PCMH

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  The Patient-Centered Medical Home (PCMH) is a model of healthcare delivery that emphasizes putting the patient at the center of their care. It's a way to improve primary care and coordinate patient care across the entire healthcare system. 

As a patient-centered medical home, The Kentucky Mountain Health Alliance, Inc., meets the needs of our patients’ physical and mental health. This includes preventative and wellness care, acute care, and chronic disease management. In order to provide quality, comprehensive care, KMHA has incorporated a team approach to treat each patient. Our teams may include physicians, advanced practice nurses, physician assistants, nurses, medical assistants, and care coordinators.

The patient-centered medical home provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.

The patient-centered medical home coordinates care with all of the entities in the health care system, including specialty care, hospitals, home health care, and community services and supports. This type of coordination is particularly critical during transitions between sites of care, such as when patients are sent to a specialist, need diagnostic testing, or are discharged from the hospital.

The patient-centered medical home makes services more accessible and wait times shorter for those with immediate needs, includes enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team. The medical home practice adapts to patient’s preferences to provide the easiest access possible.

The patient-centered medical home focuses on quality and quality improvement by continuously improving patient outcomes by participating in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.