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Context for Understanding the National Demonstration Project and the Patient-Centered Medical Home

Departments of Family Medicine, Epidemiology & Biostatistics, and Sociology, and The Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio (Stange); Department of Family Medicine, Lehigh Valley Health Network, Allentown; and Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania (Miller); Center for Research Strategies, Denver, Colorado, and Department of Family Medicine, University of Colorado Health Sciences Center, Aurora, Colorado (Nutting); Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, New Brunswick; Department of Epidemiology, School of Public Health, University of Medicine & Dentistry of New Jersey, Piscataway; and Cancer Institute of New Jersey, New Brunswick, New Jersey (Crabtree); National Research Network, American Academy of Family Physicians, Leawood, Kansas (at the time of the project, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio) (Stewart); Departments of Family & Community Medicine, and of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Jaén).

CORRESPONDING AUTHOR: Kurt C. Stange, MD, PhD, Case Western Reserve University, 10900 Euclid Ave, LC 7136, Cleveland, OH 44106, kcs{at}case.edu

This article introduces a journal supplement evaluating the country’s first national demonstration of the patient-centered medical home (PCMH) concept. The PCMH is touted by some as a linchpin for renewing the foundering US health care system and its primary care foundation.

The National Demonstration Project (NDP) tested a new model of care and compared facilitated and self-directed implementation approaches in a group-randomized clinical trial. The NDP asked what a national sample of 36 highly motivated family practices could accomplish in moving toward the PCMH ideal during 2 years within the current US health care payment and organizational system. Our independent evaluation used a multimethod approach that integrated qualitative methods to tell the NDP story from multiple perspectives and quantitative methods to assess and compare aspects that could be measured. The 7 scientific reports presented in this supplement explain the process, outcomes, lessons, and implications of the NDP.

This introductory article provides context for making sense of the NDP. Important context includes the evolution of the PCMH concept and movement, the roots of the NDP and how it developed, and both what is valuable and what is problematic about family medicine and primary care.

Together, the articles in this supplement show how primary care practices and the concept of the PCMH can continue to evolve. The evaluation depicts some of the early effects of this evolution on patients and practices, and shows how the process of practice development can be understood and how lessons from the NDP can inform ongoing and future efforts to transform primary care and health care systems.

Key Words: Primary care • family practice • National Demonstration Project • organizational change • quality improvement • patient-centered medical home • patient-centered care • practice-based research

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