title: Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.
abstract: International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority.
authors: VISN 23 Patient Aligned Care Team Demonstration Lab and, CADRE, the Center for Comprehensive Access & Delivery Research and Evaluation Department of Veterans Affairs Iowa City VA Health Care System and Division of General Internal Medicine University of Iowa Carver College of Medicine.
authors: Samantha L
authors: SL
authors: Solimeo
authors: VISN 23 Patient Aligned Care Team Demonstration Lab, Department of Veterans Affairs, Iowa City VA Health Care System and Division of Family Medicine Oregon Health and Science University and CIVIC (Center to Improve Veteran Involvement in Care), Department of Veterans Affairs VA Portland Health Care System.
authors: Sarah S
authors: SS
authors: Ono
authors: VISN 23 Patient Aligned Care Team Demonstration Lab and, CADRE, the Center for Comprehensive Access & Delivery Research and Evaluation Department of Veterans Affairs Iowa City VA Health Care System.
authors: Kenda R
authors: KR
authors: Stewart
authors: VISN 23 Patient Aligned Care Team Demonstration Lab, Department of Veterans Affairs Iowa City VA Health Care System.
authors: Michelle A
authors: MA
authors: Lampman
authors: VISN 23 Patient Aligned Care Team Demonstration Lab and, CADRE, the Center for Comprehensive Access & Delivery Research and Evaluation Department of Veterans Affairs Iowa City VA Health Care System and Division of General Internal Medicine University of Iowa Carver College of Medicine.
authors: Gary E
authors: GE
authors: Rosenthal
authors: VISN 23 Patient Aligned Care Team Demonstration Lab and, CADRE, the Center for Comprehensive Access & Delivery Research and Evaluation Department of Veterans Affairs Iowa City VA Health Care System and Tippie College of Business, University of Iowa.
authors: Greg L
authors: GL
authors: Stewart
mesh_terms: D060432:Anthropology, Medical; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D010348:Patient Care Team; D018802:Patient-Centered Care; D011320:Primary Health Care; D014481:United States / Q000208:ethnology; D014493:United States Department of Veterans Affairs; D016526:Workload
keywords: Department of Veterans Affairs; ethnography; medical home; medical receptionists; primary health care