Key Factors Supporting Higher-Performing Practices
| Key Factor | Description |
|---|---|
| Health information technology | Early adoption of EHRs (4 of 5 higher-performing practices had EHRs in place =2 years before PCMH implementation) |
| Administrative leadership | Highly engaged practice administrators who championed the PCMH transformation |
| Clinician leadership | Regular clinician meetings to discuss performance, agree on clinical guidelines, and establish standards of care |
| Shared vision and buy-in | Careful articulation and reinforcement of how the medical home will help patients and the practice and the need for changes |
| Staff development | Team orientation and early development of medical assistant role |
| Focus on improvement | Meetings revolve around PCMH and clinical quality improvement |
| Shared decision making | Feedback from practice consistently sought on changes before, during, and after implementation |
| Accountability | Clear roles and responsibilities and accountability to these roles and responsibilities |
| Finances | Stable billing and administrative systems |
| Financial autonomy | Direct receipt of and ability to invest PCMH financial incentives |
| Benchmarking | Monthly clinician-specific benchmarking to identify best practices and breakdowns in PCMH processes |
| Reporting and documentation | Careful attention to data reporting and documentation of PCMH changes |
| Inclusivity | Collective problem solving and open communication |
| Staff stability | Minimal 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.