Guest Author - Julie Reeser, RN
This past week with the passage of the landmark Health Care Bill in Washington, D.C., I learned of a model of care that is steadily growing across the United States. It is called the Medical Home Model, and was actually proposed in 1967. My husband, who works at the Veteranís Administration, stated that this is something the VA is piloting, and I read an article about it in a prominent newspaper three days ago. The vision of healthcare shifting from patient/doctor is shifting toward a team-based, holistic, streamlined approach.
Medical Home is a term that seems to start with getting everyoneís records computerized and mobile with the electronic medical record (EMR). How many of us have had to get copies of our records sent to a specialist, only to find that when we get there, the records were never sent? How many of us have had to make multiple phone calls and trips to the office in the attempt to obtain records? As a healthcare provider, think about the impact this has on the efficiency of care delivered.
The other key component in the Medical Home Model is the emphasis on communication with the patient as to self-care and management. I have seen glimmers of this when I visit the specialist for my celiac disease. I am seen first by the dietician. This is not something that I pay extra for, but is considered a part of my visit, since diet is an integral part of getting well with this disease. Having a team of professionals can save time, increase the likelihood that questions find answers, and in the long run, lower costs. With this model, the computer tells the staff that for the month of April, there are 5 patients that need mammograms, 4 that need colonoscopies, and 26 that need their HgA1C levels checked. The patients get the labwork done ahead of time, saving an extra visit. This also reduces the chances of something or someone falling through the cracks.
This morning I heard a news story on hypertension. The patient and physician used emails to tweak and manage the patientís condition. Imagine being able to send an email to your physician stating that you were noticing a rising trend in your blood pressure, and have him direct you to take an extra diuretic that day! Traditionally, you have to wait on hold, speak to the secretary, be transferred to the nurse, tell her your information, and then hope and pray that you hear from somebody before the end of the day. The physician could have a team, with a PA or NP assigned to answer incoming emails or phone calls. The chronically ill patient could also enter data into a program that is monitored by contracted nurse case managers.
This system sound wonderful, but there are two key elements missing. There arenít enough primary care physicians or nurse practitioners to sustain it. How is there enough time in the day to stop and check/answer emails? The model laid out by the AAFP gives three scenarios. All three of them have the physician or nurse practitioner answering emails throughout the day. This seems like it would take more time than is allotted in the examples.
Overall, the trend is increasing and gaining momentum. The nurse needs to shift, stretch, and find her role in this new model of care. Nursing models of care have always focused on the whole patient. It is good to hear that the medical model is catching up!