Table 4

Key Factors Supporting Higher-Performing Practices

Key FactorDescription
Health information technologyEarly adoption of EHRs (4 of 5 higher-performing practices had EHRs in place =2 years before PCMH implementation)
Administrative leadershipHighly engaged practice administrators who championed the PCMH transformation
Clinician leadershipRegular clinician meetings to discuss performance, agree on clinical guidelines, and establish standards of care
Shared vision and buy-inCareful articulation and reinforcement of how the medical home will help patients and the practice and the need for changes
Staff developmentTeam orientation and early development of medical assistant role
Focus on improvementMeetings revolve around PCMH and clinical quality improvement
Shared decision makingFeedback from practice consistently sought on changes before, during, and after implementation
AccountabilityClear roles and responsibilities and accountability to these roles and responsibilities
FinancesStable billing and administrative systems
Financial autonomyDirect receipt of and ability to invest PCMH financial incentives
BenchmarkingMonthly clinician-specific benchmarking to identify best practices and breakdowns in PCMH processes
Reporting and documentationCareful attention to data reporting and documentation of PCMH changes
InclusivityCollective problem solving and open communication
Staff stabilityMinimal staff turnover
  • EHR = electronic health record; PCMH = patient-centered medical home.

  • Note: A variety of factors supported PCMH implementation in the higher-performing practices.

  • Source: Site visit observations and semistructured interviews in the higher-performing practices.