Table 1. Comparison of Care by Design (CBD) and Patient-Centered Medical Home (PCMH) Metrics
| CBD Elements (June 2009) | Related 2008 PPC-PCMH Elements | |
|---|---|---|
| Appropriate Access (AA) | ||
| AA1 | To acute care (ie, clinical need or patient request) by same-day appointment | Same-day capacity |
| AA2 | To the provider for continuity of care | Continuity of care |
| AA4 | Attention to call center messages (in-basket messages generated by call center to first contact to patient) | Timely telephone advice during office hours |
| AA5a | Getting through to the office by phone for an appointment (dropped calls) | |
| AA5b | Getting through to the office by phone for an appointment (TSF) | |
| Care Team (CT) | ||
| CT1a | Standardized documentation: X files | Standardized narrative progress notes |
| CT1b | Standardized documentation: physical template | Standardized narrative progress notes |
| CT1c | Standardized documentation: best practice alerts | Recommended preventive screenings–by age |
| Recommended risk screening–by age | ||
| CT2 | MAs in rotation for rooming patient | |
| CT4 | Standardized stocking for exam rooms | |
| CT5 | Use of technology supports real-time communication by all team members and with patient during the visit | |
| CT6 | Patient never left alone, unless part of patient care | |
| CT7a | Throughput: efficient check-in (patient waits ≤5 min from entering clinic to rooming) | |
| CT7b | Throughput: efficient visit (patient waits ≤10 min during visit) | |
| CT9 | Huddles and schedule reviews (most days = 3 to 4 days; most providers and MAs miss no more than 1 of each) | |
| CT10 | Referrals made at time of appointment, or detailed instructions with phone number in after-visit summary | |
| CT11 | Lab draws done in room | |
| CT12 | Continuity of MA with patient throughout the visit | |
| CT13 | MA engagement in the visit (required elements: uses x-files, addresses Best Practice Alerts, documents physical exam, places orders, gives After-Visit Summary to patient, makes follow up appointment) | Complete standing orders for medication refills, tests, delivery of preventive care |
| Condition management education to patients/families | ||
| Planned Care (PC) | ||
| PC1 | Use of registries for chronic care and preventive services | Previsit planning |
| Clinician review or action | ||
| Preventive care reminders | ||
| Reminders for specific tests | ||
| Reminders for follow-up visits (ie, chronic conditions) | ||
| Care management support | ||
| Previsit planning with clinician reminders | ||
| PC2 | Labs done prior to the visit | Previsit planning with clinician reminders |
| PC3 | Documentation that after-visit summary was given to patient | Condition management education to patients/families |
| Individualized care plans in writing | ||
| Provide written care plan to patient/family | ||
| PC4 | Motivational interviewing and goal setting for self-management | Individualized treatment goals in writing |
| Assess patient/family preference, readiness to change, and self-management abilities | ||
| Patient/family self-care confidence | ||
| PC5 | Medication reconciliation | Review medication lists with patients |
| PC6 | Emergency room/hospitalization records available at time of visit | Review outside facility information to identify special outreach or at risk |
| PC7 | Procedure/consult notes available at time of visit (mammography, colonoscopy, endoscopy, cardiology) | |
MA, medical assistant.