Patient-Centered Medical Home


Patient-Centered Medical Home

South County Medical Group Primary Care East Greenwich, Wakefield, and Westerly are Patient Centered Medical Homes (PCMH). In a PCMH, the focus of the medical practice is on the entire patient and specifically on disease prevention. Despite its name, PCMHs are not “homes” but medical practices that have met specific criteria set by the National Committee for Quality Assurance.

How does a PCMH differ from a traditional primary care practice? 
PCMHs coordinate all aspects of care for their patients, emphasizing the use of preventive care and regular screenings and supporting people with diabetes, depression, and other chronic diseases in new and innovative ways.

Patient-Focused Care

  • Treats the whole person through all stages of life
  • Puts the needs of the patient first
  • Engages patients in their care
  • Provides self-management direction and counseling

Care Coordination

  • Referrals to specialists and other community agencies
  • Post-hospital follow-up, electronically or by telephone
  • Assistance in navigating the medical system
  • After-hours access to doctor or nurse

Clinical Information Settings

  • Patient registries and electronic prescribing
  • Monitor follow through treatment
  • Access to labs and test results
  • Reminders, decision support, and treatment information
  • Safe/efficient prescribing practices

Patient Responsibility

  • Patients and their caregivers/families are active decision makers in their care plans
  • Communication between patients and their care team
  • Discuss any changes to your health or medications with your doctor
  • Keep your follow-up appointment

South County Health Family Medicine is proud to be your National Committee for Quality Assurance (NCQA) recognized Patient-Centered Medical Home.