TY - JOUR
KW - Attitude of Health Personnel
KW - Evidence-Based Practice
KW - Family Practice/methods/organization & administration/trends
KW - Humans
KW - Models, Organizational
KW - Organizational Innovation
KW - Patient-Centered Care/methods/organization & administration/trends
KW - Qualitative Research
KW - Quality Assurance, Health Care/methods/organization & administration/trends
KW - United States
AU - P. A. Nutting
AU - B. F. Crabtree
AU - W. L. Miller
AU - E. E. Stewart
AU - K. C. Stange
AU - C. R. Jaen
A1 - 
AB - PURPOSE: We describe the experience of practices in transitioning toward patient-centered medical homes (PCMHs) in the National Demonstration Project (NDP). METHODS: The NDP was launched in June 2006 as the first national test of a model of the PCMH in a diverse sample of 36 family practices, randomized to facilitated and self-directed intervention groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical records, and patient and practice surveys. The evaluation team reviewed data from all practices as they became available and produced interim summaries. Four 2- to 3-day evaluation team retreats were held during which case summaries of all practices were discussed and patterns were described. RESULTS: The 6 themes that emerged from the data reflect major shifts in individual and practice roles and identities, as well as changes in practices' management strategies. The themes are (1) practice adaptive reserve is critical to managing change, (2) developmental pathways to success vary considerably by practice, (3) motivation of key practice members is critical, (4) the larger system can help or hinder, (5) practice transformation is more than a series of changes and requires shifts in roles and mental models, and (6) practice change is enabled by the multiple roles that facilitators play. CONCLUSIONS: Transformation to a PCMH requires more than a sequence of discrete changes. The practice transformation process may be fostered by promoting adaptive reserve and local control of the developmental pathway.
BT - Annals of family medicine
C5 - Medical Home
CY - United States
DO - 10.1370/afm.1075
JF - Annals of family medicine
N2 - PURPOSE: We describe the experience of practices in transitioning toward patient-centered medical homes (PCMHs) in the National Demonstration Project (NDP). METHODS: The NDP was launched in June 2006 as the first national test of a model of the PCMH in a diverse sample of 36 family practices, randomized to facilitated and self-directed intervention groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical records, and patient and practice surveys. The evaluation team reviewed data from all practices as they became available and produced interim summaries. Four 2- to 3-day evaluation team retreats were held during which case summaries of all practices were discussed and patterns were described. RESULTS: The 6 themes that emerged from the data reflect major shifts in individual and practice roles and identities, as well as changes in practices' management strategies. The themes are (1) practice adaptive reserve is critical to managing change, (2) developmental pathways to success vary considerably by practice, (3) motivation of key practice members is critical, (4) the larger system can help or hinder, (5) practice transformation is more than a series of changes and requires shifts in roles and mental models, and (6) practice change is enabled by the multiple roles that facilitators play. CONCLUSIONS: Transformation to a PCMH requires more than a sequence of discrete changes. The practice transformation process may be fostered by promoting adaptive reserve and local control of the developmental pathway.
PP - United States
PY - 2010
SN - 1544-1717; 1544-1709
EP - 56; S92
EP - S45+
T1 - Journey to the patient-centered medical home: A qualitative analysis of the experiences of practices in the National Demonstration Project
T2 - Annals of family medicine
TI - Journey to the patient-centered medical home: A qualitative analysis of the experiences of practices in the National Demonstration Project
U1 - Medical Home
U2 - 20530394
U3 - 10.1370/afm.1075
VL - 8 Suppl 1
VO - 1544-1717; 1544-1709
Y1 - 2010
ER -