Strengthening continuity of care: The journey to become a Patient-Centered Medical Home

Background: In 2010, MHC began the application process for the National Committee for Quality Assurance's Physician Practice Connections—Patient-Centered Medical Home (PPC-PCMH) Recognition Program with the belief that becoming a recognized medical home was key to achieving the hospital's strategic goal of becoming the hospital of choice in its community. To achieve PPC-PCMH recognition and to strengthen its Adult Primary Care Services, MHC launched an effort to redesign its scheduling system with an end goal of improving continuity of care. The intention was to foster a personal relationship between the patients and their assigned Primary Care Providers (PCPs). Such an effort would give patients a greater sense of comfort and confidence in their care as well as giving the physicians a greater familiarity with their patients. Methods: Defined care teams were established to ensure that each resident was supervised by the same attending during each clinic session, and a database was created of all active patients with the service. A patient was considered active if he/she had had a primary care visit in the past year. New and returning patients who had not seen a PCP in the past year were added to the database on a weekly basis. Each of the over 15,000 active patients was assigned a PCP based upon the provider they saw most frequently in the past or by their managed care assignment. A 3 month turnover period was given to implement the new provider schedule. During this time, the providers educated patients during each visit about the changes in the clinic, gave them a business card with their assigned PCP, and worked with nursing and clerical staff to ensure that the next visit was scheduled with the proper PCP. Results: Prior to the start of the project, continuity of care (# visits with PCP/all visits) was 15% in June 2010. This increased to 44% in August 2010 and is at 67% so far in January 2011, the first month of full implementation. Ambulatory Care Services, which houses primary care at MHC, consistently scored highest in staff satisfaction across all hospital departments in the 2010 staff satisfaction survey, an improvement over their 2009 results. Conclusion: Patient-PCP continuity and staff satisfaction are improving in Adult Primary Care as the new scheduling system is implemented. MHC has been recognized by NCQA as a PPC-PCMH, but the hospital continues to strive to further enhance its primary care services.