Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home

TLDR

The patient‑centered medical home is emerging as a catalyst for health‑care reform, with state‑wide demonstration projects underway and a national urgency to prove its feasibility under NCQA recognition. The American Academy of Family Physicians launched the first National Demonstration Project in June 2006 to evaluate a PCMH model across 36 diverse family practices. An independent evaluation team employed a multimethod approach—direct observation, in‑depth interviews, chart audits, and patient and practice surveys—to assess the project. Real‑time qualitative analysis revealed six early lessons highlighting concerns about current PCMH demonstration directions and offered four practice‑level and four system‑level recommendations for transformation.

Abstract

The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, along with a 3-tiered recognition process of the National Committee on Quality Assurance, are influencing the design and implementation of many demonstrations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices. The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys. Early lessons from the real-time qualitative analysis of the NDP raise some serious concerns about the current direction of many of the proposed PCMH demonstration projects and point to some positive opportunities. We describe 6 early lessons from the NDP that address these concerns and then offer 4 recommendations for those assisting the transformation of primary care practices and 4 recommendations for individual practices attempting transformation.