title: Estimating the staffing infrastructure for a patient-centered medical home.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) offers an innovative method of delivering primary care. However, the necessary staffing infrastructure is not well established.
  
  
  OBJECTIVE
  To evaluate the roles of personnel within a PCMH and to propose necessary staffing ratios and associated incremental costs to implement this model of care.
  
  
  METHODS
  We sampled primary care clinical practices that either have successfully deployed or were in the process of implementing a PCMH practice model. We conducted targeted interviews of administrators from these practices and reviewed published literature on the personnel roles within a PCMH. Collectively, these data were compared with current staffing standards and used to inform an analytical model and sensitivity analysis.
  
  
  RESULTS
  Primary care practices that successfully transitioned to a PCMH have incorporated a range of new staff and functionalities. Based on our model, we estimated that 4.25 full-time equivalents (FTEs) should be allocated to staffing personnel per 1 physician FTE. Compared with the base-case model of current staffing in the United States of 2.68 FTEs per physician FTE, this is a 59% increase. After applying sensitivity analysis for variability in staffing and compensation, the incremental staffing FTE per physician FTE was 1.57 (range 1.41-1.73) and the incremental associated cost per member per month was $4.68 (range $3.79-$6.43).
  
  
  CONCLUSIONS
  Our study suggests that additional staff with specific expertise and training is necessary to implement a PCMH. Further study and opportunities for funding additional staffing costs will be important for realizing the potential of the PCMH model of care.influence clinical recognition of depression among diabetes patients from different racial/ethnic groups, and the potential impact of low rates of clinical recognition on quality of care.
authors.affiliation: Philadelphia Veteran Affairs Medical Center, Philadelphia, PA, USA. mpatel@mail.med.upenn.edu
authors.forename: Mitesh S
authors.initials: MS
authors.lastname: Patel
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Arron
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sinsky
authors.forename: Eric H
authors.initials: EH
authors.lastname: Green
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bowen
authors.forename: Susan
authors.initials: S
authors.lastname: Day
mesh_terms: D006270:Health Facility Administrators / Q000523:psychology; D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D058007:Physicians, Primary Care / Q000600:supply & distribution; D011320:Primary Health Care; D036301:Qualitative Research; D014481:United States; D000078329:Workforce