To read the full version of this content please select one of the options below:

A tale of four practices: A comparative analysis of high and low performing patient-centered medical homes

Michelle Miller-Day (Department of Health and Strategic Communication, Chapman University, Orange, California, USA)
Janelle Applequist (The Zimmerman School of Advertising, University of South Florida, Tampa, Florida, USA)
Keri Zabokrtsky (University of California, Irvine, California, USA)
Alexandra Dalton (George Washington University, Washington, District of Columbia, USA)
Katherine Kellom (Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA)
Robert Gabbay (Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA)
Peter F. Cronholm (Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 18 September 2017

Downloads
985

Abstract

Purpose

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups.

Design/methodology/approach

As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction.

Findings

Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion.

Originality/value

Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

Keywords

Acknowledgements

Funding statement: this project was supported by Grant Number R18HW019150 from the Agency for Healthcare Research and Quality and by a grant from the Aetna Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Citation

Miller-Day, M., Applequist, J., Zabokrtsky, K., Dalton, A., Kellom, K., Gabbay, R. and Cronholm, P.F. (2017), "A tale of four practices: A comparative analysis of high and low performing patient-centered medical homes", Journal of Health Organization and Management, Vol. 31 No. 6, pp. 630-646. https://doi.org/10.1108/JHOM-01-2017-0015

Publisher

:

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited