How can providers assess whether their practices are functioning as medical homes?
There are a number of tools to assist in the determination of whether a practice is functioning as a medical home. These tools can provide specific guidelines by which to measure the existence and extent of adoption of the medical home model. While some of these measures can lead to an official, external recognition of a practice as a medical home, others can facilitate an internal assessment of a practice and its development.
One of the organizations setting medical home standards is the National Committee for Quality Assurance (NCQA). Through its Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) program, the NCQA provides recognition for practices that have achieved medical home status. The NCQA developed 9 standards and 3 levels to qualify a practice as a medical home. A certification as a level 3 medical home signifies that the practice has achieved the fullest level of integration into the medical home model. A report from the Center for Studying Health System Change provides a breakdown of the items by which a medical home is measured. Of the 166 items mentioned, 77 (or 46%) reflect the incorporation of health IT into the practice.
While the PPC-PCMH has the capability to provide external recognition for a medical home, the Medical Home Index (MHI) is a nationally accepted system primarily for practice self-assessment. Issued by the Center for Medical Home Improvement, the MHI provides 6 domains and 25 characteristics to define the medical home at 4 different levels. The usefulness of this tool in self-assessment exists in measuring the practice's progression towards becoming a more comprehensive model of the medical home.
The PPC-PCMH and the MHI are prominent tools for medical home assessment, but they are certainly not the only measures available. For example, the National Center for Medical Home Implementation webpage entitled "Practice Performance Measurement" provides tools and strategies to help evaluate physician performance and the patient/family perspective regarding the quality of their care. Also, there are assessment tools to measure the degree to which care is patient/family-centered - a key characteristic of the medical home. TrasforMed developed the Medical Home IQ, an assessment tool that allows providers to compare their current performance to competencies of an ideal PCMH. The tool recommends improvements that can be made to follow the PCMH model after assessing a provider's performance. All of these standards provide more clearly defined measures of a practice's compliance to objectives that form the framework of the medical home.
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