AFCC Women in Business Agnes Oblas
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Regardless of whether or not President Obama's health care plans succeed, a "new" concept of health care delivery is trying to take root. I put "new" in quotation marks because in my estimation it is not entirely new, as nurses have been delivering health care this way since the days of Florence Nightingale, at the very least. But in the medical community it seems to be causing quite a stir as being novel. If you sense a bit of sarcasm on my part, you are correct; but hear me out.

The "new" concept of health care delivery I am referring to is called the Patient Centered Medical Home, which does not mean patients would be getting their health care in their homes. It means there would be a single provider's office to act as the focal point from which all other care would be directed. I explain this to my patients using the following analogy: My role as their primary care provider and my office are like the hub of a wheel. It is the "home base" to which they come when ill and from which extends the spokes of all the other providers and services they may ever encounter as we coordinate/manage their health. The principles that underlie this "new" concept are as follows:

• An interdisciplinary team guides the care in a continuous, accessible, comprehensive and coordinated manner.

• The medical home takes responsibility for coordinating patients' health care across care settings and services over time, in consultation and collaboration with the patient and/or family.

• The patient has access to the care.

• The medical home knows its patients and provides care that is whole person oriented and consistent with the patients' unique needs and preferences.

• Patients and clinicians are partners in making treatment decisions.

• Open communication between patients and the care team is encouraged and supported.

• Patients and their caregivers are supported in managing the patient's health.

• The medical home fosters an environment of trust and respect.

• The medical home provides care that is safe, timely, effective, efficient, equitable, patient-centered and family focused.

Aren't the above principles what (in the 1970s) the concept of the Health Maintenance Organization (HMO) and Primary Care Provider were supposed to be? The current interest in the Patient Centered Medical Home springs from the hope that it will help contain health care costs. Our health care system is continually re-inventing the same old wheel because that is precisely what the HMO model was supposed to do. The establishment knows that patients crave a good, old-fashioned general practitioner to take care of them, to know them and their family members, to be there when they need them, and to coordinate their care. Yet, over the last many decades those practicing within the medical model still can't get it right. If only the medical model would look to its allies in nursing where these principles have been the cornerstone of our profession since time immemorial.

Nurse practitioners, with their advanced education and experience, are chomping at the bit to get this "new" model rolling and the Institute of Medicine (IOM) supports this move saying that the clinicians who will be responsible for operationalizing this model will be nurse practitioners as well as physicians. The IOM cites significant research and critical analysis supporting the ability of advanced practice nurses (nurse practitioners) to provide high quality, cost-effective health care. Some of us are one or two steps ahead of the IOM and I stand ready to extend my hand as other providers jump upon this bandwagon.

Agnes Oblas is a nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call her at (602) 405-6320 or e-mail Visit

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Medical homes face a public awareness problem. The solution? Scenarios that work.

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