Lessons Learned From the Study of Primary Care Transformation

McNellis, Robert; Genevro, Janice; Meyers, David

doi:10.1370/afm.1548

Cited by 48 publications

(45 citation statements)

References 8 publications

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“…9,17,20,25,26 A survey of medical home implementation in 65 safety-net clinics found that greater implementation of characteristics of the medical home was associated with both higher morale and higher provider burnout. 27 This finding is consistent with the context we encountered, where many participants described PACT implementation as both exciting and stressful.…”

Section: Discussionmentioning

confidence: 99%

“…The move away from a physician-centric model of care towards one that is truly team-oriented, and the challenges of aligning financial reimbursement with the PCMH's emphasis on proactive prevention, are only two of the model's persistent challenges across diverse primary care practices. [9][10][11] In 2010, the Veterans Health Administration (VA) rolled out its version of the PCMH, the Patient Aligned Care Teams (PACT) initiative. With an initial focus on primary care, PACT emphasizes common features of the PCMH Electronic supplementary material The online version of this article (doi:10.1007/s11606-013-2690-z) contains supplementary material, which is available to authorized users.…”

Section: Introductionmentioning

confidence: 99%

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“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

et al. 2014

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BACKGROUND:The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees. OBJECTIVE: We sought to identify key themes in the experience of primary care providers, nurse care managers, clerical and clinical associates, and clinic administrators implementing PACT, with the aim of informing recommendations for continued development of the model and its components. DESIGN: Observational qualitative study; data collection from 2010 to 2013, using role-stratified and team focus groups and semi-structured interviews. PARTICIPANTS: 241 of 337 (72 %) identified primary care clinic employees in PACT team or administrative roles, from 15 VA clinics in Oregon and Washington. APPROACH: Data coded and analyzed using conventional content analysis techniques. KEY RESULTS: Overall, participants were enthusiastic about the PACT concept, but felt necessary resources for success were not yet in place. Well-functioning teams were perceived as key to successful implementation. Development of such teams depended on adequate staffing, training, and dedicated time for team development. Changes within the broader VA system were also seen as necessary, including devolving greater control to the clinic level and improving system alignment with the PACT model. PACT advocates from among clinic and institutional level leadership were identified as a final key ingredient for success. These themes were consistent despite differences in clinic settings and characteristics. CONCLUSIONS: PACT implementation faced significant challenges in its early years. Realizing PACT's transformative potential will require acting on the needs identified by clinic workers in this study: ensuring adequate staffing in all team roles, devoting resources to in-depth training for all employees in communication and other skills needed to maximize team success, and aligning the broader VA hospital system with PACT's decentralized, team-based approach.KEY WORDS: primary care redesign; patient-centered medical home; team-based care; Veterans; health services research; qualitative research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

et al. 2014

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“…Two researchers audiotaped the interviews, 1 led the inquiry while the other focused on note taking. Interview questions were developed from the medical home, accountable care organization, and relevant case study literature, 2,[7][8][9][10][11][12] and reviewed by a primary care physician who was not part of the research team or the health system. Additional questions evolved from some responses.…”

Section: Methodsmentioning

confidence: 99%

The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients

2017

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Introduction:Restructuring primary care is essential to achieve the triple aim. This case study examines the human factors of extensive redesign on 2 midsized primary care clinics (clinics A and B) in the Midwest United States that are owned by a large health care system. The transition occurred when while the principles for patient-centered medical home were being rolled out nationally, and before the Affordable Care Act.Methods: After the transition, interviews and discussions were conducted with 5 stakeholder groups: health system leaders, clinic managers, clinicians, nurses, and reception staff. Using a culture assessment instrument, the responses of personnel at clinics A and B were compared with comparison clinics from another health system that had not undergone transition. Patient satisfaction scores are presented.Results

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“…21,23,35 Given the variable manifestations inherent in the politics, economics, and organizational contexts of real-world primary care practice, 21,35,36 it is important to consider whether ideal transformation processes can be universally implemented and whether at this stage they can be evaluated with universally standardized measures. 23,33,[36][37][38][39][40][41][42] Furthermore, it is important to consider what constitutes a comprehensive set of ingredients for successful transformation and how to evaluate the processes contributing to its success. 4,43 To address these gaps, we set out to elucidate the domains and evaluation strategies that constitute a comprehensive methodology to determine how transformation occurs within the context of practice and to explain why such transformation happens.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for a Mixed Methods Approach to Evaluating the Patient-Centered Medical Home

Goldman

Parker

Brown

et al. 2015

The Annals of Family Medicine

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PURPOSE There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups. METHODSTo develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion. RESULTSThe measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment. CONCLUSIONSThis evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices.

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Lessons Learned From the Study of Primary Care Transformation

Cited by 48 publications

References 8 publications

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients

Recommendations for a Mixed Methods Approach to Evaluating the Patient-Centered Medical Home

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