title: Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.
abstract: BACKGROUND
  Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control.
  
  
  METHODS
  The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care.
  
  
  RESULTS
  Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care.
  
  
  CONCLUSIONS
  Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: O'Donnell
authors.affiliation: Associate Professor, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 9 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. Email: hillary.bogner@uphs.upenn.edu.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Cronholm
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kellom
authors.affiliation: Department of Health and Strategic Communication, Chapman University, Orange, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miller-Day
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Heather F de Vries
authors.initials: HF
authors.lastname: McClintock
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Kaye
authors.affiliation: Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Gabbay
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007407:Interviews as Topic; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000592:standards*; D010414:Pennsylvania; D011320:Primary Health Care / Q000458:organization & administration*; D012648:Self Care