title: Medical home infrastructure: effect of the environment and practice characteristics on adoption in Virginia.
abstract: This study examined whether environmental factors and practice characteristics influence the existence of patient-centered medical home elements in family practices in Virginia. The study used multiple secondary data sets to measure the external environment and a survey of family practices to enumerate and describe medical home elements and practice environment. Results show a positive association between organizational slack, organizational relationships, and stakeholder expectations on the existence of medical home elements. A negative association was found between competition and medical home elements. Medicare and managed care penetration were not associated with medical home elements. The ability or willingness, or both, of family practices to innovate along the patient-centered medical home model is constrained by important institutional and resource dependencies, and policy makers should take these constraints into account if there is to be widespread adoption of a medical home approach to fee-for-service practices.
authors.affiliation: Virginia Commonwealth University, Grant House, 1008 East Clay Street, PO Box 980203, Richmond, VA 23298-0203, USA. goetzdc@vcu.edu
authors.forename: Debora Goetz
authors.initials: DG
authors.lastname: Goldberg
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Mick
mesh_terms: D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D005194:Family Practice / Q000458:organization & administration* / Q000639:trends; D006297:Health Services Accessibility; D006694:Holistic Health; D006801:Humans; D017146:Models, Organizational; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012044:Regression Analysis; D014768:Virginia