Table 1. Comparison of Care by Design (CBD) and Patient-Centered Medical Home (PCMH) Metrics
CBD Elements (June 2009)Related 2008 PPC-PCMHEmbedded Image Elements
Appropriate Access (AA)
AA1To acute care (ie, clinical need or patient request) by same-day appointmentSame-day capacity
AA2To the provider for continuity of careContinuity of care
AA4Attention to call center messages (in-basket messages generated by call center to first contact to patient)Timely telephone advice during office hours
AA5aGetting through to the office by phone for an appointment (dropped calls)
AA5bGetting through to the office by phone for an appointment (TSF)
Care Team (CT)
CT1aStandardized documentation: X filesStandardized narrative progress notes
CT1bStandardized documentation: physical templateStandardized narrative progress notes
CT1cStandardized documentation: best practice alertsRecommended preventive screenings–by age
Recommended risk screening–by age
CT2MAs in rotation for rooming patient
CT4Standardized stocking for exam rooms
CT5Use of technology supports real-time communication by all team members and with patient during the visit
CT6Patient never left alone, unless part of patient care
CT7aThroughput: efficient check-in (patient waits ≤5 min from entering clinic to rooming)
CT7bThroughput: efficient visit (patient waits ≤10 min during visit)
CT9Huddles and schedule reviews (most days = 3 to 4 days; most providers and MAs miss no more than 1 of each)
CT10Referrals made at time of appointment, or detailed instructions with phone number in after-visit summary
CT11Lab draws done in room
CT12Continuity of MA with patient throughout the visit
CT13MA 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)
PC1Use of registries for chronic care and preventive servicesPrevisit 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
PC2Labs done prior to the visitPrevisit planning with clinician reminders
PC3Documentation that after-visit summary was given to patientCondition management education to patients/families
Individualized care plans in writing
Provide written care plan to patient/family
PC4Motivational interviewing and goal setting for self-managementIndividualized treatment goals in writing
Assess patient/family preference, readiness to change, and self-management abilities
Patient/family self-care confidence
PC5Medication reconciliationReview medication lists with patients
PC6Emergency room/hospitalization records available at time of visitReview outside facility information to identify special outreach or at risk
PC7Procedure/consult notes available at time of visit (mammography, colonoscopy, endoscopy, cardiology)
  • MA, medical assistant.