title: Building the foundation for health system transformation: Oregon's Patient-Centered Primary Care Home program.
abstract: OBJECTIVE
  Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregon's Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers.
  
  
  METHODS
  We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process.
  
  
  RESULTS
  Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships.
  
  
  CONCLUSIONS
  This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in-or considering-similar system reform efforts.
authors.affiliation: Mark O. Hatfield School of Government, Portland State University, Portland, Oregon (Drs Rissi and Gelmon and Ms Baker); Patient-Centered Primary Care Home Program, Oregon Health Authority, Salem, Oregon (Dr Saulino and Ms Merrithew); Providence Portland Medical Center, Portland, Oregon (Dr Saulino), St Luke Physician Clinic, Marion, Kansas (Dr Hatcher); and Oregon Health & Science University, Portland, Oregon (Dr Hatcher).
authors.forename: Jill Jamison
authors.initials: JJ
authors.lastname: Rissi
authors.forename: Sherril
authors.initials: S
authors.lastname: Gelmon
authors.forename: Evan
authors.initials: E
authors.lastname: Saulino
authors.forename: Nicole
authors.initials: N
authors.lastname: Merrithew
authors.forename: Robin
authors.initials: R
authors.lastname: Baker
authors.forename: Paige
authors.initials: P
authors.lastname: Hatcher
mesh_terms: D003191:Comprehensive Health Care / Q000379:methods*; D006801:Humans; D009922:Oregon; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care; D011795:Surveys and Questionnaires