How nurse-led practices perceive implementation of the patient-centered medical home.
The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model.



Data were collected through in-depth interviews with providers and staff in nurse-led practices.



These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care.



Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs.
School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Rosemary
R
Frasso
Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States.
A
A
Golinkoff
School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States.
Heather
H
Klusaritz
PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Katherine
K
Kellom
Pennsylvania State University, United States.
Helen
H
Kollar-McArthur
Department of Health and Strategic Communication, Chapman University, Orange, CA, United States.
Michelle
M
Miller-Day
Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States.
Robert
R
Gabbay
Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: peter.cronholm@uphs.upenn.edu.
Peter F
PF
Cronholm
D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care; D057184:Practice Patterns, Nurses'; D011787:Quality of Health Care; D014481:United States
Delivery of health care; Organization and administration; Primary care nursing; Primary health care