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Do you need a 'medical home'?

Created date

November 24th, 2009


Think of how you take care of your car. If it needs gas, you fill up at the gas station. If the brakes don t feel right, you take it to a mechanic. If it needs tires, you go to a tire store.

Some people treat their health care in the same fragmented way. If they have foot pain, they seek out a podiatrist. If they have vision changes, they go to an eye doctor. And they see yet another doctor for an annual physical. Other people have prescriptions filled at more than one pharmacy, and some choose a walk-in clinic if they feel ill, rather than call their regular doctor.

When it comes to your car, you re lucky if you have one trusted mechanic who can do all of your services for you, and if not, can refer you to another trusted source for outlying problems. When it comes to your health, you re even more fortunate if you have one doctor who can coordinate all of your health care needs. This one doctor is the cornerstone of the medical home model of health care.

Not bricks and mortar

A medical home is not a building or a hospital, but rather a team approach to health care, with one doctor acting as a coordinator. The concept is gaining popularity, especially with regard to older adults health care. "As people age they accumulate an increasing number of chronic illnesses, and it is hard to provide quality care in today s fragmented health care system," says Amy R. Ehrlich, M.D., associate professor of clinical medicine and program director for the geriatrics fellowship at Montefiore Medical Center, Albert Einstein College of Medicine in New York City.

Good outcomes for medical home users

A 2008 University of Utah study showed that team-based care improved quality of life and lowered care costs, especially for people with chronic health conditions. Another model in a study of older adults by researchers at Indiana University demonstrated cost savings by decreasing emergency department visits and lowering hospital admission rates.

And according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health, the nation s sickest and most expensive patients need fewer health care resources and cost insurers less when they are closely supported by a nurse-physician primary care team that tracks their health and offers regular support.

"A team approach means having fewer tests, fewer doctor visits, and perhaps even fewer surgeries and hospitalizations," says Vrinda Suneja, M.D. "It reduces medication errors because you have one primary care doctor managing your medicines rather than several specialists who may not know what each is prescribing."

What to look for in your medical home

Chances are you won t see the term "medical home" either in advertisements or in anything printed from a doctor s office. Although the concept (which was introduced in 1967 by the American Academy of Pediatrics and originally referred to archiving a child s medical record in one central location) has been around for a while, the terminology is not yet in regular use. "There are very few true patient-centered medical homes out there," Ehrlich says. "You need to look for a doctor who practices a team approach to your health care."

"Geriatricians are experts in team-based care," Suneja says. "Care coordination is an integral part of a geriatrician s training."

To find your medical home, look for the following:

A personal and caring physician relationship. You want someone who sees you as a whole person, not just a diabetic, arthritis sufferer, heart patient, and so on. Does your doctor ask you about all aspects of your life or just focus on your health problems? Do you have time to ask all of your questions? Do you have access to a doctor on nights and weekends?

Doctor-directed care coordination.

Electronic medical records.

If you can t find a doctor with electronic medical records, look for signs of efficiency where your medical records are concerned. Can staff access your records quickly if you need them for a referral? Do they return your phone calls quickly? Is it easy to make appointments? Are your prescription requests handled quickly and accurately?

Take an active role in your health care

Be an active member of your team by doing a few simple things. "Make sure your doctor knows about all of the medicines you are taking, including over-the-counter products," Ehrlich says. "I ask my patients to bring the bottles in so I can make sure I have complete information. Lists can be confusing."

Tell your doctor about any specialists you see. "Know the names of all of your doctors," Ehrlich says. "Someone might be seeing four or five specialists, but there is no single doctor who is keeping track of everyone s treatment recommendations. This lack of communication can have a negative effect on your health status and quality of life."
This can be difficult to find, because few (estimates range anywhere from 5% to 18%) doctors offices use a fully-integrated electronic medical records system. A fully-integrated system allows your doctor to easily communicate your safely stored medical information in real time to specialists, emergency rooms, pharmacies, and so on. Look for a well-trained staff that makes your follow-up appointments and referrals to laboratories, radiology offices, or other specialists easy for you. Is there someone to help coordinate your care both before and after your appointments? Does your doctor have relationships with specialists and community resources? Can he or she help you with second opinions and offer suggestions or alternatives to treatments suggested by other doctors?