Policy Challenges in Building the Medical Home: Do We Have a Shared Blueprint?

The Journal of the American Board of Family Medicine

Robert J. Stenger¹  Jennifer E. DeVoe¹ 

[1] From the Department of Family Medicine, Oregon Health and Science University, Portland

关键词: Health Policy;    Health Care Economics;    Health Care Systems;    Primary Health Care;    Medical Home;    Patient-Centered Care;   

DOI  :  10.3122/jabfm.2010.03.090140

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: The notion of a patient-centered medical home features prominently in policy reform initiatives across the country, with both state and federal legislation focusing on this new model. We sought to understand the views of key stakeholders and to examine the challenging landscape facing policymakers and practitioners as they attempt to translate the medical home concept into widespread practice change.

Methods: We reviewed legislative documents from state legislative sessions in the year 2007 to identify pieces of legislation that included the medical home concept. Concurrently we conducted an in-depth qualitative analysis of de-identified field notes from a purposeful sample of semistructured interviews conducted with key stakeholders in Oregon after the passage of health reform legislation in 2007.

Results: Legislation that further defined and expounded on the medical home concept was introduced in states across the country in 2007, and some federal and state demonstration projects were already underway. However, we identified a number of barriers to widespread implementation of the medical home, most notably lack of a clear operational definition. Key stakeholders had widely disparate views about elements central to the success of medical home demonstrations, including delivery system reform, payment reform, and performance incentives for providers.

Conclusions: Since 2007 the concept of the medical home has gained increasing attention in health care reform debates. Our findings suggest that translating this concept into successful, widespread reform will require that policymakers build further consensus among key stakeholders and require them to address critical barriers to avoid repeating pitfalls of past reform efforts.

• Health Policy
• Health Care Economics
• Health Care Systems
• Primary Health Care
• Medical Home
• Patient-Centered Care

The term “medical home” was introduced in the pediatric literature in 1967.^1,2 As the concept evolved, the American Academy of Pediatrics issued policy statements specifying the essential features of a medical home and providing some operational definitions.^3,4 In 2007, the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association announced a joint set of principles defining the “patient-centered medical home” (Table 1).⁵ The medical home concept has become a central focus of health care reform advocacy efforts by the primary care community.^6,7 However, despite an intense national focus on the medical home, this new buzzword remains unfamiliar to most Americans, including key policymakers and rank-and-file primary care practitioners. In this study we aimed to describe the incorporation of the medical home concept into legislation across the country and to better understand the views held by critical local stakeholders regarding issues key to the successful implementation of medical home concepts.

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Table 1.

Joint Policy Statement: Patient-Centered Medical Home Principles^*

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