John Epling, MD, MSEd
What does it mean to be a medical home? In these times of Accountable Care Organizations, patient-centered medical home (PCMH) certifications, and Medicaid Redesign projects it can be easy to lose sight of a meaningful way to measure our progress toward becoming a PCMH. Examining our practices’ ability to deliver vaccinations across the lifespan can help us understand where we fall along the medical home spectrum.
The Joint Statement on the Patient-Centered Medical Home1 discussed five principles:
- a physician-led practice team
- whole-person orientation
- integrated and coordinated care
- a focus on quality and safety
- access
We can put each of these principles into practice with vaccinations in mind.
Physician-led practice team
One of the primary ways to reduce barriers to immunizations (as well as to most preventive and chronic care) is to not rely on physician memory for their delivery. Engaging the entire practice team—from the clerical staff who obtain immunization records to the nursing staff who implement standing order protocols and deliver the vaccines—can reinforce the commitment of the medical home to wellness and disease prevention. Look for ways in your practices that you can use your practice team to deliver vaccinations more efficiently.
Whole person orientation
Delivering all indicated vaccines across the entire life span is a challenge that no other specialty takes on. As family physicians, we know and understand our patients’ lives, social situations, environmental exposures, and behavioral risk factors. We are committed to prevention as well as to treatment of illness. We have long recognized that vaccines are the most effective of these primary preventive interventions. As such we must make the effective delivery of vaccines a priority in our practices.
Integrated and coordinated care
In this era of vaccine availability outside the physician office, the role of coordination of medical information takes on a tremendous importance to ensure that the patient’s vaccination record is up to date. Statewide immunization registries and regional health information organizations will help in this coordination, but to leverage those tools we must commit to care coordination in our practices using the value-based care incentives from medical home certification and other sources. These incentives can pay for additional staff to comb the registries and records to identify patients who are in need of vaccines. In addition, we must advocate for greater use and integration of immunization registries by all providers who give vaccines.
Focus on quality and safety
Vaccinations are some of the safest interventions we have in medicine, and there is ongoing work to make them even safer. Tracking lot numbers and sites of administration, delivering Vaccine Information Sheets, and reporting side effects to the Vaccine Adverse Events Reporting System are three important ways primary care practices contribute to the safe and effective delivery of vaccines. To maintain these processes, we must examine our practice workflows and engineer our systems to facilitate the tracking and measurement of our safety and quality.
Access
Think about ways that your practice can deliver vaccine-related services in a way that best responds to your patients’ needs. Delivering vaccines in a timely manner during times of increased demand has required us to expand access for these vaccines in creative ways such as flu vaccines clinics and special times allocated for school physicals. Also, focusing on access for all patients to vaccines using outreach methods and population health management techniques can help us eliminate socio-demographic disparities in vaccine uptake in our practices.
The safe and effective delivery of vaccinations across the lifespan in primary care is an excellent yardstick against which we can measure our progress as PCMHs. We are the trusted partners of our patients and their families as they live their lives and navigate our health care system. Let’s continue to use that partnership to deliver the most effective primary prevention measure we have.
References
- Joint principles of the patient-centered medical home. Patient-Centered Primary Care Collaborative 2007:3. http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf. Accessed July 18, 2015.
STFM Blog 