama introduced the affordable care policy 2010, which comprised various provision aiming to establish and improve PCMH so that every citizen could afford and access health facilities. For example, the PCMH will help culturally or ethnically discriminated patients like black Americans with diseases such as cancer and diabetes. On that account, many people have lost their loved ones because they could not afford health treatment costs or lack of health facilities in their localities or inadequate health services. Notably, upon the introduction of the affordable care Act, the hospital got an overwhelming number of patients with complicated illnesses, which they took long before seeking medical attention because of the cost involved that many could not afford.

Similarly, PCMH seeks to address such issues. Pines, Keyes, van Hasselt & McCall (2015) reveal that the introduction of PCMH reduced hospitalization and emergency incidences because people can afford early intervention form home care, which also has reduced mortality rate. According to the national committee of quality assurance (NCQA), PCMH transformation characterizes staff satisfaction because health policymakers will ensure there are enough and well-trained practitioners and balance the ratio of staff to patients, which reduces cases of staff burnout. Additionally, it creates room for practitioners to freely use their skills and expertise, which boosts the morale of staff and the desire to give the best. On that account, there is recognition of the teams engaged in PCMH through bonuses, allowances, and reimbursement to ensure they do not lose focus on their practices and ensure they give patients the best care.  Consequently, when there are adequate practitioners, the interaction between nurses and patients is achievable, which fosters a good experience of patients since there are minimal cases of medication errors as well as a better explanation of treatment procedure. Further, it boosts trust and relationship, which enhances smooth follow up since patients can voluntarily update the primary caregiver about their recovery progress and get timely adjustment where necessary.

Nonetheless, policymakers have taken commendable steps to implement PCMH by allocating resources and increasing the number of staff. However, there is a need to evaluate their qualification as well as the perception of citizens. As reported by Magill et al. (2015), as the medical practitioners strive to actuate PCMH, there should also consider analyzing the running and maintenance cost of the function of the primary care. However, agencies are in the process of conducting pilot studies to evaluate the effectiveness of the approach to analyze its worthiness, which will enable them to advocate for or against further investment and what kind of investment to achieve quality results. However, Moshkovich et al. (2015) claim that there are various interventions made to transform the PCMH, such as strategies to fight against health disparities, particularly on the vulnerable population. As a result, previous and current studies help in finding out several measures such as training programs for both practitioners and citizens to bury their difference and help in PCMH transformation bearing in mind that every person has a right to quality treatment. On that note, human capital is vital in national growth and development, which means that if all people are healthy, the government can quickly achieve its growth goals.

Agency/Organization Background

Even though health institutions differ in many ways, such as setup, location, and financial status, all health facilities focus on offering the best patients care. However, the big challenge lies in the cost as they try to provide treatment at reduced charges. The organization’s mission is to advocate for equal health after realizing the sufferings of the vulnerable groups. It is a non-profit making organization with a mission of quality health for all. It has previously advocated for equal and quality health for all people regardless of diversity. The organization partnered and sponsored youth who act as advocators and trainers for healthy living within the community.

Further, work closely with the community to ensure it meets the expectation of the residents, subsequently working under the health guidelines. Additionally, it has also incorporated other bodies, such as pharmacies, to ensure timely updates related to medicine. Leaders are at the forefront to facilitate research by offering the necessary resources aiming to arrive at evidence-based practices, which, in return, will boost the quality of care given to patients. Besides, it was at the frontline to adopt the affordable care policy, which was an attempt to promote the PCMH model. Also, it practices primary care, which has improved its performance. On that account, it has continually advocated for PCMH since it has done the research and understood health challenges facing mostly vulnerable and minority groups. Notably, the organization involves the community in decision making that has made it work easier as well as combat health disparities. Currently, the organization is finding out barriers and promoters of the PCMH transformation and the possible solution that it can table in front of health policymakers to improve the quality of health, reduce treatment costs and ensure every citizen can access health facilities.

Project Description/Methodology

The project concern the PCMH transformation, which the United States is striving to implement as a strategy to improve the health sector by ensuring every citizen has access to not only health care but quality care at a reduced cost. Precisely, the project aims to find out the effectiveness of PCMH by evaluating the capacity of the labor force and the perception of the people regarding the PCMH transformation. The researcher intends to use a qualitative study in three different health facilities. The researcher will randomly recruit 200 men and women participants, of eighteen years and above. Participants will include patients, health practitioners (both managers and junior staff), and families. The research will get assistance from his project committee to prepare both structure and none structured questionnaires. The researcher will use this kind of questions because they allow the respondents to express their views broadly, thereby allowing the researcher to gather in-depth information. Upon completion of preparing questions, the researcher will seek approval from the authorities where the study will take place and then the consent of the respondents.

Additionally, the study will include online interviews. After that, the project will use qualitative and quantitative technics to analyze the collected data. There will be mechanisms to limit the investigator from conducting further training of respondents while collecting the data to avoid outcome biases. Further, the researcher will abide not to disclose the respondent’s information, such as names unless otherwise authorized by the participants. In the event of disclosure, he/she will be liable.

Findings

The project will consider the requirement and ensured it is in line with the guidelines such as confirmation of authority and consent of the participants. Perhaps, the researcher expects 98% of participants to complete the study and respond adequately. Since the research followed the requirement, there should be minimal cases of biases, if any. The study will be expecting the majority of the respondents and especially patients and their families, to embrace the PCMH transformation, and most of them get enrolled. The project awaits the majority of respondents to report increased chances of being able to seek early treatment, which will reduce complications and chances of comorbidity. Further, the study look forward to registering the expertise or skills gap among the practitioners engaged in PCMH practices. However, the project will help the policymakers by identifying the gaps and proposed solutions to invest in those areas so that they can achieve the desired outcome of the entire PCMH system.

The research will engage the project committee, who will, in one way or the other, advise where need be and as well as help in data analysis to complete the study effectively. The research will eliminate all elements that can interfere or influence the outcome, which therefore means the organization structure will not affect the project outcomes.

Competence

Education requires attention, especially being in the health sector, whereby one will be dealing with human life upon completion of studies require extra attention. Precisely, some of the core competencies are crucial for a nursing student who is passionate about his/her career and willing to improve the health sector. More so, as the entire project aims to facilitate PCMH transformation, some competencies contributed to the choice of the project. The First competence I mastered through studies is the provision of patient-centered care, which talks of the value of a patient. It boosted the understanding that people are different, and as a practitioner, such difference should not dictate how to treat a patient. Instead, they should be kept aside and focus on improving the health condition of the patient, through caring, listening, educating, and involving the patient in making decisions regarding his/her treatment procedure. Bearing in mind that patients have little or no information about the illness, it is the responsibility of the nurse to educate the patient on treatment, prevention as well as healthy living. The other cross-cutting competence I learned concerns working in an interdisciplinary team, whereby it is essential to realize that to improve patient outcome, practitioners regardless of the rank or specialization, they must work together. After all, patients will require the input of different health workers even for a simple illness. For example, an expectant mother will require clinician, nurse, and pharmacist services at one visit. It then means that without proper coordination and cooperation with other practitioners, the work will be not only hard but also unreliable and unsatisfying, thereby putting the patient at unnecessary risk. Thirdly is the application of evidence-based practice, which calls for practitioners to do research and seek guidance from most experience practitioners to ensure the patients receive the best care.

Through competence, I realized the need to participate in research work, and further studies sharpen my knowledge and skills to give the patient the best care for a better outcome and also for the general improvement of the health sector. Another mastered competence is the application of quality improvement, which is directly in line with one of the primary objectives of the PCMH transformation. The ability works in steps whereby a practitioner should first establish the problem or hazard in the treatment process, then evaluate and find out appropriate safety mechanisms, followed by measurement of the care quality given to the patients and after that find intervention. Practitioners do that with the main focus on improving the health of patients. Last but not least is informatics. On this note, technology is essential to facilitate a smooth flow of information, which can also help in error mitigation. More importantly, a practitioner should participate in the decision-making process and use information technology to facilitate the process.

Eventually, since the project entails the improvement of the health sector through the PCMH model, the integration of these competencies can play a significant role in eliminating barriers that prevent the PCMH from achieving its desired goals. If nurses and other practitioners can make use of these competencies, there will be minimal issues, if any, concerning the quality of their work. Besides, they will be able to work together. In the event, one faces challenges can quickly get help from the other who understand the issue better, thereby improving the PCMH transformation and the entire health sector. Notably, the adoption of the PCMH system means practitioners will need these competencies more than ever before, because when treating patients outside the hospital, a patient may require one nurse or few caregivers, who should use these competencies to make proper judgments and in difficult situation use informatics competence to communicate with other practitioners. Further, PCMH will expose practitioners to different cultural diversity, which calls for the application of patient-centered practice to be able to fit in all situations and give patients the best care.

Discussion

PCMH researchers have realized that there is a need for more studies to evaluate and address not only the capacity of health workers engaged in its transformation but also how stakeholders perceive the change. Researchers, in conjunction with health policymakers, should carry out an in-depth evaluation and analysis to come up with a better recommendation for practice investment that will facilitate the achievement of PCMH model goals. The project involvement of different stakeholders is among the best approach to reveal the gaps in the PCMH system since every party will give opinions.  Further, such divergent views are a reflection of what people expect and what PCMH achieved and how satisfactory it is. Perhaps, the collection of information from diverse stakeholders leads to a better decision that could lack if the study used a single group. For example, many people, especially vulnerable and minority groups, have experienced health disparities that have claimed the lives of many and left others with disabilities or comorbidity.

Consequently, the government discovered the gap, and it is striving to ensure every citizen can not only get access to health care but also get quality treatment at a lower price.  It installed various strategies such as primary care and affordable care policy, which aimed at promoting the PCMH model to facilitate healthy living of all people regardless of any difference, such as race and socioeconomic status. The researcher will ensure compliance with research guidelines and get approval from the authority and participants to enhance the validity of the data collected.

Despite the achievement the PCMH has so far enjoyed, the often missing element is the evaluation of the quality of the practitioners and information that can tell whether the expected change in the health sector has been achieved or not. Compressive analysis of the quality of practitioners and people’s perception can lead to different inquiries, alternatives, and solutions. For example, the project explicitly considered the acceptance and quality of workers, whereby people seem to embrace the practice since it will reduce the cost of treatment as well as make health services more accessible to them without considering the quality of care. On the contrary, the expertise level of health practitioners engaged in PCMH calls for more evaluation and improvement, because most of the experienced practitioners seem to be involved in hospital-based services and only the graduates, and learning students are more involved in PCMH approach.

On the contrary, the research methodology will cover just part of the story, whereby the respondents may be too considerate of their culture, which could limit them from giving adequate information regarding perception, PCMH model experience as well the quality of health workers. Further, none structured questionnaires can consume much time and limit the coverage, not forgetting that respondents can as well give unnecessary or out of topic feedback since the question are open with no limits. Similarly, the investigator could compromise the interviewee to arrive at the desired outcome due to inadequate technics to prevent such issues. Subsequently, despite the effort to gather and analyze the data and lastly give feasible solutions, there is no guarantee that leaders will consider the information. However, the approached the study intends to use can provide vital information that policymakers need to transform PCMH to achieve its goals. Concurrently, several researchers have researched different issues concerning PCMH with an attempt to improve its functionality, which is in line with the study. Therefore the results of this study will not only assist in PCMH transformation but also improve the entire health sector.

Conclusion

The health sector is key to any nation’s growth and development. Thus policymakers should find strategies to improve it. Countries such as the United States have introduced and are in the process of transforming patient-centered medical home primary care targeting the improvement of the health sector of its citizens. The Strategy aims to improve health, quality of care, and reduce treatment costs. The government has taken various steps to implement PCMH, and many citizens have benefited from it, ranging from health workers to patients and their kins, especially chronic patients. PCMH has benefit both health workers and patients. It created a suitable environment that observes the practitioners’ autonomy, which, in return, facilitated them to use their knowledge and skills fully as well as showcase their capabilities.

On the other hand, families and patients have experienced quality treatment procedures at a reduced cost. On that account, patients can now seek timely medical attention, and the management of chronic diseases is attainable. Further, through PCMH, pharmacists can research and give drugs advice to patients or practitioners working on PCMH, which have boosted patient care. More so, the approach helps in bridging differences like culture and ethnicity because there are training programs initiated under PCMH to educate people on health matters, which bring different people together, facilitate interaction and foster friendship. Besides, health practitioners can learn and familiarize with different culture as they offer home-based health services. Subsequently, citizens have continuously embraced the move by the government to transform the PCMH since it has minimized health disparities. However, the policymakers should adequately address the issue cost of maintaining the PCMH model.