Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes
While the potential of patient-centered medical homes (PCMH) is promising, little is known empirically about the frontline challenges that primary care (PC) leaders face before making the decision to implement PCMH, let alone in making it a reality.
Prior to the design and implementation of the Veterans Health Administration’s (VA) national PCMH model—Patient Aligned Care Teams (PACT)—we identified the top challenges faced by PC directors and examined the organizational and area level factors that influenced those challenges.
DESIGN AND PARTICIPANTS
A national cross-sectional key informant organizational survey was fielded to the census of PC directors at VA medical centers and large community-based outpatient clinics (final sample n = 229 sites).
PC directors were asked to rate the degree to which they faced 48 management challenges in eight PCMH-related domains (access, preventive care, chronic diseases requiring care in PC, challenging medical conditions, mental health/substance abuse, special populations, PC coordination of care, and clinical informatics). Responses were dichotomized as moderately-to-extremely challenging versus somewhat-slightly-not at all challenging. Items were rank ordered; chi square or regression techniques were used to examine variations in facility size, type, urban/rural location, and region.
On average, VA PC directors reported 16 moderate-to-extreme challenges, and the top 20 challenges spanned all eight PCMH domains. Four of the top 20 challenges, including the top two challenges, were from the clinical informatics domain. Management of chronic non-malignant pain requiring opiate therapy was the third most reported challenge nationwide. Significant organizational and area level variations in reported challenges were found especially for care coordination.
Better understanding of PC challenges ahead of PCMH implementation provides important context for strategic planning and redesign efforts. As a national healthcare system, the VA provides a unique opportunity to examine organizational and area determinants relevant to other PCMH models.
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- Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes
Journal of General Internal Medicine
Volume 29, Issue 2 Supplement, pp 555-562
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- primary care
- patient-centered medical home
- VA healthcare system
- health care management
- Industry Sectors
- Author Affiliations
- 1. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda Campus (Mailcode 152), 16111 Plummer Street, Sepulveda, CA, 91343, USA
- 2. Division of General Internal Medicine and Health Services Research, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
- 3. RAND Health, Santa Monica, CA, USA
- 4. Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
- 5. Office of Patient Care Services, Veterans Health Administration, Washington, DC, USA
- 6. Office of Primary Care Clinic Operations, Veterans Health Administration, Washington, DC, USA
- 7. Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, CA, USA