Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon

Journal of the American Board of Family Medicine: JABFM

Nicole Bouranis^1¹  Sherril Gelmon^1² 

[1] Mark O. Hatfield School of Government, Portland State University, Portland (BS)^1;From Oregon Health and Sciences University-Portland State University School of Public Health, Portland OR (SG, NB, SP)

关键词: Chronic Disease;    Emergency Departments;    Focus Groups;    Mental Health;    Oregon;    Patient-Centered Care;    Primary Health Care;    Referral;    Workflow;   

DOI  :  10.3122/jabfm.2018.03.170265

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Methods: Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Results: Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and “champions,” incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Conclusion: Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a “learning organization”: systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care.

【 授权许可】

CC BY