title: Unlocking the black box: supporting practices to become patient-centered medical homes.
abstract: BACKGROUND
  Despite widespread interest in supporting primary care transformation, few evidence-based strategies for technical assistance exist. The Safety Net Medical Home Initiative (SNMHI) sought to develop a replicable and sustainable model for Patient-centered Medical Home practice transformation.
  
  
  OBJECTIVE
  This paper describes the multimodal technical assistance approach used by the SNMHI and the participating practices' assessment of its value and helpfulness in supporting their transformation.
  
  
  RESULTS
  Components of the technical assistance framework included: (1) individual site-level coaching provided by local medical home facilitators and supplemented by expert consultation; (2) regional and national learning communities of participating practices that included in-person meetings and field trips; (3) data monitoring and feedback including longitudinal feedback on medical home implementation as measured by the Patient-centered Medical Home-A; (4) written implementation guides, tools, and webinars relating to each of the 8 Change Concepts for Practice Transformation; and (5) small grant funds to support infrastructure and staff development. Overall, practices found the technical assistance helpful and most valued in-person, peer-to-peer-learning opportunities. Practices receiving technical assistance from membership organizations with which they belonged before the SNMHI scored higher on measures of medical home implementation than practices working with organizations with whom they had no prior relationship.
  
  
  CONCLUSIONS
  There is an important role for both local and national organizations to provide nonduplicative, mutually reinforcing support for primary care transformation. How (in-person, between-peers) and by whom technical assistance is provided may be important to consider.
authors.affiliation: *MacColl Center for Health Care Innovation, Group Health Research Institute †Qualis Health ‡NVB Consulting Inc., Seattle, WA §American Medical Association, Chicago, IL.
authors.forename: Katie
authors.initials: K
authors.lastname: Coleman
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Phillips
authors.forename: Nicole
authors.initials: N
authors.lastname: Van Borkulo
authors.forename: Donna M
authors.initials: DM
authors.lastname: Daniel
authors.forename: Karin E
authors.initials: KE
authors.lastname: Johnson
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Sugarman
mesh_terms: D003120:Colorado; D006284:Health Plan Implementation; D006302:Health Services Research; D006801:Humans; D007061:Idaho; D008404:Massachusetts; D017146:Models, Organizational; D009922:Oregon; D018802:Patient-Centered Care / Q000458:organization & administration*; D010414:Pennsylvania; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D011785:Quality Assurance, Health Care; D064876:Safety-net Providers / Q000458:organization & administration*