title: Support and strategies for change among small patient-centered medical home practices.
abstract: OBJECTIVE
  We aimed to determine the motivations and barriers facing small practices that seek to adopt the patient-centered medical home (PCMH) model, as well as the type of help and strategies they use.
  
  
  METHODS
  We surveyed lead physicians at practices with fewer than 5 physicians, stratified by state and level of National Committee for Quality Assurance PCMH recognition, using a Web-based survey with telephone, fax, and mail follow-up. The response rate was 59%, yielding a total sample of 249 practices from 23 states.
  
  
  RESULTS
  Improving quality and patient experience were the strongest motivations for PCMH implementation; time and resources were the biggest barriers. Most practices participated in demonstration projects or received financial rewards for PCMH, and most received training or other kinds of help. Practices found training and help related to completing the PCMH application to be the most useful. Training for patients was both less common and less valued. The most commonly used strategies for practice transformation were staff training, systematizing processes of care, and quality measurement/goal setting. The least commonly endorsed strategy was involving patients in quality improvement. Practices with a higher level of PCMH recognition were more likely to have electronic health records, to report barriers, and to use measurement-based quality improvement strategies.
  
  
  CONCLUSIONS
  To spread the adoption of the PCMH model among small practices, financial support, practical training, and other help are likely to continue to be important. Few practices involved patients in their implementation, so it would be helpful to test the impact of greater patient involvement in the PCMH.
authors.affiliation: National Committee for Quality Assurance, Washington, DC 20005, USA. scholle@ncqa.org
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morton
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Manasi A
authors.initials: MA
authors.lastname: Tirodkar
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Jaén
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D006123:Group Practice / Q000458:organization & administration*; D018166:Health Care Reform; D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement
keywords: change management; patient-centered medical home; practice-based research; primary care; quality improvement