title: Patient-centered medical home among small urban practices serving low-income and disadvantaged patients.
abstract: OBJECTIVE
  Research on the patient-centered medical home (PCMH) model and practice redesign has not focused on the unique challenges and strengths of very small primary care practices serving disadvantaged patient populations. We analyzed the practice characteristics, prior experiences, and dimensions of the PCMH model that exist in such practices participating in the Primary Care Information Project (PCIP) of the New York City Department of Mental Health and Hygiene.
  
  
  METHODS
  We obtained descriptive data, focusing on PCMH, for 94 primary care practices with 5 or fewer clinicians serving high volumes of Medicaid and minority patient populations in New York City. Data included information extracted from PCIP administrative data and survey data collected specifically for this study.
  
  
  RESULTS
  Survey results indicated substantial implementation of key aspects of the PCMH among small practices serving disadvantaged patient populations, despite considerable potential challenges to achieving PCMH implementation. Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.
  
  
  CONCLUSIONS
  Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies. The use of flexible, less formal strategies is important to keep in mind when considering implementation and assessment of PCMH-like initiatives in small practices.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York 10016, USA. Carolyn.berry@nyumc.org
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Berry
authors.forename: Tod
authors.initials: T
authors.lastname: Mijanovich
authors.forename: Stephanie
authors.initials: S
authors.lastname: Albert
authors.forename: Chloe H
authors.initials: CH
authors.lastname: Winther
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Paul
authors.forename: Mandy Smith
authors.initials: MS
authors.lastname: Ryan
authors.forename: Colleen
authors.initials: C
authors.lastname: McCullough
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
mesh_terms: D006801:Humans; D008484:Medicaid; D018802:Patient-Centered Care / Q000458:organization & administration*; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States; D019037:Urban Health Services; D035862:Vulnerable Populations
keywords: change; organizational; patient-centered medical home; practice-based research; primary care; vulnerable populations