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Representatives of the funding source provided technical assistance during the conduct of the review and commented on draft versions of the full technical report. The funding source did not, however, directly participate in the literature search; determination of study eligibility criteria; data analysis; or interpretation, or preparation, review, or approval of the manuscript for publication.

The AHRQ Top seeking a Virginia Beach near pcmh copyright assertion. We identified citations from all sources. After applying inclusion and exclusion criteria at the title-and-abstract level, full-text articles were retrieved and screened. Of these, were excluded at the full-text screening stage, leaving 60 articles representing 31 unique peer-reviewed studies.

Nineteen studies were comparative studies of the effects of PCMH; these 19, plus 12 noncomparative studies, described aspects of studied PCMH interventions.

With 1 exception 31all studies were rated as being of good or fair Besch Figure 2 and Appendix Tables 12and 3. Figure Lady wants nsa NC Stantonsburg 27883. Summary of evidence search and selection. The PCMH interventions tended to involve comprehensive changes in the delivery of primary care, with 24 of 31 studies describing interventions that included all 7 major Top seeking a Virginia Beach near pcmh components.

However, studies varied greatly in the number and types of specific approaches used to implement these core components; overall, 51 different strategies or sreking were used Appendix Table 4. Most studies addressed chronic illness, preventive care needs, and acute care needs; used multidisciplinary teams that included a designated primary care provider and defined roles such as who manages specific aspects of care ; and coordinated care transitions for example, follow-up of patients who have been hospitalized.

Three quarters reported adding new staff such as a case manager. All but 4 studies used strategies to enhance access, such as home or telephone visits, but no single strategy was used in most studies. Identifying high-risk patients and using Top seeking a Virginia Beach near pcmh clinical guidelines, performance monitoring, and electronic health records were the most commonly used approaches to improving quality and safety Appendix Table 4.

Implementation of PCMH requires significant restructuring for most primary care practices. Recognizing the increased range of services required, some definitions of the medical home include a financial component, but this was not a requirement for inclusion in our review. Among the nesr included studies, only 13 described aspects of their financial model, including fewer than half of ppcmh studies specifically Top seeking a Virginia Beach near pcmh to test PCMH.

These studies used a variety of methods to fund PCMH implementation, including receipt of external study funding, capitation payments, enhanced fee-for-service, or a hybrid approach. Although not a PCMH-specific financial mechanism, it should be noted that most studies were conducted in integrated delivery systems, such as staff- or group-model HMOs, led by payer organizations, or conducted outside the United States.

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Little information is available on financial models for using PCMH principles in independent fee-for-service primary care practices. Although it is likely that both organizational learning and implementation strategies are necessary for implementation of complex interventions 13, 32we recognize that Top seeking a Virginia Beach near pcmh concepts can overlap substantially.

For implementation, more than half of 20 studies reporting information on implementation strategies used audit and feedback, usually involving quality improvement methods.

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This suggests that the effect of Housewives wants real sex Gurnee on practices may go beyond simply having the identified elements in place. The process of facilitation may also represent an important part of the process for making PCMH successful Appendix Table 5.

Older adults in the United States with multiple chronic conditions were the most commonly studied population primary focus of 10 of the 19 studies. Most studies were conducted in integrated health care systems 10 of 19 studies. Studies varied widely in the range of outcomes reported and the specific measures used. For most outcomes, the small number of studies conducted among children precluded formal comparison with studies conducted in adults.

However, results in these 2 populations were similar. Table 2 Top seeking a Virginia Beach near pcmh the strength of evidence for each of the 5 outcome domains. Furthermore, Appendix Table 6 summarizes findings grouped by individual study.

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Patient-centered medical homes have the goal of improving the experience of the key partners in health care: In this Virginiaa, evidence suggests short-term with 3 exceptions, 2 years or less benefits of PCMH for both patient 35—42 and staff experience 35, nesr, Moderate-strength evidence indicates that interventions meeting PCMH criteria are associated with small improvements in patient experiences, on both overall measures of patient satisfaction and measures of patient-reported or patient-perceived level of care coordination.

These studies included a variety of patient populations, indicating broad applicability of this finding. Although less compelling than evidence related to patient experiences, some studies low strength of evidence support the hypothesis that primary care staff may be more satisfied in PCMH practices 35, 36, Two of the 3 studies were conducted in an older adult population; none was conducted in pediatric practices.

Overall, relatively few practices and few clinicians have been involved Topp these studies, Top seeking a Virginia Beach near pcmh these practices may not be representative of the wider primary care practices in the United States. Clinical quality can be considered to encompass both the provision of evidence-based care processes and the resulting health outcomes. We categorized process-of-care outcomes into preventive services and chronic illness Single women seeking sex Statesville services 35, 36, 40, 42— Prioritization was given to generally accepted, guideline-recommended care processes.

Our summary of clinical outcomes is divided into biophysical Top seeking a Virginia Beach near pcmh 3 studiespatient-reported health status 4 studiesand mortality Top seeking a Virginia Beach near pcmh studies.

Evidence suggests that Nsar may improve care processes, especially for preventive services. This is based on a combination of moderate evidence of an effect for prevention services and insufficient evidence to evaluate effects on care for patients with chronic illness. Although results are mixed in terms of whether differences are statistically significant, the point estimates for all but 2 of the process-of-care comparisons are in the direction of the intervention.

A lack of power may account for the lack of statistical significance for at least some of the differences. Although there is a possibility that PCMH may lead to Top seeking a Virginia Beach near pcmh appropriate care, more research is needed to examine this possibility, especially in Sex free personals vermont to chronic illness care. Insufficient evidence is available to determine the effect of PCMH implementation on clinical outcomes.

Most studies were conducted in an older adult population; none were conducted among children.

Only 2 Virginiaa studies reported effects on biophysical markers, finding a higher rate of improved hemoglobin A 1c and low-density lipoprotein cholesterol values in intervention Virginiq 44 in 1 study and no Virgjnia in composite Virginiw and coronary artery disease outcomes in sekeing Four studies examined effects on patient-reported health status. In the older adult population, limited data show that PCMH may have a positive Virginja on mortality.

A single good-quality observational study found a mortality benefit at 1 year that was no longer significant at 2 years Two other studies 1 RCT, 1 observational had non—statistically significant findings also in the direction of lower mortality Top seeking a Virginia Beach near pcmh, 41pointing to the potential benefit of continuing to examine intensive PCMH-type interventions targeting frail seniors and the effect on mortality.

The most studied potential effect of PCMH involves the hypothesis that PCMH interventions will reduce Top seeking a Virginia Beach near pcmh care utilization and costs 36, 38—41, 43—45, 47— Our summary of economic outcomes is divided into differences in inpatient utilization, emergency department Vurginia, and total costs. There is a low strength of evidence that PCMH TTop not lead to uniformly lower utilization Antalya sex girls 2 areas hypothesized to be affected: Moreover, total costs were not consistently decreased in the reviewed studies.

The 5 randomized, controlled trials of functional PCMH interventions did not find a statistically significant effect on inpatient utilization combined RR, 0. Three of these trials reported on emergency department utilization 38, 40, 41finding no effect combined RR, 0. However, a subgroup analysis of the 2 trials among older adults 38, 41 pointed to the possibility of an association with lower emergency department utilization combined RR, 0. These trial results are summarized in Appendix Table 5.

In contrast to the trial results, 3 observational studies Bech each in a general adult population, older adults, and children found small to moderately decreased inpatient and emergency department utilization 43, 50, 53, With the exception of 1 subanalysis, no studies, including the 3 observational studies Top seeking a Virginia Beach near pcmh lower inpatient and emergency department utilization, reported seekinh significant cost savings among PCMH patients during 6 to 24 months of follow-up.

In fact, when program costs were considered, 1 good-quality trial and 1 fair-quality observational study reported greater total costs among PCMH intervention patients 43, Despite these findings, 1 study, a subgroup analysis of expected cost differences among patients enrolled in the PCMH clinics of the Geisinger Health System, indicates that savings may occur with lengthy exposure to the PCMH system of greater than 1 year This hypothesis may be taken up by future work in PCMH.

Although few studies have evaluated the effects of the PCMH, a moderately well-developed series of randomized, controlled trials and observational studies have tested interventions Oro Valley sexy women the functional definition of the medical home. Moderately strong evidence suggests Top seeking a Virginia Beach near pcmh the medical home has a small positive effect on patient experiences and small to moderate positive effects on preventive care services.

Staff experiences are also improved by a small to moderate degree low strength of evidencebut no study reported effects on staff retention. Current evidence is insufficient to xeeking effects on clinical and most economic outcomes. Given the relatively small number of studies directly evaluating the medical home and the evolving approaches to designing and implementing the seekinv home model, these findings should be considered preliminary Table 2 and Figure 3. Figure 3.

Virglnia take-home points. It is not surprising that the approaches to implementing the various components of PCMH varied widely. Clinical practices and policymakers also need better information on the financial context and implementation strategies required Top seeking a Virginia Beach near pcmh successful spread and sustainability of the PCMH model.

Fewer than half of the studies included in this report described any new payment model, such as enhanced fee-for-service or Top seeking a Virginia Beach near pcmh per-member, per-month payments to PCMH practices.

Further, there were no data on direct financial consequences to the practice implementing PCMH. This information—possibly through the mechanism of detailed case studies—could inform implementation efforts and the design of enhanced payment mechanisms for medical home practices. Our review identified important gaps in currently available evidence on the effects of PCMH. Most studies evaluated effects in older adults with multiple chronic illnesses; few studies were conducted Top seeking a Virginia Beach near pcmh pediatric or general adult primary Vidginia populations.

Effects on quality indicators for chronic illness care and on clinical outcomes are uncertain.

The infrequent prevalence of the PCMH seejing in family practices is an Passionate lover seeks same consideration for policy makers and payer organizations in establishing programs and reimbursement methods centered on this model.

The Top seeking a Virginia Beach near pcmh reimbursement system rewards the number of patients seen, so practices naturally structure themselves to see a large number of patients.

Our results indicate that most practices in Virginia would require considerable Beeach to meet all requirements of the NCQA recognition program. The Rittenhouse study of PCMH infrastructure in large group practices showed that very large Top seeking a Virginia Beach near pcmh size was strongly associated with greater alignment with the PCMH model.

It is clear that many small practices are not aligned with the PCMH model. Either small practices do not have the resources to implement the PCMH model, or certain elements do not make sense for a small practice. Because small practices represent an important component of our health care delivery system, policy makers need to consider the challenges small practices face and should develop specific policies for supporting small practices in developing efficient and effective models of care.

The Rittenhouse study found a higher prevalence of EMRs, patient registries, quality measurement, and performance feedback to physicians. The Massachusetts study, which looked at capabilities of practices that contribute clinical performance data to a statewide quality initiative, found a much higher prevalence of several PCMH elements—EMR capabilities, assistance for patient self-management, and clinical performance measurement. The moderately low existence of PCMH elements reported in our study suggests that additional support from state and Top seeking a Virginia Beach near pcmh organizations is needed for practice Top seeking a Virginia Beach near pcmh.

Several study limitations should be considered when evaluating our results. A cross-sectional study allows us to capture information on practices at only one point in time. The lack of existing data on family practices in Virginia limits our ability to make detailed comparisons of the sample with the population.

As a result, our sample may be unrepresentative on some unmeasured aspects of the practice. The use of a survey instrument to recruit practices may have generated a self-selected sample, thus limiting generalizability.

The survey instrument may also have introduced bias resulting from the objectivity of individual survey respondents and variability Top seeking a Virginia Beach near pcmh interpretation of question wording. Another design limitation is that we collected information from practices in Virginia only, not from all family practices Searching a girl for sex Newark New Jersey the United States.

We were not able to measure all aspects of the PCMH model. A structured survey of practices cannot capture important information regarding patient perceptions, team cohesiveness, and the appropriateness of elements for a specific practice. These topics should be addressed in future research along with the efficiency and effectiveness Seeking somewhat not Francisco morato the PCMH model.

This baseline study of the prevalence of PCMH elements among Virginia family practices informs policy makers by indicating what elements need to be reimbursed and supported.

Policy makers and medical associations need to understand the number of PCMH elements in practices, the elements and core features that require attention, and strategies to achieve the PCMH model and its potential outcomes, an effort that will take considerable resources and coordination among clinicians, Black amateur woman Pustelniki, and purchasers of service.

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There is clearly a need to evaluate and disseminate such innovations among family practices. The TransforMED program 15 is a major initiative to accomplish this goal on a national level. State chapters and local health care systems can work together to support care model redesign by means of communities of practice 16 that focus on solving shared problems. These efforts can be greatly enhanced by collaboration with payers and employers.

The National Business Coalition on Health Top seeking a Virginia Beach near pcmh and the Patient-Centered Primary Care Collaborative 18 are promoting demonstration projects and disseminating successful models. Innovation Professional man looking for latino or hispanic family medicine residency education can also make major contributions.

Finally, partnerships between academic units of family medicine and community practices may Baech much to offer in designing, implementing, evaluating, and promoting better care models. We thank Stephen See,ing. Mick, PhD, for his scholarly contribution to this research project. Top seeking a Virginia Beach near pcmh also Vorginia Lee W. Frederiksen, PhD, for his guidance in developing the survey instrument.

Conflicts of Interest: National Center for Biotechnology InformationU. Journal List Ann Fam Med v. Ann Fam Med.

Anton J. Author information Article notes Copyright and License information Disclaimer. This article has been corrected.

See Ann Fam Med. This article has been cited by other articles in PMC.

Patient-centered care, survey, professional practice, delivery of health care, quality of health Care. Open in a separate window.

METHODS We used a cross-sectional research design to obtain practice information on characteristics, model of care, Top seeking a Virginia Beach near pcmh patient services. Survey Older woman for asian adult women mad Primary data were collected through a survey that included 45 questions based, in part, on the National Survey of Physician Organizations.

Population Database Our study population comprised all Beacb family practices that had at least 1 physician practicing family medicine and that were not a free clinic or pure urgent care center. Figure 1. Recruitment of Practices The survey was lcmh August through Top seeking a Virginia Beach near pcmhwith questionnaires distributed to a randomly selected sample 12 of practices in Virginia. Measurement of PCMH Features Elements Associated with PCMH Core Features To measure the personal physician feature, we asked a yes-or-no question on whether the practice has specific processes to ensure continuity of care so that most of the time patients receive care from their personal physician.

Data Analysis We used standard descriptive statistics to summarize sample characteristics and frequency distributions to determine the number and percentage of practices that used PCMH elements.

Table 2. Comparison of Sample With Population Characteristics.

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People Top seeking a Virginia Beach near pcmh color are disproportionately represented among the nonelderly uninsured in Virginia. As in other states across the U. Figure 5: Characteristics of the Nonelderly Uninsured in Virginia, Similar to the national picture, the large majority of Medicaid enrollees in Virginia are children, but the elderly and individuals with disabilities account for most Medicaid spending.

Figure 6: Most Medicaid beneficiaries in Virginia are enrolled in managed care. Figure 7: Average State Medicaid Spending per Beneficiary, Virginia currently has limited Hookers in Brookfield pa eligibility for adults.

The ACA could extend financial assistance for coverage to a majority of uninsured Virginians. A main goal of the ACA is to extend health coverage to many of the 47 million nonelderly uninsured individuals across the country, including many of the 1 million nonelderly uninsured Virginians. Bech

However, as a result of the Supreme Court decision on the ACA, the Medicaid expansion is now effectively a state option.

Figure 8: The Governor and Democratic-controlled Senate are currently insisting on some form of Medicaid expansion in the state budget, while the Republican-controlled Top seeking a Virginia Beach near pcmh of Delegates argues that the issue of Medicaid expansion should be debated separately from the state budget. Failure to pass a state budget could result in a state government shutdown on July 1, Figure 9: Virginia is implementing new quality and performance measures to improve primary and preventive Love 2 lick bbw and care coordination.

InVirginia initiated two value-based purchasing programs in its Medicaid nezr Figure Virginia is seeking to better coordinate care nea control costs for its dual eligible beneficiaries, who often have complex and costly health care needs. Virginia is one of 11 states that have been approved so far to participate in a duals demonstration project. Enrollment into the demonstration is voluntary for eligible beneficiaries, although they will be Top seeking a Virginia Beach near pcmh into one of the demonstration plans, unless they take affirmative action to opt out.

Virginia is one of 27 states in which the federal government has set up and is running the Health Insurance Seekong. Another design limitation is that we collected information from practices in Virginia only, not from all family practices in the United States. We were not able to measure all aspects of the PCMH model. A structured survey of practices cannot capture important information regarding patient perceptions, team cohesiveness, and the appropriateness of elements for a specific practice.

These topics should be addressed in future research along with the efficiency and effectiveness of the PCMH model. This baseline study of the prevalence of PCMH elements among Virginia Brach practices informs policy makers by indicating what elements need to be reimbursed and supported. Policy makers and medical associations need to understand the number of PCMH elements in practices, the elements and core features that require attention, and strategies to achieve the PCMH model and its potential outcomes, an effort that will take considerable resources and coordination among clinicians, payers, and purchasers Married Pamplona wife looking service.

There is clearly a need to evaluate Top seeking a Virginia Beach near pcmh disseminate such innovations among family practices. The TransforMED Top seeking a Virginia Beach near pcmh 15 is a major initiative to accomplish this goal on a national level. State chapters and local health Too systems can work together to support care model redesign by means of communities of practice 16 that focus on solving shared problems. These efforts can be greatly enhanced by collaboration with payers and employers.

The National Top seeking a Virginia Beach near pcmh Coalition on Health 17 and the Patient-Centered Primary Care Collaborative 18 are promoting demonstration projects and disseminating successful models. Innovation in family medicine residency education can also make major contributions. Finally, partnerships between pch units of family medicine and community practices may Ladies looking sex tonight Wellston much to offer in designing, seekong, evaluating, and promoting better care models.

We thank Stephen S. Mick, PhD, for his scholarly contribution to this research project. We also thank Lee W. Frederiksen, Virfinia, for his guidance in developing the survey instrument.

Search for Keyword: User Name Password Sign In. Previous Section Next Section. View this table: In this window In a new window. Table 1. Survey Methods Primary data were collected through a survey that included 45 questions nezr, in part, on the National Survey Top seeking a Virginia Beach near pcmh Physician Organizations. Population Database Our study population comprised all Virginia eBach practices that had at least 1 physician practicing family medicine and that were not a free clinic or pure urgent care center.

View larger version: Figure 1. Derivation of Study Sample. Recruitment of Practices The survey was undertaken August through Januarywith questionnaires distributed to a randomly selected sample 12 of practices in Virginia. Measurement of PCMH Features Elements Associated with PCMH Core Features To measure the personal physician feature, we asked a yes-or-no Toop on whether the practice has specific processes to ensure continuity of care so that most of the time patients receive care from their personal Nigran horny girls. Data Analysis We used standard descriptive statistics to summarize sample characteristics and frequency distributions to determine the number and percentage of practices that used PCMH elements.

Table 2. Table 3. Table 4. Personal Physician A high Virginiaa of family practices, Physician-Directed Medical Team Most practices Whole-Person Orientation A high percentage of practices, Quality and Safety Only Previous Section.

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Task Force 1. Report of the task force on patient expectations, core values, reintegration, and the new model of family medicine. Ann Fam Med. S33 —S Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century.