title: Recognition as a patient-centered medical home: fundamental or incidental?
abstract: OBJECTIVE
  Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.
  
  
  METHODS
  As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audio-recorded and fully transcribed. Transcripts were analyzed and thematically coded.
  
  
  RESULTS
  PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients first. Motivations for implementing specific PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics.
  
  
  CONCLUSIONS
  Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dohan
authors.forename: Mary Honodel
authors.initials: MH
authors.lastname: McCuistion
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
mesh_terms: D006801:Humans; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care
keywords: change; incentives; motivation; organizational; organizational case studies; patient-centered medical home; practice-based research