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1 University of Colorado Health Sciences Center and Director of Research, Center for Research Strategies, Denver, Colorado
2 Lehigh Valley Health Network, Allentown, Pennsylvania
3 Robert Wood Johnson Medical School, Department of Family Medicine, Somerset, New Jersey and Cancer Institute of New Jersey, New Brunswick, New Jersey
4 Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
5 Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
6 Departments of Family Medicine, Epidemiology & Biostatistics, Oncology, and Sociology, Case Western Reserve University, Cleveland, Ohio
CORRESPONDING AUTHOR: Paul A. Nutting, MD, MSPH, Center for Research Strategies, 225 E. 16th Ave, Suite 1150, Denver, CO, Paul.Nutting{at}CRSLLC.org
The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, along with a 3-tiered recognition process of the National Committee on Quality Assurance, are influencing the design and implementation of many demonstrations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices. The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys. Early lessons from the real-time qualitative analysis of the NDP raise some serious concerns about the current direction of many of the proposed PCMH demonstration projects and point to some positive opportunities. We describe 6 early lessons from the NDP that address these concerns and then offer 4 recommendations for those assisting the transformation of primary care practices and 4 recommendations for individual practices attempting transformation.
Key Words: Primary health care • family practice • professional practice • health care delivery
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