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Patient Centered Medical Home and Team-Based Care
(Updated December 18th 2018)
Patient-Centered Medical Home
The Patient-Centered medical home (PCMH) is described as a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, and encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, compassion, and enable strong and trusting relationships with providers and staff.
Team-Based Care
Patient-Centered Medical Home (PCMH) capabilities involve a team-based approach to patient care. Care teams are groups of primary care staff members working with the PCP to collectively take responsibility for a set of patients. Care teams blend multidisciplinary skills, focusing several people's insights on each patient's individualized plan of care. High-functioning teams deliver care in such a way that all team members work to the top of their ability and license and play a role in delivering preventive services and managing chronic diseases. The Care Manager works in close partnership with the PCP and all team members to provide coordinated, non-duplicative patient care.
Practice Facilitation Handbook Module 19. Implementing Care Teams
From the Agency for Healthcare Research and Quality
Defining the Medical Home
From the Patient-Centered Primary Care Collaborative
