PT  - JOURNAL ARTICLE
AU  - Stewart, Elizabeth E.
AU  - Nutting, Paul A.
AU  - Crabtree, Benjamin F.
AU  - Stange, Kurt C.
AU  - Miller, William L.
AU  - Jaén, Carlos Roberto
TI  - Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project
AID  - 10.1370/afm.1111
DP  - 2010 May 01
TA  - The Annals of Family Medicine
PG  - S21--S32
VI  - 8
IP  - Suppl 1
4099  - http://www.annfammed.org/content/8/Suppl_1/S21.short
4100  - http://www.annfammed.org/content/8/Suppl_1/S21.full
SO  - Ann Fam Med2010 May 01; 8
AB  - PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.