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Patient-Centered Medical Home

Clinica Sierra Vista is Joint Commission Certified as Patient Centered Medical Home
As your Patient-Centered Medical Home, we will work to provide comprehensive coordinated care, accessible services, and apply a system-based approach to quality and safety. Our goal is to provide quality medical care which is easily accessible and responsive to you in your time of need. Our staff includes a comprehensive interdisciplinary team of professionals who will consistently strive to exceed your expectations, and ensure that your experience with us is as comfortable and stress-free as possible.

What is a Patient Centered Medical Home(PCMH)?

The PCMH model of care puts patients and families at the forefront of care, building relationships between people and their interdisciplinary team of professionals.

The National Committee of Quality Assurance (NCQA) has specific standards and guidelines structured around six principles of PCMH:

  • Team-Based Care and Practice Organization: Provides structure for practice leadership, care team responsibilities and partnerships with patients, families and caregivers.
  • Know and Manage Patients: Sets standards for data collection, medication reconciliation, evidence-based clinical decision support and other activities.
  • Patient-Centered Access and Continuity: To provide patients with convenient access to clinical advice and helps ensure continuity of care.
  • Care Management and Support: Helps clinicians set up care management protocols to identify patients who need more closely-managed care.
  • Care Coordination and Care Transitions: Ensures that primary and specialty care clinicians are effectively sharing information and managing patient referrals to minimize cost, confusion and inappropriate care.
  • Performance Measurement and Quality Improvement: Helps practices develop ways to measure performance, set goals and develop activities that will improve performance.
  • CSV Patient-Centered Medical Home Responsibilities

    • You will see the same team at each visit, and they will assist you in coordinating care with other providers, specialists, and community resources if needed.
    • Your medical home team will have an ongoing relationship with you and your family to manage your healthcare needs.
    • Your team will have access to all of your health information through electronic records in order to effectively manage your care.
    • You will have easy access to care through open scheduling, expanded hours and other methods of communication with your team

    Together, you and your team can work on a plan that:

    • Is personalized or created just for you
    • Is coordinated with other healthcare providers
    • Connects you with your healthcare team

    How you can help?

    • Discuss your health concerns with your team. Be honest about your history, symptoms, current medications and any changes in your health.
    • Share your past healthcare successes and challenges.
    • Tell your team about other healthcare professionals you see
    • Follow the healthcare plan you and your team have talked about. Make sure you understand how to follow the plan and set goals you can reach. Once you begin to see results, you and your team can discuss adding new goals.
    • Tell your care team if you are having trouble sticking with your care plan.
    • Speak up if your care plan is not working. Tell your team what is not working so that, together, you can make changes if needed.

    Other steps to successful health outcomes:

    • Ask your team about how to reach them after hours.
    • Use your own words to repeat back the things you’ve discussed with your team.
    • Write down the names of your health team members.
    • Before you leave the office, be sure you know the things you need to do before your next appointment.
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