Patient-centered medical homes: observable types derived from national recognition assessment scores.

The patient-centered medical home (PCMH) is a strategy to transform primary care delivery organizations. However, PCMHs take on many forms and can "look different." To better understand the activities of organizations undertaking this strategy, we sought to identify discernible PCMH types using cluster analyses. From a sample of level 3 National Committee for Quality Assurance PCMHs, We extracted 3 types of PCMHs: information-focused, efficiency-focused, and high-scoring. Our findings confirm that the PCMH is not a uniform intervention. Characterizing PCMHs with particular areas of focus has implications for understanding the transformation process, identifying areas for continued practice development, and advancing evaluation of this organizational model.

Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT).

BACKGROUND: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). METHODS: A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated. RESULTS: Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory. CONCLUSION: The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version.

The English version of the Verona medical interview classification system (VR-MICS). An assessment of its reliability and a comparative cross-cultural test of its validity.

OBJECTIVE: This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). METHOD: Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. RESULTS: Agreement indices for the division of speech units varied between 88-96 and 87-93% for GP and patient speech, respectively; those for coding categories between 88-91 and 82-86%, with Cohen's Kappa values between 0.86-0.91 and 0.80-0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more 'doctor-centred', while the UK GPs tended to use a more 'sharing' consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. CONCLUSION: The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients' verbal behaviours in relation to their emotional state in the two settings. PRACTICE IMPLICATIONS: The VR-MICS may be an useful coding instrument to support collaborative research on doctor-patient communication between the two countries.

Implementation of the resident assessment instrument: a Canadian experience.

As the population ages, the increasing number and complexity of needs of individuals requiring institutionalization will increase the demands for chronic care services. In this article, the authors describe the implementation process used to introduce interdisciplinary staff to the use of the Minimum Data Set (MDS) for assessment of both nursing home and chronic care residents. This screening tool assesses resident characteristics over a wide spectrum of dimensions. The assessment findings are then integrated into the clinical plan of care.

Quality control (Part 2). Communication: implementation of the Resident Assessment Instrument (RAI): the benefits of a structured communication plan.

Following a government mandate to use the assessment portion of the Resident Assessment Instrument, S&WCHSC began to integrate the RAI into the care of its Aging Program residents. S&WCHSC have used this as an opportunity to provide a structure for assessment and care planning within the existing philosophy of Patient Focused Care. Implementation of the RAI required the development and implementation of a Communication Plan. An adaptation of a framework, "Effective Strategic Planning for Communications" provided guidelines for assessment of key stakeholders' communication needs.

Pediatric family-centered rehabilitation.

Family-centered rehabilitation programs are derived from a philosophy of heath care delivery known as family-centered care. The principles of family-centered care are presented with clinical examples. Its origins are reviewed, and the 10-year process of implementation of family-centered care practice and policy at a children's rehabilitation center are described. Profound changes in behavior are required of the health care professionals as meaningful collaboration with families develops. Key elements of a family-centered rehabilitation program include meaningful participation by families in medical decision making and an institutional culture flexible enough to respond to the ongoing collaboration between families and practitioners.