The most used and most helpful facilitators for patient-centered medical home implementation.
BACKGROUND
Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources. Even though PCMH and PCMH-like models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation. The purpose of this study was to assess which PCMH-implementation resources are most widely used, by whom, and which resources primary care personnel find most helpful.


METHODS
This study is an analysis of data from a cross-sectional survey of primary care personnel in the Veterans Health Administration in 2012, in which respondents were asked to rate whether they were aware of and accessed PCMH-implementation resources, and to rate their helpfulness. Logistic regression was used to produce odds ratios for the outcomes (1) resource use and (2) resource helpfulness. Respondents were nested within clinics, nested, in turn, within 135 parent hospitals.


RESULTS
Teamlet huddles were the most widely accessed (80.4% accessed) and most helpful (90.4% rated helpful) resource; quality-improvement methods to conduct small tests of change were the least frequently accessed (42.4% accessed) resource though two-thirds (66.7%) of users reported as helpful. Supervisors were significantly more likely (ORs, 1.46 to 1.86) to use resources than non-supervisors but were less likely to rate the majority (8 out of 10) of resources as "somewhat/very helpful" than non-supervisors (ORs, 0.72 to 0.84). Longer-tenured employees tended to rate resources as more helpful.


CONCLUSIONS
These findings are the first in the PCMH literature that we are aware of that systematically assesses primary care staff's access to and the helpfulness of PCMH implementation resources. Supervisors generally reported greater access to resources, relative to non-supervisors, but rated resources as less helpful, suggesting that information about them may not have been optimally disseminated. Knowing what resources primary care staff use and find helpful can inform administrators' and policymakers' investments in PCMH-implementation resources. The implications of our model extend beyond just PCMH implementation but also to considerations when providing implementation resources for other complex quality-improvement initiatives.
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 790 Willow Road, Menlo Park, CA, 94025, USA. Randall.Gale@va.gov.
Randall C
RC
Gale
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 790 Willow Road, Menlo Park, CA, 94025, USA. Steven.Asch@va.gov.|Division of General Medical Disciplines, Stanford University, Palo Alto, CA, USA. Steven.Asch@va.gov.
Steven M
SM
Asch
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 790 Willow Road, Menlo Park, CA, 94025, USA. Thomas.Taylor4@va.gov.
Thomas
T
Taylor
US Department of Veterans Affairs, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. Karin.Nelson@va.gov.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Karin.Nelson@va.gov.|Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. Karin.Nelson@va.gov.
Karin M
KM
Nelson
College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA. Jeff.Luck@oregonstate.edu.
Jeff
J
Luck
VA HSR&D Center for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA. seidel@rand.org.|RAND Corporation, Santa Monica, CA, USA. seidel@rand.org.
Lisa S
LS
Meredith
US Department of Veterans Affairs, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. Christian.Helfrich@va.gov.|Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. Christian.Helfrich@va.gov.
Christian D
CD
Helfrich
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D016730:Program Development; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D055815:Young Adult