title: Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers.
abstract: Implementation of a patient centered medical home challenges primary care providers to change their scheduling practices to enhance patient access to care as well as to learn how to use performance metrics as part of a self-reflective practice redesign culture. As medical homes become more commonplace, health care administrators and primary care providers alike are eager to identify barriers to implementation. The objective of this study was to identify non-technological barriers to medical home implementation from the perspective of primary care providers. We conducted qualitative interviews with providers implementing the medical home model in Department of Veterans Affairs clinics-the most comprehensive rollout to date. Primary care providers reported favorable attitudes towards the model but discussed the importance of data infrastructure for practice redesign and panel management. Respondents emphasized the need for administrative leadership to support practice redesign by facilitating time for panel management and recognizing providers who utilize non-face-to-face ways of delivering clinical care. Health care systems considering adoption of the medical home model should ensure that they support both technological capacities and vertically aligned expectations for provider performance.
authors.affiliation: US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Health Care System, Iowa City, IA 52246, United States; US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 152, Iowa City, IA 52246, United States. Electronic address: Samantha.Solimeo@va.gov.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Solimeo
authors.affiliation: US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Health Care System, Iowa City, IA 52246, United States; US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 152, Iowa City, IA 52246, United States; US Department of Veterans Affairs, Veteran Rural health Resource Center Central Region, Iowa City VA Health Care System, Iowa City, IA 52246, United States.
authors.forename: Kenda R
authors.initials: KR
authors.lastname: Stewart
authors.affiliation: US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Health Care System, Iowa City, IA 52246, United States; US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 152, Iowa City, IA 52246, United States; Tippie College of Business, University of Iowa, Iowa City, IA 52242, United States.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Stewart
authors.affiliation: US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Health Care System, Iowa City, IA 52246, United States; US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 152, Iowa City, IA 52246, United States; Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States; Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA 52242, United States.
authors.forename: Gary
authors.initials: G
authors.lastname: Rosenthal
keywords: Empanelment; Health care quality, access, and evaluation; Leadership; Organizational culture; Patient aligned care team; Patient-centered care; Primary health care; Qualitative research; Telemedicine; Veterans health