Nurse practitioners AND. PHysician Assistants. Going beyond the numbers in patient-centered medical homes

Transcription

1 Nurse practitioners AND PHysician Assistants Going beyond the numbers in patient-centered medical homes

2 NPs, PAs, and the rise of PCMHs Patient-centered medical homes (PCMHs) have taken the comprehensive care approach to a new level and are increasing in number and prominence. The PCMH Approach to Primary Care Catches On 1 NCQA PCMH Growth ,191 15,000 12,000 9,000 7,676 6,000 3, ,302 1, , /31/08 12/31/09 12/31/10 12/31/11 Legend Clinicians Practice Sites In December of 2008, few sites or clinicians met the new standards for PCMHs established by the National Committee for Quality Assurance (NCQA). By the end of 2011, more than 16,000 clinicians had achieved PCMH standards and 3,302 sites were PCMH-recognized. 1 The increasing prominence of the PCMH, along with provisions of the Patient Protection and Affordable Care Act, place nurse practitioners (NPs) and physician assistants (PAs) in an increasingly important role in primary care in the United States. 2

3 What makes a PCMH? A number of organizations define their own PCMH accreditation standards, including: URAC (formerly the Utilization Review Accreditation Commission) Accreditation Association for Ambulatory Health Care (AAAHC) The Joint Commission NCQA (National Committtee for Quality Assurance) Accreditation of PCMHs is achieved through adherence to a robust set of standards. 1 To be recognized, as a PCMH, a practice must truly embrace the patient-centric approach by offering coordinated and integrated care across a complex health care system, and engage patients in their long-term, individual treatment plans. 1,3 There are a number of national organizations committed to providing support for the development of the PCMH presence, including 4 : NCQA 2011 Recognition Program Patient-Centered Primary Care Collective (PCPCC) American Academy of Family Physicians (AAFP) American Academy of Pediatrics (AAP) American College of Physicians (ACP) American Osteopathic Association (OA)

4 NCQA Recognition Programs The NCQA Recognition Program reflects the Joint Principles, which describe the characteristics that embody the PCMH model 4 : Personal clinician Enhanced access Whole-person orientation Quality and safety Care is coordinated and integrated The NCQA has 6 standards with corresponding focus areas to measure PCMH quality. 1 Enhance access and continuity Identify and manage patient populations Plan and manage care Provide self-care and community support Track and coordinate care Measure and improve performance NCQA emphasizes that these high standards cannot be reached without collaboration across the health care team. The most important characteristic of PCMHs is teamwork. 5

5 NPs and PAs are at the frontline of a changing health care system The role of NPs and PAs in PCMHs The specific roles of NPs and PAs in a PCMH-accredited practice may vary depending on the clinical setting, patient population, clinical expertise, and relationships among the health care team. The number of NPs and PAs practicing has grown rapidly, and is expected to continue to grow, making them a fast-growing profession in the United States. 6,7 Some benefits and services that team-based PCMHs offer are 3 : Care grounded in strong patient relationships that improve health care delivery Patient-engagement with treatment plans that strengthen program adherence and commitment Findings from PCMH evaluations suggest that the PCMH approach results in an improved quality of care and overall experience for both patients and HCPs. Interventions conducted by PCMHs have been able to: Reduce ER visits by 15% to 50% Reduce hospitalizations by 11% to 40% One clinic reported less staff burnout, with only 10% of the staff reporting emotional exhaustion at 12 months, compared to 30% at control clinics

6 References: 1. National Committee for Quality Assurance. Patient-centered medical home (PCMH) 2011 recognition program. Accessed August 30, Taylor EF, Lake T, Nysenbaum J, Peterson G, Meyers D; for US Department of Health & Human Services. Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms. Washington, DC: Agency for Healthcare Research and Quality; National Committee for Quality Assurance. NCQA patient-centered medical home Accessed August 31, National Committee for Quality Assurance. NCQA patient-centered medical home. PCMH%20brochure-web.pdf. Accessed August 31, Wood DA. Safe at home. National Nursing News. May 23, Accessed August 30, Elliott VS. Number of physician assistants doubles over past decade. Posted September 27, Accessed July 31, Auerbach DI. Will the NP workforce grow in the future?: new forecasts and implications for healthcare delivery. Med Care. 2012;50(7): Grumbach K, Boednheimer T, Grundy P. The outcomes of implementing patient-centered medical home interventions: a review of the evidence on quality, access and costs from recent prospective evaluation studies, August Washington, DC: Patient-Centered Primary Care Collaborative. Accessed September 26, NPC Pfizer Inc. All rights reserved. September 2012