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Community-Based Medical Homes to Increase Primary Care Access for Families

By US Medicine

WASHINGTON, DC—A new Army medicine initiative is aiming to give military families better access to healthcare.

Seventeen new off-base Army primary care clinics are being built off of the military installation, allowing those families of soldiers who had challenges in getting access to care at busy installations to be able to get it off post.

The first of the “community based medical homes,” as they are called, has already been established for families around Fort Campbell, KY, with the rest scheduled to be up and running during this year. Each clinic is expected to handle over 8,100 patients.

“This is not a shifting of patients just from on post to off post,” said Army Maj Chad Rodarmer, assistant project manager for the community-based medical homes initiative. “It actually is building capacity.”

In order to determine the locations for the 17 clinics, the Army examined where there was a need for greater access. “Way back when the MTFs were built, people lived on post,” said Rodarmer. “Well, the opposite is true now. Most people live off post and commute to work. So it just made sense to look at the zip codes around each of the Army installations and determine where people were, where there are big pockets of Army families.”

The clinics will primarily service the families of soldiers, while soldiers who are working on the base will find it more convenient to receive care on the base.

Patient Centered Care

The new clinics will utilize the concept of the “patient centered medical home,” a model of healthcare being adopted across military healthcare in which healthcare is team based and in which the aim is for the patient to maintain the same primary care provider on each visit.

In addition, patients will get more face time with medical personnel at these new community based medical homes. “The way we have this set up, the patient gets a full 20 minutes with the nurse going through the history and background, and then they have a full 20 minutes with the physician completely focused on them,” said Rodarmer. “For the physician that is still three patients per hour, but the patient is getting more personal face time with the physician.”

Rodarmer said that because the nurse is taking the patient’s history first and then will review it with the doctor in the presence of the patient, the documentation is being done more efficiently and increases patient safety.

When the physician evaluates the patient, the nurse continues to do the documentation, allowing the patient to have the full attention of their provider, said Rodarmer. “From beginning to end this entire initiative has been a lot of people stepping back and saying, ‘forget about how we do things now. What is the best way to do this?’ Because some of the biggest complaints with healthcare is that the doctor does not pay attention and does not listen.”

Staffing the Clinics

Each clinic will have 35 staff members. The medical personnel serving in these clinics will all be civilians.

The military deals with the challenge of military medical personnel deploying or being moved to a new location, which means that military patients typically often change primary care managers. Continuity of care for the patient can be maintained by utilizing civilian medical personnel. “It has been proven time and time again in research that someone who has a consistent primary care manager actually has better health outcomes. By staffing these with government employed civilians, by keeping civilians in the clinic and not having ‘green suiters’ practicing, here we can take away that one confounding factor that prevents us from providing as much continuity as we can.”

Those patients with multiple conditions who may need a specialist to manage their care may prefer to continue their care on the military installation, Rodarmer said. “We are not making anyone come out to these clinics. So if they prefer to stay with their specialist with the MTF on post then they are absolutely able to [do that].”

All of the clinics will be located in leased space off base. While there are 17 clinics in the works, Rodarmer said that they have recently been asked to suggest four more clinics.

Jobs for the new clinics are being posted at www.cpol.army.mil and www.usajobs.com.

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