RT Journal Article
SR Electronic
T1 Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP S21
OP S32
DO 10.1370/afm.1111
VO 8
IS Suppl 1
A1 Elizabeth E. Stewart
A1 Paul A. Nutting
A1 Benjamin F. Crabtree
A1 Kurt C. Stange
A1 William L. Miller
A1 Carlos Roberto Jaén
YR 2010
UL http://www.annfammed.org/content/8/Suppl_1/S21.abstract
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.