Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home

University of Colorado Health Sciences Center and Director of Research, Center for Research Strategies, 225 E. 16th Ave, Suite 1150, Denver, Colorado, USA.
The Annals of Family Medicine (Impact Factor: 4.57). 05/2009; 7(3):254-60. DOI: 10.1370/afm.1002
Source: PubMed

ABSTRACT The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, along with a 3-tiered recognition process of the National Committee on Quality Assurance, are influencing the design and implementation of many demonstrations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices. The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys. Early lessons from the real-time qualitative analysis of the NDP raise some serious concerns about the current direction of many of the proposed PCMH demonstration projects and point to some positive opportunities. We describe 6 early lessons from the NDP that address these concerns and then offer 4 recommendations for those assisting the transformation of primary care practices and 4 recommendations for individual practices attempting transformation.

Download full-text


Available from: Carlos Roberto Jaén, Aug 19, 2015
1 Follower
  • Source
    • "In this study we collected outpatient data from a random sample of 888 different facilities (which corresponds to 130 VAMCs of all 23 VISNs) during FY11 quarter 3 to FY12 quarter 2. To achieve a better picture of the data environment, we tentatively arranged all independent attributes into five groups as summarized in Table 1[14] [15]. It should be noted that these variables remain the same for a patient during the fiscal year. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recently the patient centered medical home (PCMH) model has become a popular approach to deliver better care to patients. Current research shows that the most important key for succession of this method is to make balance between healthcare supply and demand. Without such balance in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non continuity of care will eliminate many advantages of the medical home strategy. To reach this end we need to have information about both supply and demand in healthcare system. Healthcare supply can be calculated easily based on head counts and available hours which is offered by professionals for a specific time period while healthcare demand is not easy to calculate, and it is affected by some healthcare, diagnostic and demographic attributes. In this paper, by extending the hierarchical generalized linear model to include multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. Our analyses of a recent data from Veteran Health Administration indicate that our prediction model works for clinical data with high performance.
  • Source
    • "Also, despite the importance of providing care that meets patients' needs and preferences and recognizes the role of patients and family members as part of the care team, patients with multiple chronic conditions frequently do not receive patient-centered care (Haywood, Marshall, & Fitzpatrick, 2006). National and local payers and providers have made substantial investments in efforts intended to improve the integration of patient care, such as accountable care organizations (McClellan, McKethan, Lewis, & Roski, 2010), patient-centered medical homes (Nutting et al., 2009), meaningful use of electronic health records (Center for Medicare and Medicaid Services, 2010) and episode-and performance-based payments (Rosenthal, 2008). Whether these initiatives will result in better integrated patient care—and better health outcomes and lower costs of care—is an important empirical question. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Valid measures of the integration of patient care could provide rapid and accurate feedback on the successfulness of current efforts to improve health care delivery systems. This article describes the development and pilot testing of a new survey, based on a novel conceptual model, which measures the integration of patient care as experienced by patients. We administered the survey to 1,289 patients with multiple chronic conditions from one health system and received responses from 527 patients (43%). Psychometric analysis of responses supported a six-dimension model of integration with satisfactory internal consistency, discriminant validity, and goodness of fit. The Patient Perceptions of Integrated Care survey can be used to measure the integration of care received by chronically ill patients for two main purposes: as a research tool to compare interventions intended to improve the integration of care and as a quality improvement tool intended to guide the refinement of delivery system innovations.
    Medical Care Research and Review 11/2012; 70(2). DOI:10.1177/1077558712465654 · 2.57 Impact Factor
  • Source
    • "Practices must account for their patient panels, location, and financial resources when creating policies. The practices must then decide whether it would better suit their needs to attempt the transformation incrementally or all at once [7]. Once these policies have been written, implemented, and then the outcomes documented, the practice can apply for NCQA recognition through an online survey that collects information regarding its guidelines about administration (appointments, access, telephone calls), clinical services (patient satisfaction, tracking critically important conditions), and performance tracking [8] [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients' needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.
    International Journal of Telemedicine and Applications 08/2012; 2012(1687-6415):103685. DOI:10.1155/2012/103685
Show more