title: Medical home transformation: a gradual process and a continuum of attainment.
abstract: OBJECTIVE
  The patient-centered medical home is often discussed as though there exist either traditional practices or medical homes, with marked differences between them. We analyzed data from an evaluation of certified medical homes in Minnesota to study this topic.
  
  
  METHODS
  We obtained publicly reported composite measures for quality of care outcomes pertaining to diabetes and vascular disease for all clinics in Minnesota from 2008 to 2010. The extent of and change in practice systems over that same time period for the first 120 clinics serving adults certified as health care homes (HCHs) was measured by the Physician Practice Connections Research Survey (PPC-RS), a self-report tool similar to the National Committee for Quality Assurance standards for patient-centered medical homes. Measures were compared between these clinics and 518 non-HCH clinics in the state.
  
  
  RESULTS
  Among the 102 clinics for which we had precertification and postcertification scores for both the PPC-RS and either diabetes or vascular disease measures, the mean increase in systems score over 3 years was an absolute 29.1% (SD = 16.7%) from a baseline score of 38.8% (SD = 16.5%, P ≤.001). The proportion of clinics in which all patients had optimal diabetes measures improved by an absolute 2.1% (SD = 5.5%, P ≤.001) and the proportion in which all had optimal cardiovascular disease measures by 4.4% (SD = 7.5%, P ≤.001), but all measures varied widely among clinics. Mean performance rates of HCH clinics were higher than those of non-HCH clinics, but there was extensive overlap, and neither group changed much over this time period.
  
  
  CONCLUSIONS
  The extensive variation among HCH clinics, their overlap with non-HCH clinics, and the small change in performance over time suggest that medical homes are not similar, that change in outcomes is slow, and that there is a continuum of transformation.
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota 55440-1524, USA. Leif.I.Solberg@HealthPartners.com
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: A Lauren
authors.initials: AL
authors.lastname: Crain
authors.forename: Juliana
authors.initials: J
authors.lastname: Tillema
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.forename: Patricia
authors.initials: P
authors.lastname: Fontaine
authors.forename: Robin
authors.initials: R
authors.lastname: Whitebird
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy; D019538:Health Care Surveys; D006801:Humans; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D014652:Vascular Diseases / Q000628:therapy
keywords: certification; change; organizational; patient-centered medical home; practice-based research; primary care