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Annals of Family Medicine 7:254-260 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.1002
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Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home

Paul A. Nutting, MD, MSPH1, William L. Miller, MD, MA2, Benjamin F. Crabtree, PhD3, Carlos Roberto Jaen, MD, PhD4,5, Elizabeth E. Stewart, PhD5 and Kurt C. Stange, MD, PhD6

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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TRACK Comments:

Read all TRACK Comments

Evaluations are Essential
Thomas Rosenthal MD
Annals of Family Medicine, 13 May 2009 [Full text]
Caveat Venditor
Martin-J. Sepulveda MD
Annals of Family Medicine, 13 May 2009 [Full text]
Re: Caveat Venditor
Greg Pawlson, et al.
Annals of Family Medicine, 17 May 2009 [Full text]
misunderstood – by the press and policymakers
Paul H Grundy
Annals of Family Medicine, 17 May 2009 [Full text]
Great Recommendations for the Patient-Centered Medical Home
Joseph E Scherger
Annals of Family Medicine, 17 May 2009 [Full text]
Whatever It Takes
William G Harrington
Annals of Family Medicine, 17 May 2009 [Full text]
Re: misunderstood – by the press and policymakers
Paul A. Nutting
Annals of Family Medicine, 18 May 2009 [Full text]
What will it take going forward
Robert Eidus
Annals of Family Medicine, 18 May 2009 [Full text]
The PCMH Genie is NOT going back in the bottle
Larry A. Green
Annals of Family Medicine, 18 May 2009 [Full text]
Transform First, Technology Second
David J Morin
Annals of Family Medicine, 20 May 2009 [Full text]
Two of Many Important Lessons
Stephen C Schoenbaum
Annals of Family Medicine, 22 May 2009 [Full text]
Real Redesign Required
Katie Coleman
Annals of Family Medicine, 22 May 2009 [Full text]
Focus on the good news
Susan T Andrews
Annals of Family Medicine, 22 May 2009 [Full text]
Break or Brake
Gordon D. Schiff
Annals of Family Medicine, 22 May 2009 [Full text]
Proceed with Caution
Susan S. Wilder
Annals of Family Medicine, 25 May 2009 [Full text]
Avoiding Implementation Myopia
Wm. Thomas Summerfelt
Annals of Family Medicine, 11 Jun 2009 [Full text]
It's all about attitude
Anna Lucas
Annals of Family Medicine, 11 Jun 2009 [Full text]
ARE YOU SERIOUS?
Kurt f. von brunn
Annals of Family Medicine, 17 Jun 2009 [Full text]
Distance to PCMH depends on your starting point
William Schreiber
Annals of Family Medicine, 18 Jun 2009 [Full text]
Medical Homes - NOT
Jeff D Taber
Annals of Family Medicine, 13 Aug 2009 [Full text]

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