TY - JOUR
KW - Evidence-Based Practice
KW - Family Practice/methods/organization & administration/trends
KW - Humans
KW - Models, Organizational
KW - Organizational Innovation
KW - Outcome Assessment (Health Care)
KW - Patient Satisfaction
KW - Patient-Centered Care/methods/organization & administration/trends
KW - Randomized Controlled Trials as Topic
KW - United States
AU - P. A. Nutting
AU - B. F. Crabtree
AU - E. E. Stewart
AU - W. L. Miller
AU - R. F. Palmer
AU - K. C. Stange
AU - C. R. Jaen
A1 - 
AB - PURPOSE: The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year patient-centered medical home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH. METHODS: Thirty-six family practices were randomized to a facilitated intervention group or a self-directed intervention group. We measured 3 practice-level outcomes: (1) the proportion of 39 components of the NDP model that practices implemented, (2) the aggregate patient rating of the practices' PCMH attributes, and (3) the practices' ability to make and sustain change, which we term adaptive reserve. We used a repeated-measures analysis of variance to test the intervention effects. RESULTS: By the end of the 2 years of the NDP, practices in both facilitated and self-directed groups had at least 70% of the NDP model components in place. Implementation was relatively harder if the model component affected multiple roles and processes, required coordination across work units, necessitated additional resources and expertise, or challenged the traditional model of primary care. Electronic visits, group visits, team-based care, wellness promotion, and proactive population management presented the greatest challenges. Controlling for baseline differences and practice size, facilitated practices had greater increases in adaptive reserve (group difference by time, P = .005) and the proportion of NDP model components implemented (group difference by time, P=.02); the latter increased from 42% to 72% in the facilitated group and from 54% to 70% in the self-directed group. Patient ratings of the practices' PCMH attributes did not differ between groups and, in fact, diminished in both of them. CONCLUSIONS: Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient's experience of care. Intense facilitation increases the number of components implemented and improves practices' adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs.
BT - Annals of family medicine
C5 - Medical Home
CY - United States
DO - 10.1370/afm.1119
JF - Annals of family medicine
N2 - PURPOSE: The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year patient-centered medical home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH. METHODS: Thirty-six family practices were randomized to a facilitated intervention group or a self-directed intervention group. We measured 3 practice-level outcomes: (1) the proportion of 39 components of the NDP model that practices implemented, (2) the aggregate patient rating of the practices' PCMH attributes, and (3) the practices' ability to make and sustain change, which we term adaptive reserve. We used a repeated-measures analysis of variance to test the intervention effects. RESULTS: By the end of the 2 years of the NDP, practices in both facilitated and self-directed groups had at least 70% of the NDP model components in place. Implementation was relatively harder if the model component affected multiple roles and processes, required coordination across work units, necessitated additional resources and expertise, or challenged the traditional model of primary care. Electronic visits, group visits, team-based care, wellness promotion, and proactive population management presented the greatest challenges. Controlling for baseline differences and practice size, facilitated practices had greater increases in adaptive reserve (group difference by time, P = .005) and the proportion of NDP model components implemented (group difference by time, P=.02); the latter increased from 42% to 72% in the facilitated group and from 54% to 70% in the self-directed group. Patient ratings of the practices' PCMH attributes did not differ between groups and, in fact, diminished in both of them. CONCLUSIONS: Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient's experience of care. Intense facilitation increases the number of components implemented and improves practices' adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs.
PP - United States
PY - 2010
SN - 1544-1717; 1544-1709
EP - 44; S92
EP - S33+
T1 - Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home
T2 - Annals of family medicine
TI - Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home
U1 - Medical Home
U2 - 20530393
U3 - 10.1370/afm.1119
VL - 8 Suppl 1
VO - 1544-1717; 1544-1709
Y1 - 2010
ER -