Last Monday, Stephanie Mensh wrote about her experience with medical homes. Dr. Pamela Mitchell, President of the American Academy of Nursing, has provided Disruptive Women with another perspective.
Guest post by Pamela H. Mitchell, RN, PhD, FAHA, FAAN
There is much talk these days in health professional, health payer, and even legislative circles about the “medical home.” This is a term coined in 1967 by the American Academy of Pediatrics. The medical home was originally meant as a single place for a child’s medical record and was particularly salient for children with special care needs. It later expanded to denote the one place that families with children with special care needs might obtain coordinated, continuous, family-centered and culturally effective care.1 The concept of a medical home has additional roots in recognized needs for care coordination for people with chronic illness in managed care, case management, disease management and comprehensive discharge planning for complex or chronic illnesses. Most recently, a coalition of the American Association of Family Practice, American College of Physicians, American Academy of Pediatrics, and American Osteopathic Association developed and disseminated “Joint Principles of the Patient-Centered Medical Home.” This document defines the Patient-Centered Medical Home (PC-MH) as “an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians and, when appropriate, the patient’s family.”1 At its best, this new movement promises quality, coordinated care for people, rather than their diseases. Further, it recognizes that care coordination and management is a complex skill that deserves payment in our current payment system. However, because of the consistent emphasis on physicians as the home “owner” and leading partner, it connotes care centered in a particular practice profession rather than care for the person or family who comes “home.”
The physician-centered approach being advocated by many groups does not recognize the 20-year history of primary care provided by multiple professions, in addition to physicians. Nor does it recognize the multiple kinds of “homes” from which coordinated care can emanate—such as the freestanding birthing center that offers comprehensive health and social care2 or the advanced practice nurse-directed transitional care service for elders.3
This brings me to the title of this message. Does it matter what we call this patient-centered primary or chronic care service? Shakespeare’s heroine Juliet said:
What’s in a name? That which we call a rose
By any other name would smell as sweet…4
If Shakespeare is correct, it shouldn’t matter whether we call this a “medical home” or a “health home,” and this is what many of my colleagues in medicine have contended when we have talked about this important concept. I believe, however, that to call it a “medical” home limits the possibilities for patients, families, and providers about what constitutes patient-oriented, comprehensive, coordinated and culturally appropriate care. To call it a “health” or “healthcare” home expands those possibilities, without excluding physicians who have developed outstanding demonstrations of quality primary and chronic care. The American Academy of Nursing has developed a briefing paper on the health home debate that may be found at www.aannet.org. All health care professionals need to think carefully about the language we use to define the best approach to compassionate, coordinated, and comprehensive care of our citizens. I invite you to examine that briefing paper and send us your comments.
Note from Hygeia: This post was reprinted, with permission, from the July/August 2008 Nursing Outlook.
About the Author
Pamela H. Mitchell, RN, PhD, FAHA, FAAN, is President of the American Academy of Nursing and an Associate Dean for Research, School of Nursing; The Elizabeth S. Soule Professor of Health Promotion, School of Nursing; Adjunct Professor, Department of Health Services; SPHCM Director, Center for Health Sciences Interprofessional Education at the University of Washington, Seattle, WA.
1. Joint Principles of the Patient-Centered Medical Home. http://www.aafp.org/pcmh/principles.pdf Accessed on May 9, 2008.
3. Naylor MD. A decade of transitional care research with vulnerable elders. J Cardiovasc Nurs. 2000;14:1–14. MEDLINE