How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Becoming a medical home is a radical change, requiring both a new mental model for primary care and the skills and resources to accomplish it. Although numerous reports indicate practice change is feasible—particularly with technical support and either insulation from or alignment with financial incentives—sustained transformation appears difficult. We identified the following critical success factors: leadership, financial resources, personal and organizational relationships, engagement with patients and families, competence in management, improvement methods and coaching, health information technology properly applied, care coordination support, and staff development. Each factor raises researchable questions about what policies can facilitate achieving success so that transformation becomes mainstream rather than the province of the innovative few.
- Baron, RJ (2009) The chasm between intention and achievement in primary care. JAMA 301: pp. 1922-4 CrossRef
- Green LA, Cifuentes M, Glasgow RE, et al. Redesigning primary care practice to incorporate health behavior change. Am J Prev Med. 2008;35(5S).
- Nickols F. Change management 101: A primer. Distance consulting LLC. Available at http://home.att.net/∼nickols/change.htm. Accessed January 12, 2010.
- Robert Graham Center. The patient centered medical home: History, seven core features, evidence and transformational change. November, 2007. Available at http://www.graham-center.org/online/graham/home/publications/monographs-books/2007/rgcmo-medical-home.html Accessed on January 12, 2010.
- Report on Comprehensive Care Internal Medicine. American Board of Internal Medicine. Available at www.CCIMReport.org. Effective Clinical Practice. May/June 2000. Accessed January 12, 2010.
- Solberg LI, Kottke TE, Brekke ML, et al. Failure of a continuous quality improvement intervention to increase the delivery of preventive services a randomized trial. Effective Clinical Practice, May/June 2000.
- Margolis, PA, Lannon, CM, Stuart, JM (2004) Practice based education to improve delivery systems for prevention in primary care; randomized trial. BMJ 328: pp. 7436-388 CrossRef
- Homer, CJ, Forbes, P, Horvitz, L (2005) Impact of quality improvement program on care and outcomes for children with asthma. Arch Pediatr Adolesc Med 159: pp. 464-94 CrossRef
- Dietrich, AJ, Oxman, TE, Williams, JW (2004) Re-engineering systems for the treatment of depression in primary care: cluster randomized controlled trial. BMJ 329: pp. 602 CrossRef
- Chin, MH, Walters, AE, Cook, SC (2007) Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev 64: pp. 7S-28S CrossRef
- Landon, BE, Hicks, LS, O’Malley, AJ (2007) Improving the management of chronic disease at community health centers. N Engl J Med 356: pp. 921-34 CrossRef
- Thompson RS. The prescription for health initiative. Am J Prev Med. 2008;35(5S).
- Lukas, CV, Holmes, SK, Cohen, AB (2007) Transformational change in health care systems: an organizational model. Health Care Manage Rev 32: pp. 309-20
- Cohen, D, McDaniel, RR, Crabtree, BF (2004) Practice change model for quality improvement in primary care practice. J Health Manag 49: pp. 155-68
- Solberg, LI (2007) Improving medical practice. Ann Fam Med 5: pp. 251-6 CrossRef
- Margolis PA, McLearn KT, Earls MF, et al. Assisting primary care practices in using office system to promote early childhood development. Ambul Pediatr. 2008: 8(6); Epub 2008 Aug 22.
- Goodwin, MA, Zyzanski, SJ, Zronek, S (2001) A clinical of tailored office for preventive service delivery. The study to enhance prevention by understating pratice (STEP-UP). Am J Prev Med 21: pp. 68-9 CrossRef
- Strange, KC, Goodwin, MA, Zyzanski, SJ (2003) Sustaining of a practice-individualized preventive service delivery intervention. Am J Prev Med 25: pp. 296-300 CrossRef
- Ganz, PA, Farmer, MM, Belman, MJ (2005) Results of a randomized controlled trial to increase colorectal cancer screening in a managed care health plan. Cancer 104: pp. 2072-83 CrossRef
- O’Connor, PJ, Desai, J, Solberg, LI (2005) Randomized trial of quality improvement intervention to improve diabetes care in primary care settings. Diabetes Care 28: pp. 1890-7 CrossRef
- Ballard, DJ, Nicewander, DA, Qin, H (2007) Improving delivery of clinical preventive services: a multi-year journey. Am J Prev Med 33: pp. 492-7 CrossRef
- Coleman, K, Austin, BT, Brach, C (2009) Evidence on the chronic care model in the new millennium. Health Affairs 28: pp. 75-85 CrossRef
- Calvo AC, Calvo LR, Bezold C. Comprehensive health homes: using the expanded care model of the hrsa health disparities collaborative. 2009.
- Mandel, KE, Kotagal, UR (2007) Pay for performance alone cannot drive quality. Arch Pediatr Adolesc Med 161: pp. 650-5 CrossRef
- Center for Medical Home Improvement. Available at www.medicalhomeimprovement.org.
- Nutting, PA, Miller, WL, Crabtree, BF, Jaen, CR, Stewart, EE, Stange, KC (2009) Initial lessons from the first national demonstration project on practice transformation to a patient centered medical home. Ann Fam Med 7: pp. 254-60 CrossRef
- Hogg, W, Lemelin, J, Moroz, I (2008) Improving prevention in primary care. Can Fam Physician 54: pp. 712-20
- Baron, RJ (2007) Quality improvement with an electronic health record: Achievable, but not automatic. Ann Intern Med 147: pp. 549-52
- http://www.ct.gov/ctf/cwp/view.asp?a=1786&q=296676, accessed January 3, 2010.
- Sutherland, D, Hayer, M (2009) Structured review: evaluating the effectiveness of nurse case managers in improving health outcomes in three major chronic diseases. J Clin Nurs 18: pp. 2978-92 CrossRef
- Laurant, M, Reeves, D, Hermens, R, Braspenning, J, Grol, R, Sibbald, B (2005) Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev 18: pp. CD001271
- How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
Journal of General Internal Medicine
Volume 25, Issue 6 , pp 625-629
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical home
- primary care
- patient centered medical home
- Industry Sectors
- Author Affiliations
- 1. National Initiative for Children’s Healthcare Quality, 30 Winter St, 6th Floor, Boston, MA, 02108-4720, USA
- 2. Harvard Medical School and School of Public Health, Boston, MA, USA
- 3. Greenhouse Internists, P.C., Philadelphia, PA, USA