Supporting Primary Care Patient-Centered Medical Homes with Community Care Teams: Findings from a Pilot Study

Objective: With the growing recognition that team-based care might help meet the country’s primary care needs, this study’s objective was to evaluate the preliminary effectiveness of multidisciplinary community care teams (CCTs) deployed to primary care practices transforming into patient-centered medical homes (PCMHs). Methods: A nonrandomized longitudinal study design was used contrasting the CCT practices/patients with non-CCT comparison groups. Outcomes included utilization (ED/hospital use), quality indicators (QIs), practice joy, and patient satisfaction. Two CCTs (consisting of nurse care manager, behavioral health specialist, social worker, and pharmacist) were deployed to 6 primary care practices and provided services to 406 patients. Practice level analyses compared patients from the 6 CCT practices not receiving team services (29,881 patients) to 3 non-CCT practices (22,350 patients) that were also transforming toward PCMH. The comparison group for the patient level analyses (patients who received CCT services) was patients from the same CCT practice who did not receive CCT services. Results: At the practice level, there were significant improvements in QIs for practices both with and without CCTs. However, reductions in the probability of an admission and readmission occurred only for high-risk patients in CCT practices. At the patient level, the probability of an unplanned admission was reduced for CCT and non-CCT patients, but the probability of a readmission was only reduced in CCT patients receiving hospital discharge reconciliation calls from CCT staff. Conclusion: Preliminary results suggest possible added benefit of CCTs over PCMHs alone for reducing hospitalization

John M. Eisenberg Patient Safety Awards. The LVHHN patient safety video: patients as partners in safe care delivery.

BACKGROUND: In fall 2002, Lehigh Valley Hospital and Health Network (LVHHN), an 800-bed, three-site academic community hospital, embarked on an initiative to produce an educational patient safety video. IMPLEMENTING THE INITIATIVE: The video addresses six topics relevant to optimum patient safety: treatment plan, medication safety, falls, surgical site identification, hand washing, and discharge planning. Each segment outlines strategies that patients may employ or observations they should make to improve patient safety. RESULTS: Analysis of the patient survey data, which were based on 217 surveys, indicated that patients felt more comfortable talking with their health care workers about questions or concerns after viewing the video and that they rated their knowledge of patient safety higher. Patients generally rated the six sections as helpful. DISCUSSION: The video was intended to become an important step in the preadmission process. Releasing the video to patients and staff helped to normalize some practices that initially were not comfortable for staff (repeatedly asking an inpatient for his or her name and date of birth before administering all medications) or patients (inquiring whether a staff member has washed his or her hands). Additional methods were in development to share the video with current and prospective patients and assess its impact. The LVHHN patient safety council plans to share the video with the community at large