Patient-Centered Medical Home Implementation:A Qualitative Study to Inform Primary Care Practice and Implementation Science.

Patient-Centered Medical Home;Primary Care;Implementation;Organizational Learning;Family Medicine and Primary Care;Health Sciences;Health Services Organization & Policy

Keith, Rosalind EveLowery, Julie C. ;

University of Michigan

关键词: Patient-Centered Medical Home;    Primary Care;    Implementation;    Organizational Learning;    Family Medicine and Primary Care;    Health Sciences;    Health Services Organization & Policy;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/93999/rekeith_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Current organizational, population, economic, and regulatory trends are increasingly emphasizing the importance of primary care in the health care system in the United States. As a result, the Patient-Centered Medical Home (PCMH) has been set forth as a promising model of care delivery. However, the complexity involved in implementing the PCMH into primary care practice has proven to be quite challenging. Although multiple stakeholders are exerting increasing pressure on provider organizations to adopt the PCMH model of care delivery, internal dynamics within primary care practices that promote or hinder PCMH implementation and transformation are not well understood. An enhanced understanding of PCMH implementation is needed to achieve sustained changes in health care delivery.A comparative case analysis was conducted to study PCMH implementation in six general internal medicine and family medicine clinics purposefully selected for theoretical heterogeneity. Observations (n = 46) and structured interviews (n = 46) were conducted with clinicians and staff involved in PCMH implementation, approximately eight to ten informants in each clinic. Data were analyzed using deductive and inductive approaches. Findings are organized in three papers. The first paper describes variation in the fidelity with which PCMH principles and operational components were implemented across the six primary care clinics. The results demonstrate that despite similar organizational structures, considerable variation in fidelity to the PCMH occurred across clinics. This paper concludes that aspects of individual level adaptation, knowledge of PCMH principles and understanding of role, are important in the fidelity with which the PCMH is implemented into practice. In the second paper, organizational learning theory is used to explore how capacity for change is developed during PCMH implementation. Inductively generated findings identify common characteristics of clinic meetings and front-line leadership as organizational learning mechanisms associated with PCMH implementation. In the third paper, a grounded theory approach is used to identify contextual factors associated with varying levels of fidelity to the PCMH. In this paper, the Consolidated Framework for Implementation Research was adapted to frame contextual factors that confirm previous findings and merit further investigation for understanding PCMH implementation. Recommendations for policy, practice, and theory are presented.