Original Article

Journal of General Internal Medicine

, Volume 25, Issue 6, pp 601-612

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Defining and Measuring the Patient-Centered Medical Home

  • Kurt C. StangeAffiliated withFamily Medicine, Epidemiology & Biostatistics, Sociology and Oncology, Case Western Reserve UniversityCase Comprehensive Cancer Center, Case Western Reserve University Email author 
  • , Paul A. NuttingAffiliated withUniversity of Colorado Health Sciences CenterCenter for Research Strategies
  • , William L. MillerAffiliated withLeonard Parker Pool Chair of Family MedicineLehigh Valley Health Network, Penn State College of Medicine
  • , Carlos R. JaénAffiliated withFamily & Community Medicine, University of Texas Health Science Center at San AntonioEpidemiology & Biostatistics, University of Texas Health Science Center at San Antonio
  • , Benjamin F. CrabtreeAffiliated withDepartment of Family Medicine, Robert Wood Johnson Medical SchoolProgram Leader in Population Sciences, Cancer Institute of New Jersey
  • , Susan A. FlockeAffiliated withDepartment of Family Medicine, Epidemiology & Biostatistics and Oncology, Case Western Reserve University
  • , James M. GillAffiliated withDelaware Valley Outcomes ResearchDepartment of Family and Community Medicine, Thomas Jefferson University


The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare.

The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care.

The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change.

Measuring the PCMH involves the following:

  • Giving primacy to the core tenets of primary care

  • Assessing practice and system changes that are hypothesized to provide added value

  • Assessing development of practices’ core processes and adaptive reserve

  • Assessing integration with more functional healthcare system and community resources

  • Evaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspects

  • Recognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings.

Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster individual and population health.


primary care patient-centered medical home measurement quality improvement