title: Undergoing transformation to the patient centered medical home in safety net health centers: perspectives from the front lines.
abstract: OBJECTIVE
  Safety net health centers (SNHCs), which include federally qualified health centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the patient centered medical home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs.
  
  
  METHODS
  This qualitative study characterizes early PCMH adoption experiences at SNHCs.
  
  
  METHODS
  We interviewed 98 staff (administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative.
  
  
  METHODS
  We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH.
  
  
  RESULTS
  Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback.
  
  
  CONCLUSIONS
  SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved health care delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL 60637, USA. mquinn@medicine.bsd.uchicago.edu
authors.forename: Michael T
authors.initials: MT
authors.lastname: Quinn
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Gunter
authors.forename: Robert S
authors.initials: RS
authors.lastname: Nocon
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lewis
authors.forename: Anusha M
authors.initials: AM
authors.lastname: Vable
authors.forename: Hui
authors.initials: H
authors.lastname: Tang
authors.forename: Seo-Young
authors.initials: SY
authors.lastname: Park
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
authors.forename: Jonathan
authors.initials: J
authors.lastname: Birnberg
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Burnet
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Summerfelt
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
mesh_terms: D001291:Attitude of Health Personnel; D003151:Community Health Centers / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D010563:Personnel Turnover; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D058996:Quality Improvement; D014481:United States
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