Patient-Centered Medical Home

The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, referring to a central location for archiving a child’s medical record. In its 2002 policy statement, AAP expanded the concept to refer to primary care that emphasizes timely access to medical services, enhanced communication between patients and their health care team, coordination and continuity of care, and an intensive focus on quality and safety.

In 2007, a set of seven principles describing the characteristics of a practice-based care model was issued by four physician membership organizations representing over 300,000 physicians.  The authoring organizations are:  the American Academy of Family Physicians, the American College of Physicians, the American Osteopathic Association, and AAP. The clinicians represented by these organizations provide the majority of primary care in the United States.

Background reading


The American College of Physicians Medical Home Builder
This self-paced program from ACP guides practices through a simple process for evaluating their practice in seven different important areas:  patient-centered care & communication; access & scheduling; organization of practice; care coordination & transitions in care; use of technology; population management; and quality improvement & performance improvement.

TEAMcare:  Successful approach to chronic care
Group Health’s TEAMcare study shows that a collaborative approach to managing chronic disease works.  During the intervention, the nurse and patient set realistic step-by-step goals to reduce depression and blood sugar, pressure and cholesterol levels.  Each patient was coached by a nurse care manager who monitored disease control and depression, and worked with the patient’s primary care doctors to make changes in medications and lifestyle when treatment goals were not reached.

“TEAMcare is a truly patient-centered approach that enhances a primary care team to deliver optimal care for both physical and mental health in a seamless manner,” said co-author Elizabeth H.B. Lin, MD, MPH, Group Health family physician and an affiliate investigator at Group Health Research Institute. “It recognizes there can be no health without mental health.”