How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
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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.
Key wordsmedical home primary care transformation patient centered medical home
This paper was presented at the Society of General Internal Medicine conference, “Patient Centered Medical Home: Setting a Policy Agenda” on July 28, 2009. The conference was funded in part by grants from the Agency for Health Care Research and Quality, the Commonwealth Fund, and The American Board of Internal Medicine Foundation.
The authors would like to acknowledge the following individuals who generously contributed their insights and experiences:
W. Carl Cooley MD, Thomas Bodenheimer MD, Carlos Jaen MD, PhD, FAAFP, Jennifer Lail MD, Jeanne McCallister BSN, MS, MHA, Patricia Rutherford RN, MS, Jane Taylor EdD, and Edward Wagner MD, MPH.
In addition we express our deep gratitude to Hillary Anderson for her expert administrative and editorial support.
Conflict of Interest Statement
Richard J. Baron, MD discloses his role as a consultant to Mercer Health Benefits working on models of advanced primary care.
Charles J. Homer, MD reports no conflicts of interest.
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