title: The safety net medical home initiative: transforming care for vulnerable populations.
abstract: BACKGROUND
  Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries.
  
  
  OBJECTIVE
  To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations.
  
  
  METHODS
  Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period. To guide transformation, we developed a framework of change concepts aligned with supporting tools including implementation guides, activity checklists, and measurement instruments.
  
  
  METHODS
  Sixty-five health centers, homeless clinics, private practices, residency training centers, and other safety net practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania.
  
  
  METHODS
  We evaluated implementation of the change concepts using the Patient-Centered Medical Home-Assessment, and conducted a survey of participating practices to assess perceptions of the impact of the technical assistance.
  
  
  RESULTS
  All practices implemented key features of the medical home model, and nearly half (47.6%) implemented the 33 identified key changes to a substantial degree as evidenced by level A Patient-Centered Medical Home-Assessment scores. Two thirds of practices that achieved substantial implementation did so only after participating in the initiative for >2 years. By the end of the initiative, 83.1% of sites achieved external recognition as medical homes.
  
  
  CONCLUSIONS
  Despite resource constraints and high-need populations, safety net clinics made considerable progress toward medical home implementation when provided robust, multimodal support over a 4-year period.
authors.affiliation: *Qualis Health †MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA ‡The Commonwealth Fund, One East 75th Street, New York, NY.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Sugarman
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Phillips
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: Katie
authors.initials: K
authors.lastname: Coleman
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Abrams
mesh_terms: D003120:Colorado; D006284:Health Plan Implementation; D006297:Health Services Accessibility; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D007061:Idaho; D008404:Massachusetts; D009922:Oregon; D018802:Patient-Centered Care; D010414:Pennsylvania; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D064876:Safety-net Providers; D035862:Vulnerable Populations