title: Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders.
abstract: BACKGROUND
  Little is known about the most important organizational factors and strategies for transforming primary care clinics into patient-centered medical homes (PCMHs), so we studied this in newly certified medical homes in Minnesota.
  
  
  METHODS
  We collected the following information from the first 120 clinics serving adults to be certified: (1) a 105-item survey about the presence and function of practice systems now and 3 years ago; (2) standardized composite clinic performance measures for diabetes and cardiovascular disease; and (3) a 44-item survey about PCMH transformation derived from 31 qualitative interviews about barriers, facilitators, and change strategies with participants from 9 diverse clinics.
  
  
  RESULTS
  The response rates for the systems survey was 92.5% and was 98.3% for the survey about transformation. Nearly all the items from the qualitative interviews identified as potentially important for transformation were strongly endorsed. Eighteen items in this survey also correlated significantly (P = <.01) with change in practice systems at the level of r ≥ 0.20. However, there was little relationship between these items and either absolute levels of systems or performance on composite measures of diabetes or vascular disease quality outcomes.
  
  
  CONCLUSIONS
  Many items in the survey about transformation seem to have face validity for leaders of certified PCMHs and to be associated with the extent to which their clinics have made systems changes. While clinics may need to find their own unique path to transformation, the items identified here should be considered in those decisions.
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ. Leif.I.Solberg@HealthPartners.com.
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: A Lauren
authors.initials: AL
authors.lastname: Crain
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Juliana O
authors.initials: JO
authors.lastname: Tillema
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Fontaine
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Whitebird
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Thom J
authors.initials: TJ
authors.lastname: Flottemesch
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.affiliation: From the HealthPartners Institute for Education and Research, Minneapolis MN (LIS, ALC, JOT, PLF, RRW, TJF); the National Committee for Quality Assurance, Washington, DC (SHS); and the Department of Family Medicine (BFC), Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D006801:Humans; D008910:Minnesota; D018802:Patient-Centered Care / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D011787:Quality of Health Care
keywords: Medical Home; Organizational Innovation; Patient-Centered Care; Primary Health Care; Quality of Health Care