The patient centered medical home has been something that all the different societies
of primary care got together and developed a series of joint principals.
It’s really what we sort of think primary care always should have been.
Every person should have a personal physician, that their care should be coordinated that
there should be access to the health care team.
That the providers should work as part of a team to really work together to meet the
needs of the patient.
The practices typically have really started with one disease as their target disease and
then once they learn how to implement the model of care around that they move to other
chronic illnesses.
And so the initial disease has been diabetes and that’s my area of expertise and if you
look at sort of diabetes we know probably more than other disease that if you can have
people reach certain goals, if their blood pressure is controlled and their cholesterol
and blood sugar you can prevent the long term complications, blindness, kidney failure amputation.
The results that we have seen is that much larger percentage of patients are meeting
those goals now since they have taken the new model then before the new model got started.
One of the things were interested in doing around the process through some of our research
is really going out and quantifying that better.
Understanding what the transformation process looks like.
Using an approach called positive deviance which is essentially in a group there will
always be those that do better and honing in on what is it that they are doing.
So the practices that have approved the most in this kind of thing, what are they doing
differently that everyone else can learn.
And so we are doing a lot of interviews and collecting a lot of data to be able to share
that story.
The exciting thing that we just got funded to do that we’re going to look at is asking
patients what they think about this and although the term for this is the Patient Centered
Medical Home.
For better or worse, they haven’t asked patients that much what they think of this
so this is going to be really exciting to get a sense of the patients perspective on
this.
We’re really fortunate that we were chosen one of the four states in the US to get this
grant and essentially what it looks to do is build a state level infrastructure for
something called the primary care extension service.
And the primary care extension service comes from what is described as the greatest dissemination
model in the history of the US, the Corporative Extension.
At the turn of the century they knew better farming techniques but many farmers weren’t
using it and they needed to figure out a way to do this and the corporative extension that’s
housed at Penn State here in Pennsylvania but exists in every state.
Went out to local farmers and taught everybody how to do it better and now everybody grow
things a better way.
We want to do the same thing for primary care.
To setup an extension service working with the AHEC system here at Penn State Area Health
Education Centers and AHEC’s are present in all states and there sort of goal is an
educational goal for providers so they are the perfect infrastructure for this kind of
extension service.
And the idea is that the extension service would have local extension agents that would
work with practices to help them change.
So the impact grant is for us to take the model of what we have been doing with the
thousand providers I described, work through AHEC to really bring that out to a lot of
small practices that are often the most challenging ones to reach with these kind of changes.
And then take our model and disseminate it to three other states in the US.
With the idea that we will ultimately be a hub for a regional area of this extension
service.
You know one of the challenges here, as we develop this new system we want to make sure
that the next generation doctors learn to practice in the same way, and so we have been
fortunate that a group of folks here at Penn State led by Dr. Shou Ling Leong who received
a grant from HERSA to train medical students in the medical home.
So there is a curriculum they are going through, they’re rotating through practices and not
only are the learning the medical home by being in those practices but they are also
helping those practices become more like medical homes and incorporate the things they are
learning.
So, it’s sort of a two way street.
It’s been piloted by a small group of students and is going to be expanded more and more
or so.
The goal there is to really to train medical students so they’re ready for this new healthcare
delivery system.
I think the exciting thing for us here at Penn State is, we’re involved at all levels
of this, implementing this in our own practices, teaching our students it, getting it into
residency education and then evaluating it from a research perspective across the state.
And now with the impact grant, looking to spread this across the region and not only
in Pennsylvania and building the infrastructure but in New York and New Jersey and other states.