Abstract:
PURPOSE:Our goal was to describe an approach to patient-centered medical home (PCMH) measurement based on delineating the desired properties of the measurement relative to assumptions about the PCMH and the uses of the measure by Blue Cross Blue Shield of Michigan (BCBSM) and health services researchers. METHODS:We developed and validated an approach to assess 13 functional domains of PCMHs and 128 capabilities within those domains. A measure of PCMH implementation was constructed using data from the validated self-assessment and then tested on a large sample of primary care practices in Michigan. RESULTS:Our results suggest that the measure adequately addresses the specific requirements and assumptions underlying the BCBSM PCMH program-ability to assess change in level of implementation; ability to compare across practices regardless of size, affiliation, or payer mix; and ability to assess implementation of the PCMH through different sequencing of capabilities and domains. CONCLUSIONS:Our experience illustrates that approaches to measuring PCMH should be driven by the measures' intended use(s) and users, and that a one-size-fits-all approach may not be appropriate. Rather than promoting the BCBSM PCMH measure as the gold standard, our study highlights the challenges, strengths, and limitations of developing a standardized approach to PCMH measurement.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Alexander JA,Paustian M,Wise CG,Green LA,Fetters MD,Mason M,El Reda DKdoi
10.1370/afm.1472subject
Has Abstractpub_date
2013-05-01 00:00:00pages
S74-81eissn
1544-1709issn
1544-1717pii
11/Suppl_1/S74journal_volume
11 Suppl 1pub_type
杂志文章abstract::We sought to describe the proportion of patients in contact with a primary care physician, as well as the total number of primary care contacts over a 2-year period, using the 2002-2017 Medical Expenditure Panel Survey. The rate of any contact with a primary care physician for patients in the population decreased by 2...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2631
更新日期:2021-01-01 00:00:00
abstract:PURPOSE:In 30 small, independent primary care practices, we examined the association between clinician-reported use of elements of the Chronic Care Model (CCM) and diabetic patients' hemoglobin A(1c) (HbA(1c)) and lipid levels and self-reported receipt of care. METHODS:Ninety clinicians (60 physicians, 17 nurse-practi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.610
更新日期:2007-01-01 00:00:00
abstract:PURPOSE:Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODS:We conducted a systematic mixed s...
journal_title:Annals of family medicine
pub_type: 杂志文章,评审
doi:10.1370/afm.1677
更新日期:2014-09-01 00:00:00
abstract:PURPOSE:We wanted to identify characteristics of adults who do not have a usual source of care and then stratify the analysis by those who prefer vs those who do not prefer to have a usual source of care. METHODS:We analyzed data from a nationally representative sample of 9,011 adults to identify characteristics of th...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.557
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation. METHODS:A random sample of adult health plan members with diabetes were mailed a survey questionnaire, with tel...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.36
更新日期:2004-01-01 00:00:00
abstract:PURPOSE:Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care. METHODS:Five hundred...
journal_title:Annals of family medicine
pub_type: 杂志文章,评审
doi:10.1370/afm.1377
更新日期:2012-09-01 00:00:00
abstract:PURPOSE:The Seventh Report of the Joint National Commission (JNC 7) on High Blood Pressure established prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic) as a new risk category. We aim to determine the risk of major cardiovascular events associated with blood pressure in the prehypertensive range i...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.312
更新日期:2005-07-01 00:00:00
abstract:PURPOSE:We hypothesized that antibiotic overuse for acute cough illness (ACI) is in part due to a mismatch between patients' expectations and the natural history of ACI. METHODS:We performed a population-based random digit dialing survey of 493 adults in Georgia to determine their expectations regarding the duration o...
journal_title:Annals of family medicine
pub_type: 杂志文章,评审
doi:10.1370/afm.1430
更新日期:2013-01-01 00:00:00
abstract:PURPOSE:Describe the duration of symptoms, proportion of parents seeking primary care consultations, and costs for respiratory tract infections (RTIs) of children in the community. METHODS:Community-based, online, prospective inception cohort study. General practitioners from socioeconomically diverse practices posted...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2327
更新日期:2019-01-01 00:00:00
abstract:PURPOSE:We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. METHODS:We undertook a qualitative study using in-depth interviews of African American and Latina girls (n = 22) aged 13 to 19 years attending public high schools in the Bronx, NY. ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.124
更新日期:2004-11-01 00:00:00
abstract::Modern medical care is a 2-edged sword. Technical advances have improved our ability to diagnosis and treat disease, but they can also create a frightening, painful and bewildering environment for the patient seeking care. In this essay, the author shares his recent encounter with a life-threatening disease, emphasizi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.93
更新日期:2004-03-01 00:00:00
abstract:PURPOSE:The aim of this study was to assess whether the quality of diabetes care differs among practices employing nurse-practitioners (NPs), physician's assistants (PAs), or neither, and which practice attributes contribute to any differences in care. METHODS:This cross-sectional study of 46 family medicine practices...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.758
更新日期:2008-01-01 00:00:00
abstract::In the United States, stable health insurance coverage is associated with improved health outcomes. A lack of insurance is associated with premature death from preventable causes. Although primary care clinicians are often in a position to see firsthand the impact that being uninsured has on patients, most ambulatory ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1541
更新日期:2013-09-01 00:00:00
abstract:PURPOSE:In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors. METHODS:In 11 family practices (total practice popu...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.997
更新日期:2009-09-01 00:00:00
abstract:PURPOSE:The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. METHODS:We conducted a cross-sectional, population-based study of fee-for-service and capitated interprofessional and non-interprofe...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1864
更新日期:2016-01-01 00:00:00
abstract:PURPOSE:Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socia...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.543
更新日期:2006-09-01 00:00:00
abstract:PURPOSE:We wanted to compare 2 screening instruments for problem drinking, the CAGE and a single question, assessing frequency of use, patient and clinician comfort, and patient engagement in change. METHODS:The study was a crossover, cluster-randomized clinical trial with 31 clinicians in Missouri and 13 in the Ameri...
journal_title:Annals of family medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.83
更新日期:2004-09-01 00:00:00
abstract:PURPOSE:Practice transformation is the cornerstone of the future of family medicine and health care reform, but little is known about how the process occurs. We sought to develop and test a model of the natural history of practice transformation. METHODS:We developed an outcomes-based model of how a practice moves thr...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1497
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to trans...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.130
更新日期:2004-03-01 00:00:00
abstract:PURPOSE:The health care system in the United States is inherently hierarchical. Patients are "nested" within physicians who in turn are "nested" within practices. Much of the research data gathered in practice-based research networks (PBRNs) also have similar patterns of nesting (clustering). When research data are nes...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.340
更新日期:2005-05-01 00:00:00
abstract::Hatpins is a first-person narrative that delves into a physician's experience of a patient death during the early years of residency. The essay reflects on the conflicted physician-patient relationships that can develop even over the short tenure of residency. While residency seeks to create medically prepared and com...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2135
更新日期:2017-11-01 00:00:00
abstract::PURPOSE We examined how the closure of a large safety-net hospital in Los Angeles County, California, affected local primary care physicians. METHODS We conducted semistructured interviews with 42 primary care physicians who practiced in both underserved and nonunderserved settings in Los Angeles County. Two investiga...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1317
更新日期:2011-11-01 00:00:00
abstract:PURPOSE:We undertook a study to examine the impact of experiences shared between patient and physician and the value patients place on continuity of care. METHODS:Data on 4,454 patients collected in The Direct Observation of Primary Care (DOPC) study conducted between October 1994 and August 1995 were analyzed to asse...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.84
更新日期:2004-09-01 00:00:00
abstract:PURPOSE:In primary care, the involvement of health care assistants (HCAs) in clinical depression management is an innovative approach. Little is known, however, about how HCAs experience their new tasks. We wanted to describe the perceptions and experiences of HCAs who provided case management to patients with depressi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1037
更新日期:2009-11-01 00:00:00
abstract:PURPOSE:A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based hea...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1756
更新日期:2015-08-01 00:00:00
abstract:PURPOSE:Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression i...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1418
更新日期:2012-07-01 00:00:00
abstract:PURPOSE:Persons with multiple chronic diseases must integrate self-management tasks for potentially interacting conditions to attain desired clinical outcomes. Our goal was to identify barriers to self-management that were associated with lower perceived health status and, secondarily, with lower reported physical func...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.722
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS:This cohort study includes participants from 4 waves (1994-2000) of the He...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.54
更新日期:2003-11-01 00:00:00
abstract:PURPOSE:Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection;...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.1954
更新日期:2016-07-01 00:00:00
abstract:PURPOSE:Practice transformation in primary care is a movement toward data-driven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS:A total of 48 practices with 109 practice si...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2382
更新日期:2019-08-12 00:00:00