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Explaining patient-centered medical home (PCMH)


A recent Journal of General Internal Medicine provides a core definition of the PCMH as a team of people committed to improving the health and healing of individuals in a community. This concept was initially introduced in 1967 by the American Academy of Pediatrics (AAP) to coordinate care for children with multiple needs.

Kurt C. Stange, MD, PhD and colleagues in an article in the Annuls of Family Medicine Supplement (topic: PCMH) states, “The PCMH is a political construct that includes new ways of organizing and financing care, while attempting to remain true to the proven value of primary care.”

The original AAP idea has been taken up by other medical organizations developing models of revitalized primary care. The PCMH continues to evolve in the context of other national movements calling for transformative changes in health care organization.

It is meant to transform the traditional medical practice model with a focus on the fundamental tenets of primary care (e.g., accessibility, comprehensiveness, coordination and integration, and relationships) which takes advantage of electronic medical records (EMR), and making reimbursement changes (e.g., blended payments and care management fees).

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Team-based care provided in a PCMH is meant to be preventive and comprehensive. Use of EMRs is meant to allow keeping and sharing patient information/records to be seamless and simple. Patients in PCMH ideally have easy access to a team clinician in person, on the phone or via the Internet within 24 hours.

Beginning in 2006, 36 traditional primary care offices began adopting the hallmarks of patient-centered medical home practices. Dr. Pauline Chen points out in her New York Times article that often the patient got missed as the offices made the changes needed to improve quality of care and added the electronic records. The concept needs all—physicians, nurses, office staff, AND patients—to be involved for it to work.

The PCMH model will hopefully continue to improve and truly put the patient first.

K. C. Stange, P. A. Nutting, W. L. Miller et al., "Defining and Measuring the Patient-Centered Medical Home," Journal of General Internal Medicine, June 2010 25(6):601–12.

Elizabeth A. Bayliss, MD, MSPH, and William R. Phillips, MD, MPH, Guest Editors; Evaluation of the American Academy of Family Physicians' Patient-Centered Medical Home National Demonstration Project; Annuals of Family Medicine Supplement, Volume 8, 2010

American Academy of Family Physicians



With all due respect, the Medical Home is not so much about team care - which patients may or may not want - but is about putting the patient at the center of their own health care. The first tenet of the Joint Principles of the Medical Home speak to this very point. That is that “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.” Frankly, for a lot of patients, the term team care suggests that they will not be able to see their doctor but instead be required to see a PA or nurse practitioner. This fear could cause problems for the Medical Home movement if enough people believe this way. I have addressed this topic in depth in a recent blog post at "Mind the Gap". Steve Wilkins, MPH http://www.healthecommunications.wordpress.com