RT Journal Article SR Electronic T1 Contrasting Trajectories of Change in Primary Care Clinics: Lessons From New Orleans Safety Net JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP S60 OP S67 DO 10.1370/afm.1493 VO 11 IS Suppl 1 A1 Diane R. Rittenhouse A1 Laura Schmidt A1 Kevin Wu A1 James Wiley YR 2013 UL http://www.annfammed.org/content/11/Suppl_1/S60.abstract AB PURPOSE We sought to compare and contrast patterns of change toward patient-centered medical homes (PCMHs) in 5 New Orleans primary care safety net clinics in the aftermath of Hurricane Katrina. We assessed the general direction of change in practice to discover possible reasons for differences in patterns of change, and to identify impediments to change. METHODS Data collection consisted of 5 semiannual telephone interviews with clinic leadership over 2.5 years supplemented by administrative audits. We used standard survey indexes of PCMH to monitor practice change. We conducted site visits and unstructured in-person interviews with clinicians and staff of the 5 clinics. RESULTS PCMH index scores improved during the observation period with variations in rates of change and initial levels of PCMH. Qualitative analysis suggested possible explanations for this differential success: (1) early vs later starts in practice change, (2) funding based on patient outcomes, (3) demands that compete with practice change, (4) qualities of clinic leadership, and (5) relations with the communities where patients live. Barriers to practice change included high demand for services, deficient linkages between hospital and specialty care, lack of staff resources, and a need to focus on clinic finances. CONCLUSIONS The PCMH model can successfully address the needs of safety net populations. Stable leadership committed to serving safety net patients via the PCMH model is important for successful practice transformation. Beyond clinic walls, cultivating deep ties to the communities that clinics serve also supports the PCMH model.