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Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

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 (Crab-tree); Center for Research Strategies, Denver, Colorado and Department of Family Medicine, University of Colorado Health Sciences Center, Aurora, Colorado (Nutting); Department of Family Medicine, Lehigh Valley Health Network, Allentown; and Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania (Miller); Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and The Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio (Stange); 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: Benjamin F. Crabtree, PhD, Department of Family Medicine, UMDNJ-Robert Wood Johnson, Medical School, New Brunswick, NJ 08873, crabtrbf{at}umdnj.edu

This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care.

The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated?

We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation.

Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform.

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

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