What is a patient-centered medical home?

To date, the evidence indicates that market forces are not … efficient in medicine because … they tend to promote more care. … In fact more care can be worse, especially at the extremes when it is based on the proliferation of specialty care. More care, when poorly organized, seems to produce results that are worse from both an economic and social perspective, actually leading to inferior outcomes….we need to build on the principles that good, generalist-based primary care offers an alternative to a wasteful and inflationary system. Rather than uncoordinated, episodic care, we need…care that is well organized, coordinated, integrated, characterized by effective communication, and based on continuous healing relationships.

• Larson EB, Grumbach K, Roberts KB., The future of generalism in medicine, from the Annals of Internal Medicine, 2005.

Definition
The patient-centered medical home has been defined by the National Committee for Quality Assurance (NCQA) as "a model for care provided by physician practices aimed at strengthening the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship." To become a medical home, a practice incorporates seven attributes.

Attribute	Services
Access to care	Open access Short waiting times Online appointments and e-visits Group visits Telephone consultations After-hours service Electronic prescribing/refills
Patient engagement	Care reminders Information given to patient on condition, treatment plan, options, etc. After-visit summaries Patient access to medical records Assistance meeting treatment guidelines Physicians as advisors Anticipatory guidance Patients/surrogates as final decision-makers
Care coordination	Coordination of specialist care Coordination post-discharge Follow-up to ensure attendance at referral visits Systems to prevent errors for patients with multiple doctors Open communication between providers treating the same patient Chronic Disease Management
Team-based care	Multi-disciplinary physician-led team responsible for primary care
Clinical information systems with decision support	EHRs Patient registries Easy access to lab/test results Patient/physician reminders of care opportunities Clinical Practice Guideline software (embedded in EHR)
Feedback to physicians	Patient surveys Outcomes analysis PDSA cycle for incorporating patient suggestions and preferences
Transparency	Publicly available cost, quality, and demographic info by physician