Medical Homes Can Improve Diabetes Care

One of the problems with our health-care system is that it delivers care in a very fragmented manner. Patients seek medical treatment in a wide variety of places for a many different reasons. Although the treatment is somewhat coordinated, the frame of reference is on the individual episodes of care and not on the overall, cumulative effect on the patient's health.

With managed-care companies requiring authorizations and electronic medical records providing continuity of data across patient visits, coordination of care is improving. As progress continues, the system is evolving toward patient-centered care.

Patient-centered care has various meanings. In marketing, it is often used to describe convenience and comfort, such as providing easier access to related services or improving satisfaction among patients and their families. On a larger scale, it is used to describe a more holistic approach to care in which patients are not treated as the sum of their medical diagnoses, but as individuals whose medical needs are just one part of their health and well-being.

Patient-centered care involves coordinating and delivering the full range of services that will optimize each patient's health. The intended results are more positive outcomes, increased cost efficiency and greater satisfaction.

But how can we break down traditional "silos" of care and place the patient at the center?

One answer is medical homes. This approach involves having a physician lead a team that is responsible for the continuous and comprehensive care of the patient, including coordinating and tracking delivery of care across the full spectrum of medical specialties, hospitals, physicians offices and social service providers.

In a study recently published in The Joint Commission Journal on Quality and Patient Safety, researchers in Pennsylvania demonstrated that the medical-home model can improve outcomes in diabetes patients. By applying Patient-Centered Medical Home (PCMH) standards developed by the National Committee for Quality Assurance in 2011, physicians enabled patients to achieve lower levels for LDL, hemoglobin A 1 C and blood pressure, which are the key predictors of morbidity and mortality in diabetes. Patients involved in the study were also significantly more likely to comply with evidence-based clinical guidelines for diabetes care, such as yearly examinations of the feet and eyes. (http://live.psu.edu/story/54122)

PCMH standards are likely to form the foundation for America's efforts at health care reform. Regardless of the outcome of the reform debate, medical homes are moving forward. More than 30 states have launched medical home projects, and the recent report from Pennsylvania confirms that diabetic patients who have medical homes achieve better outcomes.

Beyond the profound implications for families with diabetes, PCMH has the potential to reduce the estimated $174 billion the U.S. spends on diabetes care annually. Hopefully, the imperative to save health care dollars will drive us to do something that really makes sense.

— Tom DeSanto