title: A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.
abstract: OBJECTIVE
  To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms.
  
  
  METHODS
  Systematic review of peer-reviewed literature.
  
  
  METHODS
  PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012.
  
  
  METHODS
  Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model.
  
  
  METHODS
  One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness.
  
  
  RESULTS
  Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance.
  
  
  CONCLUSIONS
  This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.
authors.affiliation: Centre of Research Excellence in Primary Health Care Microsystems, University of Queensland, Brisbane, QLD, Australia. t.janamian1@uq.edu.au.
authors.forename: Tina
authors.initials: T
authors.lastname: Janamian
authors.affiliation: Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Jackson
authors.affiliation: Faculty of Medicine, James Cook University, Townsville, QLD, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Glasson
authors.affiliation: Mater-UQ Centre for Primary Healthcare Innovation, Mater Health Services, Brisbane, QLD, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Nicholson
mesh_terms: D001315:Australia; D003431:Cross-Cultural Comparison; D005194:Family Practice / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration*; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D014481:United States