PT - JOURNAL ARTICLE AU - Carolyn A. Berry AU - Tod Mijanovich AU - Stephanie Albert AU - Chloe H. Winther AU - Margaret M. Paul AU - Mandy Smith Ryan AU - Colleen McCullough AU - Sarah C. Shih TI - Patient-Centered Medical Home Among Small Urban Practices Serving Low-Income and Disadvantaged Patients AID - 10.1370/afm.1491 DP - 2013 May 01 TA - The Annals of Family Medicine PG - S82--S89 VI - 11 IP - Suppl 1 4099 - http://www.annfammed.org/content/11/Suppl_1/S82.short 4100 - http://www.annfammed.org/content/11/Suppl_1/S82.full SO - Ann Fam Med2013 May 01; 11 AB - PURPOSE Research on the patient-centered medical home (PCMH) model and practice redesign has not focused on the unique challenges and strengths of very small primary care practices serving disadvantaged patient populations. We analyzed the practice characteristics, prior experiences, and dimensions of the PCMH model that exist in such practices participating in the Primary Care Information Project (PCIP) of the New York City Department of Mental Health and Hygiene. METHODS We obtained descriptive data, focusing on PCMH, for 94 primary care practices with 5 or fewer clinicians serving high volumes of Medicaid and minority patient populations in New York City. Data included information extracted from PCIP administrative data and survey data collected specifically for this study. RESULTS Survey results indicated substantial implementation of key aspects of the PCMH among small practices serving disadvantaged patient populations, despite considerable potential challenges to achieving PCMH implementation. Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH. CONCLUSIONS Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies. The use of flexible, less formal strategies is important to keep in mind when considering implementation and assessment of PCMH-like initiatives in small practices.