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Articles   |    
A Comparison of Assertive Community Treatment Fidelity Measures and Patient-Centered Medical Home Standards
Erik R. Vanderlip, M.D.; Joseph M. Cerimele, M.D.; Maria Monroe-DeVita, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200469
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The authors are with the Department of Psychiatry and Behavioral Health, University of Washington, Box 356560, 1959 Pacific St., Seattle, WA 98195 (e-mail: ervander@uw.edu).

Copyright © 2013 by the American Psychiatric Association


Objective  This study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation.

Methods  The authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards.

Results  PCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy “must-pass” elements of the standards.

Conclusions  ACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases.

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Figure 1 Scores for ACT program standards and fidelity measures, by implicit or explicit satisfaction of the NCQA standards for accreditation of the PCMHa

aACT, assertive community treatment; NCQA, National Committee for Quality Assurance; PCMH, patient-centered medical home; TMACT, Tool for Measurement of Assertive Community Treatment; and DACTS, Dartmouth Assertive Community Treatment Scale. A total of 23 points could be earned by comprehensive use of electronic medical records.

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Table 1Overlap of factors in elements of the NCQA standards for accreditation of the PCMH with ACT measures and program standardsa
Table Footer Note

a NCQA, National Committee for Quality Assurance; PCMH, patient-centered medical home; and ACT, assertive community treatment. Points per element are weighted and do not correlate to factors in each element. Possible scores range from 0 to 100, with higher scores indicating higher levels of accreditation.

Table Footer Note

b Dartmouth Assertive Community Treatment Scale

Table Footer Note

c Tool for Measurement of Assertive Community Treatment

Table Footer Note

d Must-pass element: a practice must satisfy 50% of the factors within this element to be accredited.



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