Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home.
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.
University of Colorado Health Sciences Center and Director of Research, Center for Research Strategies, 225 E. 16th Ave, Suite 1150, Denver, Colorado, USA. Paul.Nutting@CRSLLC.org
Paul A
PA
Nutting
William L
WL
Miller
Benjamin F
BF
Crabtree
Carlos Roberto
CR
Jaen
Elizabeth E
EE
Stewart
Kurt C
KC
Stange
D018166:Health Care Reform / Q000379:methods*; D006291:Health Policy; D006801:Humans; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods; D012955:Societies, Medical; D014481:United States