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Why Risk-Stratifying is Important
Ability to risk-stratify patients is one of the major differences between beginning and advanced PCMHs. While beginning PCMHs have their hands full just establishing a patient/disease registry, identifying patients with target conditions, and flagging gaps in care, the more advanced PCMHs are able to sort patients into high, moderate, and low-risk categories. (Note -- for all practical purposes, "risk" here means "risk of hospital admission").
Risk-Stratifying Patients - Two Example Approaches
Early findings from our primary care/medical home benchmarking initiative provide a quantitative snapshot of medical homes investing in more clinical support staff per physician and taking on new site-level functions.
PCMH Staff Data: Benchmarks Suggest Transformation in Staff Model, Site Functions