title: Exploring Variation in Transformation of Primary Care Practices to Patient-Centered Medical Homes: A Mixed Methods Approach.
abstract: The objective was to quantify the activities required for patient-centered medical home (PCMH) transformation in a sample of small to medium-sized National Committee for Quality Assurance (NCQA) recognized practices, and explore barriers and facilitators to transformation. Eleven small to medium-sized PCMH practices in Southeastern Pennsylvania completed a survey, which was adapted from the 2011 NCQA standards. Semistructured follow-up interviews were conducted, descriptive statistics were computed for the quantitative analysis, and a process of thematic coding was deployed for the qualitative analysis. Practices had considerable quantitative variation in their workforce composition and the PCMH-related activities they implemented. Most practices improved access and continuity through staff training and team-based care as well as expanded data collection for population management. The barriers to PCMH recognition were least burdensome for the largest practices. The heterogeneity of the small PCMH practices within the study sample underscore the need to understand the key transformation issues as efforts to disseminate the PCMH model continue.
authors.affiliation: 1 Department of Public Health, University of Tennessee , Knoxville, Knoxville, Tennessee.|2 College of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Lieberthal
authors.affiliation: 2 College of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Tom
authors.initials: T
authors.lastname: Karagiannis
authors.affiliation: 2 College of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania.|3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Evan
authors.initials: E
authors.lastname: Bilheimer
authors.affiliation: 4 Einstein Healthcare Network , Philadelphia, Pennsylvania.
authors.forename: Manisha
authors.initials: M
authors.lastname: Verma
authors.affiliation: 3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Colleen
authors.initials: C
authors.lastname: Payton
authors.affiliation: 3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Mona
authors.initials: M
authors.lastname: Sarfaty
authors.affiliation: 3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: George
authors.initials: G
authors.lastname: Valko
mesh_terms: D003363:Cost Control; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D018802:Patient-Centered Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D010414:Pennsylvania; D011785:Quality Assurance, Health Care
keywords: cost control; medical home; patient-centered care; practice management; primary health care