frank degruy september 12, 2011. our healthcare system is broken what distinguishes a high-quality...
TRANSCRIPT
Our Healthcare System Is Broken What Distinguishes A High-Quality
System? The Definition of Primary Care Improving Healthcare Services The Principles of Redesign The Particulars of Redesign Sustainability
Answer: A foundation of high-quality primary care
“Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, [no matter how measured].
The means by which primary care improves health have been identified….”
Contributions of Primary Care to Health Systems and Health Starfield B, Shi L, Macinko J.
The Milbank Quarterly; 83: 457-502. 2005
“Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”
Defining Primary Care: An Interim Report.
Institute of Medicine Committee on the Future of Primary Care.National Academy Press, Washington DC, 1994
“…responsible for providing for all the patient’s health care needs…”
“Care is coordinated and/or integrated across all elements…”
Joint Principles of the Patient Centered Medical Home
American Academy of Family Physicians (AAFP)American Academy of Pediatrics (AAP)American College of Physicians (ACP)
American Osteopathic Association (AOA)
February 2007
Acute Care Chronic Care Preventive Services
Self-management Education Coordination & integration
Mental and Medical Others
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Robert Graham Center, “Why there must be room for mental health in the medical home; NBGH: An Employers’ Guide to Behavioral Health Services
13McGinnis JM, Foege WH. Actual Causes of Death in the United States. JAMA 1993;270:2207-12.Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States, 2000. JAMA 2004;291:1230-1245.
Myopia Psoriasis Hypothyroidism Allergies
Depression Multiple Sclerosis Epilepsy
Chronic Back PainInfertility Crohn’s Disease GERD
Ulcerative Colitis
Sickle Cell Disease
Type I Diabetes
Parkinson’s
Cystic Fibrosis CAD
Chronic Hep B
Osteoporosis Cerebrovascular Dz Hypertension Hyperlipidemia
Asthma CHFSchizophrenia Type II DM
Alzheimer’s Obesity
Bipolar Disorder Addictions
Requirement for behavior change
Moti
vatio
n to
cha
nge
Vision for serving the whole person PCMH as a prototype CMHC’s already ahead in some areas
Care managers Wraparound services Chronic illness management
Behind in others Medical illness and medical system Pace of practice Sharing health information
Culture of change QI Plan-Do-Study-Act (PDSA)
Measurement-based outcomes Team-based care Leadership for change New principles of communication Self-management, groups, peer support External partnerships
Registries Comprehensive personal care plan for all Solid expertise on hand for
Common physical conditions The deep end Health behavior change
Self management Preventive services
Payment reform is an absolute prerequisite
Eliminate fragmentation of payment Commingled funding streams Accountability for all elements of health
Pay for health, not procedures, not visits Pay for quality care Pay for collaboration & coordination Pay patients for healthy living Pay for innovation Reward cost savings