A Patient-Centered Medical Home (PCMH) is not a place but a concept. PCMH facilitates partnerships between individual patients, their personal physicians or care providers, and the patient’s family. It is a way of coordinating all health services in a quality, cost-effective and accessible manner through use of a team approach to health care that is centered on patient and family needs.
This type of patient centered care is often created in some manner by default in rural and safety-net communities, but is not always cohesive or well documented. Additionally, team-centered care is especially important given significant workforce constraints in most rural communities where physician-led care may not be available. The Patient-Centered Medical Home encompasses five functions and attributes:
- Patient-centered
- Comprehensive care
- Coordinated care
- Continuous access
Quality care delivered in a PCMH model is enabled by health information technology, health information exchange and the use of registries and other tools to assure that patients get culturally and linguistically appropriate care when and where they need it, provided at an appropriate health literacy level. For uninsured and underinsured patients, especially those with chronic diseases and complex needs, this philosophy allows for continuity of care with better outcomes and potential decrease in utilization of urgent and emergent care services. ClinicNET and the Colorado Rural Health Center (CRHC) support the PCMH model and provide services to assist clinics in pursuing PCMH certification or designation.
