Investing in Relationship

The medical home is just that, a "home" where someone feels welcome, known, and part of a community. The ongoing relationship with patients provides insight into the complexity of their health care needs and honors the interaction between multiple health perspectives. It allows the clinician to use evidence-based guidelines while realizing that variability is the norm. The best care for one individual may not be best for another. Patient-centered care recognizes that care should be focused on the needs of the individual patient, not simply on a disease state. Ideally, the goal should be "relationship centered," encouraging attention to the unique needs of the patient to be well. Thus, creating healing relationships is a core goal of an effective medical home (Chez and Jonas, 2005).

The evidence for the benefits of continuous, relationship-centered primary care is solid and growing. It has been found to improve quality of care (Starfield, 1991), reduce expenditures on diagnostic testing (Epstein et al., 2005), reduce hospital admissions (Gill and Mainous, 1998), and lower total health care costs (De Maeseneer et al., 2003). Having continuous, ongoing relationships with patients is often cited as the most rewarding aspect of being a family physician (Fairhurst and May, 2006). A systematic review of controlled trials on effective "team care," where relationship-centered factors are formalized in the care process, has demonstrated reduced mortality and morbidity, improved morale of health care workers, and reduced costs of health care (Safran et al., 2006).

One health care system that restructured its whole organization around establishing long-term, trusting, accountable relationships is the Southcentral Foundation Alaska Native Health Care model (Eby, 2007). This was the main request of the leaders of native Alaskans when they were asked what they wanted most in their public-owned health care system. Above all else, they valued the relationship with their physician, someone who "listens to them, takes time to explain things and who is able to coordinate effectively their overall care" (Gottlieb, 2007). The system made this its primary objective. After transforming their health model in 1999, urgent care and emergency department utilization decreased by 40%, specialist utilization by 50%, and hospitalization days by 30%. Customer satisfaction surveys showed that 91% rated their overall care as "favorable" (Gottlieb et al., 2008).

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