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Dr. Blount's new book - the next chapters for IBH

Thursday, April 04, 2019


Alexander Blount, known to nearly everyone as "Sandy" is the founding director of the Center for Integrated Primary Care. His new book is 


For about 18 months I have been working on a book. 

Well, that’s not exactly right.  For 18 months I have been working on a book under contract to Springer.  I have early drafts of a proposal for this book going back to 2005.  

It took a long time for me to have a conception of the book that gave me a pathway to go forward when I had the time to write.  All the material, including all of the manuscript fixes recommended by the editorial crew, is done and has been submitted. 

The Patient-Centered Medical Home (PCMH), is an outgrowth of the 10 rules for a new healthcare from the “Quality Chasm” report of the Institute of Medicine in 2001. Patient-Centered Primary Care: Getting from Good to Great, the result of my labor, takes a look at the ways that PCMH has guided the implementation of some of those quality chasm rules and failed to achieve the goals of the Institute of Medicine for others.  (Crossing the Quality Chasm: A New Health System for the 21st Century. Editors Institute of Medicine (US) Committee on Quality of Health Care in America. Washington (DC): National Academies Press (US); 2001. Link)

Roughly speaking, PCMH has succeeded in implementing the practice transformation rules and failed to implement the rules for a fundamental change in the relationships between doctors and other health professionals, on one hand, and patients, on the other.  The kind of partnership, in which patients are fully part of the team that guides their own care, goes against so much of the training and socialization of health professionals and, for that matter, the expectations of many patients.   

This is particularly true for patients we sometimes call “complex” but just as well could call “disadvantaged,” “heartsink patients,” or “people with trauma histories.”  I call them “multiply-disadvantaged” patients.  To successfully serve these patients requires our best versions of team-based care, including behavioral health and care management team members, though every member of the team needs help in engaging these patients and mutual support in adapting to the rapid changes in roles that new team approaches are creating. 

The book offers a summary of the approaches that are currently in growing use, such as health literacy assessment, motivational interviewing, shared decision making, minimally disruptive care, trauma-centered care, enfranchisement coaching, relationship-centered care, and family-informed care.  It shows the problems that these methods can pose, either because they are challenges for the skills of the members of healthcare team or because they tend not to lead to full partnership for patients.  The book offers a transformative method, based on familiar elements, that is Transparent, Empowering, Activating, and Mutual:  the T.E.A.M. Way. 

Finally, Patient-Centered Primary Care: Getting from Good to Great shows how to develop a culture in a practice that can grow and retain a team that can enact this method and how to use data to support the method.

The excerpt below is from the Forward by Dr. Frank deGruy, Professor and Chair, Department of Family Medicine, University of Colorado School of Medicine:

For those of us laboring for the betterment of primary care, this modest volume by Sandy Blount is of outsized, even monumental importance.  Our efforts at advancing the field and thereby improving primary care have been stultified along the way by a number of complications and difficulties.  This book - exquisitely turned and perfectly timed - explains how we got here, dissects the elements of primary care that stubbornly resist improvement, and describes a way forward that is entirely within our capacities…. This volume is a perfect and perfectly timed gift to the field, a gift made of gifts; made out of what others have learned and bequeathed to the field, and of Sandy’s imagination, good thinking and formidable hard work.  I for one am deeply grateful for this book and have already begun using it to help patients be healthier.