Directly involving patients and families in care improvement increasingly is viewed as an important component of patient-centered care. To assess the extent to which practices actually involve patients, we surveyed 112 patient-centered medical home practices in twenty-two states. Nearly all of these practices sought patient feedback. However, only 29 percent involved patients and families as advisers and sought feedback through surveys, and only 32 percent involved patients in a continuing role in quality improvement. Interviews showed that practices that highly value patient involvement overcame barriers to ongoing patient participation. We argue that a cultural shift is needed in how practices view patients as partners, not just in areas such as personal responsibility and self-management, but also in quality improvement and governance. Practices must gain more experience and see more examples of the benefits of engaging patients, and they may need more incentives and support for engaging them.

PURPOSE We aimed to determine the motivations and barriers facing small practices that seek to adopt the patient-centered medical home (PCMH) model, as well as the type of help and strategies they use. METHODSWe surveyed lead physicians at practices with fewer than 5 physicians, stratifi ed by state and level of National Committee for Quality Assurance PCMH recognition, using a Web-based survey with telephone, fax, and mail follow-up. The response rate was 59%, yielding a total sample of 249 practices from 23 states.RESULTS Improving quality and patient experience were the strongest motivations for PCMH implementation; time and resources were the biggest barriers. Most practices participated in demonstration projects or received fi nancial rewards for PCMH, and most received training or other kinds of help. Practices found training and help related to completing the PCMH application to be the most useful. Training for patients was both less common and less valued. The most commonly used strategies for practice transformation were staff training, systematizing processes of care, and quality measurement/goal setting. The least commonly endorsed strategy was involving patients in quality improvement. Practices with a higher level of PCMH recognition were more likely to have electronic health records, to report barriers, and to use measurement-based quality improvement strategies. CONCLUSIONSTo spread the adoption of the PCMH model among small practices, fi nancial support, practical training, and other help are likely to continue to be important. Few practices involved patients in their implementation, so it would be helpful to test the impact of greater patient involvement in the PCMH.

Using patient-reported outcome measures (PROMs) in care planning has the potential to improve care, but information about routine implementation in settings serving disadvantaged groups is needed. Two primary care clinics serving populations predominantly eligible for Medicaid and diverse in race/ethnicity implemented the PROMIS-29 as part of clinical care planning. Of the target population with diabetes, 26% (n = 490) completed the PROMs; the proportion that set a goal based on the PROMs differed by site. This report describes factors influencing the PROMs process and the results of interviews with patients and members of the care team about PROMs' implementation and impact.