Pittsburgh is among five areas nationally in which designated primary care safety net clinics are participating in a four-year initiative to become high-performing, patient-centered medical homes.

Like the patient- and family-centered care paradigm being put in place in hospitals, patient-centered medical homes put patients first while providing comprehensive primary care that is well-coordinated and integrated across all levels of health care.

"A patient-centered medical home is a model that provides a framework for organizing primary care to meet a patient's need," said Tina Hahn, medical home facilitator for the Pittsburgh Regional Health Initiative. The collaborative group is overseeing the 10 local primary care sites in the national initiative being supported by the Commonwealth Fund.

Dr. Keith Kanel, chief medical officer at PRHI and medical director for the Safety Net Medical Home Initiative, said there has been increasing recognition that seeing one's doctor only in his office "was probably not the best way of giving care.

"Care doesn't have to [be in an office]. It can be by extender -- like a physician assistant -- by telephone or by computer. ... It's best done at home in the community. It's more convenient for the patient and leads to a better outcome," Dr. Kanel added.

"The emphasis is on care coordination and maintaining contact with your team. The physician has a team rather than being by himself or herself."

Executive director Lynne Medley-Long of the participating East Liberty Family Health Care Center and its associate executive director, David R. Brewton, talked about how patient-centered care is practiced at their facilities.

"When managed care came into vogue, the primary care physician was the gatekeeper to the whole system," Mr. Brewton said. "We take a relational approach to that. We get to know the patient as a whole person. The doctors are spending more time because they want to know the whole person inside out. ...

"We just take the time to get to know them, offer prayer with them."

He added, "we make sure we don't stop with their medical needs. We also take care of their social needs, their mental health needs."

Ms. Medley-Long offered what she called "another example of patient-centered care focused around the individual, family and community": the East Liberty health center's partnership with the University of Pittsburgh's Healthy Black Family Project.

"We monitor our high-risk diabetic patients on the medical side. ... We develop significant goals for improving the health outcomes for those individual patients that are all defined clinical practice standards for the care of diabetics."

The guidelines include such goals as healthy eating, healthy behavior and exercise. "That's what our partnership with the Healthy Black Family Project is," Ms. Medley-Long said.

The goals of this national demonstration project are two-fold, she said.

One is to meet criteria to be be recognized by the National Center for Quality Assurance as a patient-centered medical home. The other is to change the model for reimbursement for federally qualified health centers to include payment for the costs of whole-person health care, which include disease prevention efforts.

Ten individual primary care sites representing seven corporate entities are participating in the Safety Net Medical Home Initiative here in Pittsburgh.

Besides East Liberty, which has two sites, the other six clinics are North Side Christian Health Center, which has two sites; Metro Family Practice Inc. in Wilkinsburg; Sto-Rox Neighborhood Family Health Center, with two sites; Squirrel Hill Health Center; Beaver Falls Primary Care; and Matilda Theiss Health Center, part of the University of Pittsburgh Medical Center.

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