地域医療と健康教育

抽象的な

Evaluation of a Curriculum in an Internal Medicine Residency and Patient- Centered Medical Home Rotation

Nawaz H, Via C, Wild D, Costales V, Gentile C, Petraro P and Lim L

Introduction: The Patient-Centered Medical Home (PCMH) model aims to transform primary care by delivering high-quality, safe, comprehensive, patient-centered, and accessible care. Few evaluations of PCMH curricula for internal medicine residency programs have been published. The objective of this study was to develop and implement a PCMH curriculum, a new PCMH rotation, and to redesign the resident ambulatory care clinic and private primary care practices of the residency program. Effects were evaluated by examining: 1) residents’ attitudes towards primary care and PCMH, 2) residents’ skills in communicating and managing care and 3) patients’ assessments of practice accessibility.

Methods: From 2010-2015, we implemented a multi-modal program combining practice redesign, a lecture series, a one-month PCMH rotation, clinical activities, a quality improvement project, and self-reflection at an academic community hospital, a Federally Qualified Health Center (FQHC) and faculty practice offices to internal medic ne residents. Evaluations were conducted through resident self-assessment, patient assessment of practice accessibility, and objective structured clinical examinations.

Results: Twelve residents [41% (12/29)] completed all components of the curriculum. After the rotation, residents thought their PCMH skills improved in 13 components of PCMH (all domains: p<0.02). Residents’ attitudes towards primary care and PCMH did not improve from 2010 to 2012 [response rate: 38% (11/29) and 44% (13/29), respectively]. Patient ratings improved, mostly in practice accessibility (p<0.001) and test notification (p=0.01).

Conclusion: By engaging in the PCMH curriculum and practice redesign, residents showed improvement in PCMH skills across all domains, and patients demonstrated increased satisfaction with the practice. This curriculum in PCMH can be utilized as a useful model for other internal medicine programs.