title: Correlation of the Care by Design primary care practice redesign model and the principles of the patient-centered medical home.
abstract: BACKGROUND
  Health care reform requires major changes in the organization and delivery of primary care. In 2003, the University of Utah Community Clinics began developing Care by Design (CBD), a primary care model emphasizing access, care teams, and planned care. In 2007, leading primary care organizations published joint principles of the patient-centered medical home (PCMH), the basis for recognition of practices as PCMHs by the National Committee for Quality Assurance (NCQA). The objective of this study was to compare CBD and PCMH metrics conceptually and statistically.
  
  
  METHODS
  This was an observational study in 10 urban and rural primary care clinics including 56 providers. A self-evaluation included the CBD Extent of Use survey and self-estimated PCMH values. The main and secondary outcome measures were CBD scores and PCMH values, respectively.
  
  
  RESULTS
  CBD and PCMH principles share common themes such as appropriate access, team-based care, the use of an augmented electronic medical record, planned care, and self-management support. CBD focuses more on the process of practice transformation. The NCQA PCMH standards focus more on structure, including policy, capacity, and populated electronic medical record fields. The Community Clinics' clinic-level PCMH/CBD correlations were low (P > .05.)
  
  
  CONCLUSIONS
  Practice redesign requires an ability to assess uptake of the redesign as a transformation progresses. The correlation of CBD and PCMH is substantial conceptually but low statistically. PCMH and CBD focus on complementary aspects of redesign: PCMH on structure and CBD on process. Both domains should be addressed in practice reform. Both metrics are works in progress.
authors.affiliation: Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA. marlene.egger@hsc.utah.edu
authors.forename: Marlene J
authors.initials: MJ
authors.lastname: Egger
authors.forename: Julie
authors.initials: J
authors.lastname: Day
authors.forename: Debra L
authors.initials: DL
authors.lastname: Scammon
authors.forename: Yao
authors.initials: Y
authors.lastname: Li
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Michael K
authors.initials: MK
authors.lastname: Magill
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration; D057286:Electronic Health Records / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration; D006785:Hospitals, University; D006801:Humans; D033183:Interdisciplinary Communication; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D013223:Statistics as Topic; D014589:Utah