Medical Home

2008 Medical Home Activities

Medical Home Beta Project

We have been fortunate to recruit physician leaders for a beta pilot who are interested in publishing the results of this pilot.   The strategy was to recruit physicians across hospital sites.   They practice in affiliation with large hospital groups for both the safety net and private practice community.    We are taking the approach that institutions may not share data but physicians who admit patients to the facilities and in whose interest it is to have reliable information and to share information to other doctors for continuity of care needs, will do so.  

The HealthQuilt medical home Beta project is currently being deployed in a transition phase from the laboratory to the field.    The first step is to test physician and patient acceptance and to revise the QHR, teleconsultation, and quality improvement activities based on the physician and patient’s use of the system.   The second step has been to expand the telespecialty care that can be brought to the medical homes.  

The following has been completed to support the beta project:

Medical Home Component

•  Agreements vetted by UT and community physicians. (See Agreements)
• Minimum Security Policy
• Business Associates Agreement
• Peer Review and Telemedicine Agreement
• Equipment Use Agreement (MIRTH appliances, web-enabled PDAs for on-call access to call center, web equipment for telemedicine)
• Recruitment materials developed and field tested with safety net and private physicians.
• Primary Care Physicians agreeing to pilot 10 patients with Version 1.0 of the QHR system / telemedicine.
• Action plan / Mapping documents completed for medical home using the quality model and telespecialty care.

Specialty Care Component

• Survey of safety net completed and accepted for publication on specialty care in the uninsured.   “Telemedicine for Urban Uninsured: A Pilot Framework for Specialty Care Planning for Sustainability" has been accepted by Journal of Telemedicine and e-Health.
• “Curbside” telepsychiatry has been piloted in the lab with usability testing.
• “Curbside" telepsychiatry model has been tested in practice with one primary care physician and ten patients to test the training, support, and patient acceptance.  
• The evaluation methodology has been developed and is currently being finalized for IRB submission with expected December 2008 approval.  
• A collaboration has been established with UT Specialty Physicians to expand to cardiology, endocrinology, radiology, pulmonology for field testing in the beta pilot.   This is significant in that the coverage of specialty care for the indigent and underinsured population is an extreme need.   Academic specialty physicians will be participating in the publication program to be launched in January 2009.  Two publications per specialty are expected.  The first will describe the current state of quality issues in the referral process for both safety net and private practice with a description of the “curbside consult” model.   The second will describe the results from the beta pilot from that specialty perspective. 
• An action plan for expanding to any specialty care has been developed and will be tested with expansion to the four above named specialties in November 2008.  
• A call for a meeting for safety net health homes has been extended through the Health Care Alliance and Gateway to Care for a joint meeting to recruit additional medical homes that would like to have telemedicine for their practices.   Conditions for participation in the telemedicine pilot is to participate in the QHR quality pilot and to explore same day follow up for post-Ike recovery patients identified with the 1800 call in.   High effort targeted to recruit clinics located at the City of Houston facilities is targeting our recruitment. 
• A publication program has been established to support the specialists’ participation in the beta project.  It is anticipated that two publications per specialty will emerge during 2009.   One publication will describe the current problems with the referral process and the other will share the lessons learned from the beta pilot.
  

Medical Home Presentations and Documents

• " HealthQuilt Medical Home Model"
  by Kim Dunn, MD, PhD
  An overview of the HealthQuilt Medical Home model
• " Current Trends in Medical Home Model"
  By Joe Ring 
  A presentation focusing on current trends in patient-centered medical homes and personal health records (PHR).  With large organizations adopting PHRs, what barriers are preventing others choosing to adopt?
• Medical Home Mapping Document
  
• Medical Home Action Plan