miércoles, 12 de marzo de 2014

AHRQ Study Identifies Best Practices for Care Management in Primary Care

An AHRQ-funded study, “Implementing Effective Care Management in the Patient-Centered Medical Home,” appearing in the American Journal of Managed Care, identified best practices among patient-centered medical homes (PCMHs) that embedded care management in their medical team. Using diabetes care as a comparative measure, the study (abstract) found that PCMHs showing the most improvement in diabetes management used care managers who had strong patient-centered duties, fully used the electronic medical record for team messaging and patient tracking, and ensured ongoing communication among team members through techniques such as office huddles. Findings were based on semistructured interviews of 21 National Committee on Quality Assurance-recognized PCMHs in Pennsylvania. The authors suggested that PCMHs may want to ensure care managers meet with patients during medical visits and provide patient self-management support for chronic conditions.

2013 Dec;19(12):957-64.

Implementing effective care management in the patient-centered medical home.

Taliani CA, Bricker PL, Adelman AM, Cronholm PF, Gabbay RA1.

Author information

Abstract

Objectives: To explore how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices. Study Design: A positive deviance approach was used to contrast care management implementation in practices having the greatest and least improvement on clinical measures of diabetes, the initial target disease for a multipayer-supported statewide initiative involving 25 National Committee on Quality Assurance-recognized PCMH practices participating in a regional learning collaborative. Methods: Practices were ranked according to their average absolute percentage point increase from baseline to 18 months on 3 diabetes quality measures. Semistructured interviews were conducted with 136 individuals in 21 of the 25 practices. Interview data were analyzed using grounded theory with NVivo 9.0 software. To develop hypotheses related to care management best practices, we compared and contrasted emerging themes across clinical performance tertiles. Results: Practices with the greatest diabetes improvement described (1) more patient-centered care manager duties, (2) better use of the electronic medical record (EMR) for messaging and patient tracking, and (3) stronger integration of the care manager into the care team compared with practices with the least diabetes improvement. Conclusions: PCMHs may want to ensure that care managers are available to meet with patients during visits, support patient self-management, fully leverage the EMR for team messaging and patient tracking, and ensure integration into the care team with office huddles and ongoing communication.